Pressure ulcers: causes, prevention, and clinical management

Nursing

Pressure Ulcers

A pressure ulcer is a lesion that is caused by unrelieved pressure, which consequences in damage to underlying issue. Pressure ulcers normally develop on bony prominences, but they can also develop in other areas related to pressure from an ill-fitting device, cast, and cervical collar or other many other things. It is believed that up to 1.7 million pressure ulcers occur every year in the United States. Treatment is costly in both healthcare dollars and patient quality of life, but the good news is that they are preventable.

Pathophysiology / Risk factors

Pressure is the vertical force exerted that causes tissue hypoxia and ischemia. Over time, pressure to an area occludes capillary blood flow and lymphatic circulation. If pressure is relieved in a timely fashion before injury has occurred, they body can compensate and blood will return to the area and the skin will seem to flush. This is called reactive hyperemia. The area of erythema will become white when condensed with a finger. When hyperemia continues there is a greater chance for deeper tissue injury to take place. This is a serious sign that tissue damage is about to happen or has already taken place.

Assessment (Staging)

Pressure ulcers are staged according to the anatomic depth of soft tissue damage. There are four stages that have been identified. Stage 1 pressure ulcers are areas of intact skin with nonblanchable redness in a contained area, usually over a bony prominence. Stage 2 pressure ulcers involve partial thickness loss of the dermis. These ulcers present as shallow and dry, with a reddish-pink would bed and no slough. Stage 3 pressure ulcers involve full thickness tissue loss without visible bone, muscle, or tendon. Subcutaneous fat may be visible. If slough is present, the wound bed is still visible. Stage 4 pressure ulcers involve full thickness tissue loss with exposure of bone, muscle, or tendon. Undermining and tunnelling may be present, and slough or eschar may be present on the wound bed.

Prevention / Intervention

Screening tools can be a cost effective means of identifying patients who are at risk for developing pressure ulcers. These tools identify specific areas that need to be addressed and watched closely. After areas of risk are identified, targeted interventions can be put into place that can further reduce the risk of pressure ulcer development.

Knowledge of pressure ulcer prevention strategies is vital. Implementation of targeted prevention strategies may be dependent on the areas that have been acknowledged to be at risk. Education is the essential piece of pressure ulcer prevention. This includes education for staff at all levels, as well as patients and caregivers. Staff education should include information on the facilities specific policies and pressure ulcer prevention program. Staff should be educated on the risk assessment tool used, excellent skin assessment skills, how to consult the wound care specialist if need be and the importance of consultation with the multidisciplinary team if necessary.

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