PRESSURE ULCERS

Dr. Samara Shaukat

 What are Pressure Ulcers?
• Area of skin breaks
down when no
movement occurs
– Constant pressure
reduces blood supply
to specific area
death of tissue
 4 Stages of Pressure Ulcers
Stage 1
Reddened area of skin (“intact
skin with non-blanchable redness of a localized
area usually over a bony prominence.”)
Stage 2
Blister/Open Sore
Stage 3
Crater (bowl shaped depression on surface)
Stage 4
Damage to muscle or bone
I) Unstageable: Depth Unknown
II) Suspected Deep Tissue Injury: Depth Unknown
4 Stages of Pressure Ulcers
 WOUND ETIOLOGY
Extrinsic factors
• Moisture
• Friction
• Irritants
Intrinsic Factors
• Age
• spinal cord injury
• Nutrition
• steroid administration
These factors are believed to affect collagen synthesis and
degradation.
Other intrinsic factors affect tissue perfusion,
including
1. Systemic blood pressure
2. Extracorporeal circulation
3. Serum protein
4. Smoking
5. Hemoglobin and hematocrit, vascular disease
6. diabetes mellitus
7. Vasoactive drugs
8. Increases in body temperature.
• Epidemiological studies show that limitations
in activity and mobility are independently
predictive of pressure ulcers. Changes in
sensory perception may further impair
movement.

Pressure is greatest
on tissues at the
apex of the gradient
and lessens to the
right and left of this
point.
Shear injury is a mechanical force
parallel, rather than
perpendicular, to an area of
tissue. In this illustration, gravity
pulls the body down the incline of
the bed. The skeleton and
attached deep fascia slide within
the skin, while the skin and
superficial fascia, attached to the
dermis, remain stationary, held in
place by friction between the
skin and the bed linen. This
internal slide compromises blood
supply to the area and deforms or
distorts tissue.
HEELS can be used to care for heels at risk
for pressure ulcers
HEELS© mnemonic
• H ave foot or leg movement?
• E valuate heels and sensation.
• E valuate foot drop risk.
• L imit friction.
• S uspend
PRACTICE POINT
• Careful observation of the sacrum/ coccyx and heels is
warranted because these are the most frequent sites of
pressure ulcers. heels with devices as needed.