Pressure ulcers, also called bedsores, are injuries to the skin and underlying tissue that occur primarily from prolonged pressure on the skin. They mainly affect people who spend a lot of time in a bed, chair, or wheelchair.
These sores are caused by pressure against the skin that limits blood flow to the skin. Other factors related to limited mobility can make the skin vulnerable to damage and contribute to the development of pressure sores.
There are several stages of pressure ulcers:
Stage 1: The skin isn’t broken but it’s discolored. Depending on the complexion, it can appear as red, blue, or purple.
Stage 2: There is breakage in skin revealing a shallow, open ulcer.
Stage 3: The sore gets worse and extends into the tissue beneath the skin, forming a small crater.
Stage 4: The pressure sores is very deep, reaching into muscle and bone and causing extensive damage.
Preventing pressure ulcers involves regular position changes to relieve the pressure on vulnerable areas, good hygiene and nutrition. Treatment includes managing the wound with dressings and creams. Cases of severe pressure ulcers might require surgery.
Causes of Pressure ulcers
Pressure ulcers, also known as bedsores, are injuries to skin and underlying tissue resulting from prolonged pressure on the skin. The main causes of pressure ulcers include:
1. Pressure: Constant pressure on certain parts of your body reduces the blood flow to tissues. Blood carries oxygen and other essential nutrients that tissues need to stay healthy. If tissues regularly receive less oxygen and nutrients, they are at risk for injury and may eventually lead to the formation of ulcers.
2. Friction: Friction occurs when the skin rubs against clothing or bedding. It can make delicate skin more vulnerable to injury, particularly if the skin is also moist.
3. Shear: This happens when two surfaces move in the opposite directions. For example, when a bed is elevated at the head end, a person can slide down in bed. As the tailbone moves down, the skin over the bone may stay in place – essentially being pulled in the opposite direction.
4. Aging skin: Older skin tends to be thinner, drier and less elastic, making it more prone to damage.
5. Immobility: Whether due to a health condition or not, being confined to a bed or a wheelchair increases the risk of developing pressure ulcers.
6. Poor nutrition and dehydration: Both can make the skin more prone to damage and slow the rate of healing.
7. Medical conditions affecting blood flow: Conditions like diabetes and vascular disease can affect the body’s ability to deliver nutrients and oxygen to tissues, making them more susceptible to injury and slower to heal.
In most cases, prevention strategies like frequent position changes, skin care, good nutrition, and maintaining a healthy lifestyle can help to prevent pressure ulcers. If such ulcers do occur, they require careful management to promote healing and avoid infection.
Risk Factors of Pressure ulcers
Pressure ulcers, also known as bedsores, are injuries to skin and underlying tissue resulting from prolonged pressure on the skin. There are several risk factors associated with the development of pressure ulcers:
1. Mobility issues: People with mobility problems who can’t change position without help, especially those confined to a bed or a wheelchair, are at high risk of developing pressure ulcers due to constant pressure on certain points of the body.
2. Sensory perception: Conditions that impact sensory perception can increase the risk of pressure ulcers. People with spinal cord injuries, neurological disorders, or other conditions that affect sensation may not notice the pain or discomfort that typically signals the need to change position.
3. Poor nutrition and hydration: The skin needs nutrients and hydration to maintain its health and resilience. People with malnourishment or dehydration are therefore at increased risk of developing pressure ulcers.
4. Advanced age: Older adults are at higher risk for pressure ulcers due to several factors. Skin tends to thin and lose elasticity with age, which can make it more vulnerable to damage. Also, older individuals may have decreased mobility or chronic conditions that increase their risk.
5. Medical conditions affecting blood flow: Diabetes and vascular diseases can affect blood flow and makes a person more susceptible to tissue damage, hence increasing the risk of pressure ulcers.
6. Obesity or thinness: Too much body fat can increase friction on the skin, while too little body fat can reduce the amount of padding between bones and a bed or wheelchair.
7. Continence: The presence of moisture on the skin from urinary or fecal incontinence can greatly increase the risk of pressure ulcers. The moisture can break down the skin, making it more prone to damage from pressure.
8. Smoking: Smoking impairs the circulation, affects the nutrition of the skin and can slow down wound healing, hence increasing the risk of pressure ulcers.
9. Chronic diseases: Patients with chronic diseases like cancer, heart disease, diabetes etc are more prone to pressure ulcers. These diseases weaken the immune system making it harder to prevent and heal pressure ulcers.
