What are pressure ulcers?
Assessment, prevention, care
What are pressure ulcers?
The European Ulcer Advisory Panel (EPUAP) defines pressure ulcers as injuries to the skin and underlying soft tissue that are caused by prolonged pressure on the skin.
Pressure ulcers, sometimes known as bedsores or pressure sores, can have a huge impact on an individual’s quality of life. Pressure ulcers can even become life-threatening if treated improperly. They are associated with pain, reduced mobility, infection, social isolation, and longer hospital stays.
Pressure ulcers can have a significant physical and emotional impact on individuals and their families, but they also place a large financial burden on healthcare services. This is because the cost of preventing pressure ulcers is 2.5 x lower than the cost of treatment.
What causes pressure ulcers?
As the name indicates, pressure is the primary cause of pressure ulcer development. Spending a lot of time in one position (i.e., sitting in a chair or lying in bed) can lead to the skin being pressed down by the body’s weight. Extra pressure in one part of the body can reduce blood flow to the skin.
Pressure in the skin can be relieved through movement. However, if a person has mobility issues, they might find shifting positions to relieve any pressure extremely difficult. In cases where considerable pressure has built up in a specific part of the body, the skin will begin to ulcerate to regulate pressure levels.
Who is at risk of a pressure ulcer?
Figures reveal that around 700,000 people will develop a pressure ulcer every year. Pressure ulcers can affect anyone, but certain risk factors make people more susceptible to them. These risk factors include:
• Mobility issues that make it difficult to change position in bed or in a chair.
• Poor circulation.
• Age.
• Unsuitable mattress for lying down or sitting.
• Unhealthy or unbalanced diet.
• Have damp skin due to incontinence or a weeping wound.
One of the primary and most obvious indicators of an at-risk person is whether they have a history of pressure ulcers.
Where do pressure ulcers occur on the body?
They normally occur on or near the bony prominences of the body. These are parts of the body where the bones are closest to the surface of the skin.
• Shoulders
• Spine
• Heels
• Toes
• Elbow
• Hips
• Knees
• Ankles
Although they are most common in these areas, parts of the body with more muscle or tissue can also develop ulcers when under pressure.
What are the symptoms of pressure ulcers?
As with most conditions or wounds, pressure ulcer symptoms can vary from person to person. There are, however, some early signs and symptoms that may indicate the development of a pressure ulcer:
- Skin discolouration – people with lighter complexions typically develop red patches, while people with darker complexions tend to develop blue or purple patches.
- These discoloured patches of skin not turning white when pressed.
- Pain, itchiness, or warmth in the affected area.
- As the pressure ulcer progresses, the symptoms may start to become more serious:
- Development of an open wound or blister.
- A wound that extends into the deeper tissues.
- A wound that reaches the muscle and bone.
What are the different grades of pressure ulcer?
The EPUAP advises that following a grading system is a fundamental part of effective prevention and management. This is because it provides a standardised method of identifying and documenting the degree of tissue damage. It also offers a benchmark against which the improvement and deterioration of the wound can be measured.
Grade 1: The skin is not broken, but requires monitoring and care. The skin appears reddened, even when no pressure has been applied. The skin will usually feel warmer, harder than the surrounding skin, and more sensitive to pain.
Grade 2: A Grade 2 pressure ulcer is defined as partial-thickness skin loss. This means that the top layers of the skin are damaged. The skin may resemble a superficial blister or abrasion.
Grade 3: A Grade 3 pressure ulcer is defined as full-thickness skin loss. This is because all of the skin’s layers are damaged, and the wound extends into the subcutaneous tissue. The wound may be covered in slough (dead skin and pus) and there may be the presence of necrotic tissue (dead skin).
Grade 4: The wound and surrounding skin have extensive damage and much of it has become necrotic. The muscles, tendons, and bones may also have significant damage. The wound is usually either covered in slough or has begun to scab.
How can pressure ulcers be prevented?
Pressure ulcers can often be prevented with the right precautions and care. While these precautions will not eliminate the development of pressure ulcers entirely, they will considerably reduce the risk.
• Change position regularly – Movement is the key to relieving pressure. If a person has mobility issues and struggles changing positions, a relative or member of their care team will need to help them move every few hours (or more frequently, if deemed necessary).
• Stop smoking – Stopping smoking is the single best thing anyone can do for their health. Quitting smoking improves your circulation, which reduces the risk of pressure ulcers.
• Eat a balanced diet – Maintaining adequate nutrition and hydration is important for a person’s overall health and protecting the integrity of the skin.
What are some pressure ulcer treatments?
The severity of the pressure ulcer will determine the type of treatment a person requires. The main goal of treatment is to implement pressure-reducing strategies. These strategies include:
• Choose a suitable dressing – Certain dressings can be used to speed up the healing process. For example, hydrocolloid dressings contain a gel that promotes the growth of new skin cells.
• Use pressure-relieving mattresses and cushions – Special foam mattresses and cushions can be used as a soft and supportive surface for vulnerable parts of the body. This is because they distribute pressure over a larger surface area, preventing it from building up in certain regions. The type of mattress required will depend on the grade of the pressure ulcer.
• Use topical ointments – Although antibiotic and antiseptic creams are not recommended as a pressure ulcer treatment, barrier creams can protect skin that has been damaged and reduce maceration.
• Debridement – This is the process by which dead tissue is removed from a wound to help it heal better.
• Antibiotics – In the case of a serious infection, antibiotics can be used to reduce the chance of further complications such as sepsis or cellulitis.
• Surgery – Most pressure ulcers heal without surgical intervention. However, if the pressure ulcer is severe, surgery may be required to thoroughly clean and seal the wound. This will minimise the risk of infection and promote more timely healing.
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Please note that while every effort is made to ensure the accuracy of the content presented, it is purely for educational purposes only and is not a substitute for professional medical advice.