Pressure ulcers, also known as bed sores and decubitus ulcers, are the result of external prolonged pressure causing damage to soft tissue such as skin, fat, muscle and fascia (Godman & Fuller, 2015). Most pressure ulcers begin over bony prominent areas and can occur anywhere bone protrudes. Pressure ulcers occur for several reasons including: external pressure, friction, shearing, tissue softening from moisture, tissue weakening from dehydration, under nourishment and poor circulation (Goodman & Fuller, 2015). Additional patient related influences that can cause pressure ulcers are reduced sensation, poor mobility, incontinence, malnutrition and confusion. Unfortunately, acute care hospital admissions is the most common factor in causing pressure ulcers, because of acute illness and immobility during the hospital stay.
Pressure ulcers are identified and documented in stages I, II, III, IV and unstageable: Stage I is non-blanchable with intact skin, Stage II is non-intact skin with tissue damage to epidermis and/or dermis but superficial, Stage III is non-intact skin with tissue damage to epidermis, dermis, fat and muscle, but not past fascia. Stage IV is non-intact skin with tissue damage to epidermis, dermis, fat, muscle, fascia, bone and / or tendon. Unstageable is non-intact skin with tissue damage that is covered with eschar or necrotic tissue of 50% or more, viewing wound unstageable (Goodman & Fuller, 2015). In addition, pressure ulcers once they are staged should never be backstaged. As the wound heals documentation should be written as healing stage I, II or III and so on (Goodman & Fuller, 2015).
Preventing pressure ulcers from ever happening is difficult and challenging for the patient and caregivers, but is the best line of defense. Prevention guidelines include: patients at risk should undergo a full skin evaluation daily with close attention to bony areas, keep patients skin clean after soiling with gentle washing using gentle soaps and washing to avoid drying or shearing skin, avoid skin drying with adequate moisturizer, avoid skin friction and / or shearing using correct positioning, transferring, turning and use moisturizers, skin barriers and padding, preserve patients activity function and mobility, monitor nutrition to avoid drop in albumin levels and dehydration, reposition all patients at risk every 2 hours or more and use pillows and wedges assist in maintaining positioning and avoid pressure on knees, ankles and heels, use equipment such as trapeze bar, lifts, sliding boards, or sheets to avoid dragging movement, use pressure- redistributing mattresses on all high risk patients, patients who are wheelchair bound are at high risk and should be taught to relieve pressure every 15 to 30 minutes and use pressure- redistributing chair devices such ae Roho cushion (do not use doughnut-type devices) (Goodman & Fuller, 2015).
References
Goodman, C. C., & Fuller, K. S. (2015). Pathology: Implications for the physical therapist.