10. Extended immobilization: This could be as a result of recovery from surgery, sedative medications, coma etc. The prolonged lack of movement puts pressure on certain parts of the body leading to pressure ulcer development.
Signs and Symptoms of Pressure ulcers
Pressure ulcers, also known as bed sores or pressure sores, are injuries to the skin and underlying tissue. They are often caused by prolonged pressure on the skin. People who have medical conditions that prevent them from shifting or moving are most at risk. The signs and symptoms of pressure ulcers can include:
1. Unusual changes in skin color or texture: The skin may appear red, purple, or black. It may be warmer or cooler than the surrounding skin, and might be either hard and firm, or soft and mushy.
2. Swelling: The affected skin area might swell, which is a typical reaction of the body to injury or irritation.
3. Pus-like draining: If the pressure ulcer is further along, there might be pus-like fluid draining from it.
4. Areas of the skin that feel cooler or warmer to touch than the surrounding areas: A cool area can signal reduced blood flow, and a warm area might suggest infection.
5. Localized pain or discomfort in the affected area: The level of pain may vary, depending on the stage of the ulcer.
Advanced stages of pressure ulcers can manifest more severe signs and symptoms, such as:
1. Exposing layers of the skin, sometimes down to muscles or bones.
2. Rapidly deteriorating or spreading.
3. Formation of a crater in the skin.
4. Foul-smelling discharge coming from the sore.
5. Signs of infection spread to other parts of the body, like fever, rapid heartbeat or changes in mental status.
If signs or symptoms of a pressure ulcer are present, it is important to start treatment as soon as possible, early treatment can lead to faster healing. It’s always advisable to seek medical advice in such a situation.
Diagnosis Pressure ulcers
Pressure ulcers, also known as bedsores or decubitus ulcers, are areas of skin and underlying tissue damage caused by prolonged pressure on the skin. This pressure interrupts the blood flow, starves the tissues of oxygen and nutrients, eventually leading to tissue damage and ulcer formation.
They typically develop on body parts where the bones are close to the skin, such as heels, elbows, hips, and tailbone. People who have difficulty moving or changing position while seated or in bed are most at risk of developing pressure ulcers.
Pressure ulcers are diagnosed based on a physical examination of the skin, usually conducted by a nurse or a doctor. The main symptom is an area of skin that feels different than the surrounding skin. It may feel warm, or swollen, or it may appear discolored.
The National Pressure Ulcer Advisory Panel has developed a system for determining the severity of pressure ulcers, ranging from I to IV, with I being the least severe, indicating redness of the skin, and IV being the most severe, where there is extensive damage to deeper tissues.
Treatment typically involves reducing the pressure on the affected skin, caring for the wounds, controlling pain, preventing infection, and maintaining good nutrition.
If unattended, pressure ulcers can lead to serious complications, including cellulitis, bone and joint infections, cancer (in chronic wounds), and sepsis. Brain damage and death can occur in extreme cases. So, early diagnosis and treatment are vital.
Treatment of Pressure ulcers
Treatment for pressure ulcers (also known as bedsores) includes a combination of approaches depending upon the severity of the condition. Here are some primary treatments:
1. Pressure relief: One of the most essential treatments is relieving the pressure causing the ulcer. This could mean repositioning an individual who is bedridden or in a wheelchair regularly or using support surfaces like a pressure-reducing mattress or cushion.
2. Cleaning and dressing wounds: Wounds must be cleaned to prevent infection, and dead tissue should be removed – a process called debridement. The wound is dressed afterward to help speed up healing and protect from further damage or infection. Dressings can include films, gels, foams, and treated coverings.
3. Medication and Topical creams: In some cases, antibiotics may be used if the ulcer is infected. Topical creams and ointments can help soothe the area and promote healing.
4. Nutrition support: Proper nutrition and hydration are critical for wound healing. A dietitian may recommend a diet rich in protein, vitamin C and Zinc, which can aid skin recovery.
5. Surgery: In severe cases, surgery might be required to clean the wound, remove dead tissue, or to help close the wound over time.
6. Negative Pressure Wound Therapy: This type of therapy uses vacuum technology to help with wound healing. It involves the application of a sterile pad and a vacuum pump to the wound.
It’s important to remember that effective pressure ulcer treatment requires the expertise and supervision of healthcare professionals. Always consult with a healthcare provider for precise diagnosis and treatment.
