A pressure injury (also known as bedsore, pressure ulcer, pressure sore, or decubitus) is a damaged skin area. A pressure injury occurs when force is applied to the skin’s surface. This force can be applied as a constant pressure to a specific skin area or as a dragging (shearing) force between the skin and another surface. These injuries typically occur on bony parts of the body (hips, heels, tailbone, elbows, head, and ankles). If a pressure injury progresses to a deep wound or becomes infected, it can be fatal.
What is the progression of a pressure injury?
The severity of the wound is classified into four stages. These stages are as follows:
Stage 1 is characterized by discolored skin. Skin with lighter skin tones appears red, while skin with darker tones appears blue/purple. The skin does not blanch (turn white) when pressed with a finger.
Stage 2: This stage involves superficial skin damage. The top layer of the skin has been removed. It may also resemble a blister. The top layer of skin can repair itself at this stage.
Stage 3: This is a more severe wound. The wound is open and extends to the fatty layer of the skin, but no muscles or bones are visible.
Stage 4: This is the most severe stage. The wound goes all the way down to the bone. Muscles and bones are vulnerable to infection, which can be fatal.
Who is vulnerable to pressure injuries?
People who have limited mobility or are entirely unable to move. Those in wheelchairs or bedridden are especially vulnerable and must be moved or turned regularly.
Those who have artificial (prosthetic) limbs. If the device does not fit properly, it can irritate the skin and cause a pressure injury.
People who have sensory loss. They are vulnerable because they may not feel the pressure applied to their skin. As a result, they may not move, exacerbating the damage.
Those suffering from malnutrition. When nutritional requirements are not met, wound healing is slowed.
Senior citizens. Skin naturally thins and becomes more easily damaged as people age.
Causes and Symptoms
What factors contribute to pressure injuries?
Pressure injuries occur when a force is applied to the skin, causing tissue damage. Among the various types of force are:
Constant pressure on the skin is caused by staying in the same position for an extended period.
When the head of the bed is raised, and the body slides down, shear damage or a dragging force can occur. Although the skin adheres to the sheets, internal structures are damaged.
Fluids (sweat, urine, feces) that remain on the skin can cause it to become overly wet, increasing the risk of pressure injury development.
What are the signs of a pressure injury?
Pressure injuries can cause the following symptoms:
Skin color changes (non-blanchable redness in lighter skin tones and non-blanchable blue/purple skin in darker skin tones)
Swelling, pain, or tenderness of the skin
Skin that is cooler or warmer to the touch than the rest of the body
Skin thinning exposes more profound layers of skin
Pus-like drainage from an open skin area