Medications commonly used for Pressure ulcers
Pressure ulcers, also known as bedsores, are injuries to skin and underlying tissue resulting from persistent pressure on the skin. Bedsore management typically includes preventive measures, wound care protocols, nutrition support, and sometimes, medication. Here are few medicines commonly used:
1. Topical Antiseptics: These are used to cleanse the wound or ulcer and prevent or control infection. Examples are iodine and hydrogen peroxide.
2. Topical Antibiotics: When a pressure ulcer shows signs of infection, antibiotics may be applied directly onto the ulcer to kill the bacteria. These can include creams or ointments containing fusidic acid, metronidazole, or neomycin.
3. Oral Antibiotics: If the infection has spread to other areas, oral antibiotics may be prescribed. These can include flucloxacillin, amoxicillin, or ciprofloxacin.
4. Pain Relievers: Over-the-counter drugs like acetaminophen or ibuprofen can soothe the pain caused by pressure ulcers. More severe pain may need prescription-strength painkillers.
5. Topical Wound Healing Agents: Some specialized creams or ointments are created to facilitate wound healing by keeping it moist and providing necessary nutrients. These are often only used for more severe pressure sores. Examples include silver sulfadiazine (Silvadene), hydrogel dressing, and collagenase ointment.
6. Serious cases may be treated with advanced therapies like vacuum-assisted closure (VAC) or ‘negative pressure wound therapy’ (NPWT), where a device decreases air pressure on the wound to increase blood flow, promote healing and remove excess fluids.
Remember always to take these medications under the advice and supervision of a healthcare provider to prevent complications or side effects. Additionally, pressure ulcers can be best prevented by regular shifting and repositioning to avoid constant pressure on one area, along with regular skin inspections for early detection. Providing proper nutrition and hydration also plays a vital role in preventing and treating pressure ulcers.
Prevention of Pressure ulcers
Prevention of pressure ulcers, also known as bedsores, is very important, especially for individuals who are bedridden or use wheelchairs. Here are some preventive measures you can take:
1. Regular Movement: This is one of the most important parts of pressure ulcer prevention. If an individual’s mobility is limited, they should be moved or repositioned every 1-2 hours, If they are in a wheelchair, they should try to reposition every 15-30 minutes.
2. Skin Care: Keep the skin clean and dry. Use mild soap and warm (not hot) water. Be gentle when cleaning the skin, to avoid damaging it. Apply moisturizers to dry skin.
3. Healthy Diet: Nutrition plays a vital role in maintaining skin health and resilience. Ensure a diet rich in protein, vitamin C, and zinc promotes wound healing.
4. Hydration: Drinking enough fluid throughout the day will help maintain skin elasticity, making it less likely to develop pressure ulcers.
5. Use of Support Surfaces: Use specially designed foam, air, or gel mattresses, overlays, and cushions can help redistribute pressure and lessen the risk of pressure ulcers.
6. Regular Inspection: Regularly inspect skin for signs of pressure sores, paying particular attention to the bony parts of the body like hips, heels, tailbone, and elbows. Look for areas of redness or other discoloration, swelling, or soreness.
7. Control moisture and humidity: Excessive moisture from sweating or incontinence can weaken skin and make it more susceptible to damage. If the individual has incontinence, take measures to prevent the skin from getting wet.
Remember, consulting a healthcare professional is always advisable for personalized advice based on your personal health situation.
FAQ’s about Pressure ulcers
1. What Is a Pressure Ulcer?
A: A pressure ulcer, also known as a bed sore or decubitus ulcer, is a type of injury affecting skin and the underlying tissue resulting from prolonged pressure on the skin. It commonly occurs on skin that covers bony areas such as the heels, ankles, hips, and the tail bone.
2. What Causes Pressure Ulcers?
A: Pressure ulcers are usually caused by constant pressure on certain parts of your body. This may happen if you cannot move easily or cannot change your position, increased skin moisture, friction, and shear can also contribute to the formation of ulcers.
3. Who Is at Risk of Getting Pressure Ulcers?
A: Anyone with restricted mobility is at risk of developing pressure ulcers. This includes people who are bedbound, use wheelchairs, or are unable to change position without help. People with certain health conditions like diabetes, vascular diseases, or nutritional deficiency are also at risk.
4. What Are the Symptoms of Pressure Ulcers?
A: The initial symptoms of a pressure ulcer include a patch of skin, often over a bony area, that looks red in people with lighter skin and purple or blue in people with darker skin. With time, the skin may get damaged, leading to an ulcer forming. If the damage continues, the ulcer may become deep, reaching into muscle and bone.
5. How Are Pressure Ulcers Treated?
A: The basic treatment for pressure ulcers includes relieving pressure on the affected skin, caring for wounds, controlling pain, preventing infection, and maintaining good nutrition. In severe cases, surgical intervention may be required.
6. Can Pressure Ulcers Be Prevented?
A: Yes, many pressure ulcers are preventable. It involves regular position changes to avoid stress on the skin, keeping skin clean and dry, a good diet, and regular skin inspections to detect early signs of pressure sores.
7. What Complications Can Occur from Pressure Ulcers?
A: If not treated, pressure ulcers can lead to serious complications such as cellulitis, bone and joint infections, cancer (rarely), and sepsis.
8. How Long Does It Take for a Pressure Ulcer to Heal?
A: Healing time for pressure ulcers varies greatly by individual, depending on the severity of the ulcer and the individual’s overall health. It can take from a few days to several months or even years in severe cases.
9. What should I do I think I have a pressure ulcer?
A: If you or someone in your care has symptoms of a pressure ulcer, you should contact a healthcare provider immediately. Early diagnosis and treatment can help stop the ulcer from getting worse and prevent serious complications.
10. Are there any lifestyle changes that can help prevent pressure ulcers?
A: Yes. Regular movement, either on your own or with assistance, combined with good hygiene, nutritional support, and immediate attention to any areas of discomfort or skin breakdown can greatly reduce the risk of developing a pressure ulcer.
Useful links
Pressure ulcers, also known as bed sores, are injuries to the skin and underlying tissue that result from prolonged pressure on the skin. Pressure ulcers often develop on the skin that covers bony areas of the body, such as the heels, ankles, hips, and tailbone.
Here are some useful links from various medical journals about pressure ulcers:
Please note that some of these articles may require special access or login due to them being medical journals.
Complications of Pressure ulcers
Pressure ulcers, also known as bed sores or pressure sores, are injuries to skin and underlying tissue caused by prolonged pressure on the skin. They often occur on skin that covers bony areas of the body such as hips, ankles, and tailbone. The complications of pressure ulcers include:
1. Infection: Serious infections can develop in the tissue and bone beneath the pressure ulcers. These can become life-threatening if they spread to the bloodstream (sepsis).
2. Cellulitis: This is a common infection of the skin and the soft tissues underneath, which can cause life-threatening complications, including sepsis and necrotizing fasciitis.
3. Necrotizing Fasciitis: This is a severe infection that results in the death of parts of the body’s soft tissue. It’s extremely serious and life-threatening.
4. Squamous Cell Carcinoma: Chronic wounds can increase the risk of developing this type of skin cancer.
5. Abscess: A pus-filled cavity can develop under the skin or deeper within the body if pressure ulcers become infected.
6. Reduced Quality of Life: Pressure ulcers can lead to reduced mobility, long-term discomfort, and psychological stress. They may also require surgery or lead to disabilities or deformities in severe cases.
7. Mortality: If left untreated, pressure ulcers can lead to serious illness and death, especially in individuals with other underlying health conditions.
8. Malnutrition: Severe pressure ulcers can put a strain on the body’s resources, which can lead to malnutrition.
9. Joint infections: In certain cases, pressure sores can lead to septic or infectious arthritis, which impacts the fluid and tissues of joints.
To prevent pressure ulcers, it’s important to change positions often, maintain good nutrition, keep skin clean and dry, and protect skin from stress and injury.
Home remedies of Pressure ulcers
Pressure ulcers, also known as bedsores, can be serious and painful. They’re caused by pressure on the skin that restricts blood flow, often from prolonged sitting or lying in one position. It’s important to consult a healthcare professional for serious cases. However, alongside medical treatments, you might use some home remedies to help:
1. Regular Position Changes: Change the person’s position every two to three hours while bedridden or every 15 minutes while sitting. This lessens the pressure on the skin and promotes blood circulation.
2. Skin Care: Keep the skin clean and dry. Use mild soap and warm (not hot) water. Apply moisturizers to prevent dryness.
3. Healthy Diet: Provide a balanced diet high in protein, vitamins A and C, and other nutrients necessary for skin health and repair.
4. Hydration: Ensure the person drinks plenty of water to keep the skin hydrated and promote overall health.
5. Use of Support Surfaces: Use special cushions, pads, or mattresses to help reduce pressure.
6. Regular Exercise: As much as possible, the person should move and exercise to stimulate blood flow.
However, it’s crucial to note that these measures should complement, not replace, a health professional’s guidance. For deep or severe pressure ulcers, specialized wound care is often necessary.