Pressure Ulcers: Definition, Stages, Prevention, and Treatment

A bed sore, also known as a pressure ulcer or decubitus ulcer, is an area of damaged skin and tissue that develops when prolonged pressure cuts off circulation to particular parts of the body, especially over bony areas. Without enough blood flow, the affected tissue dies. Understanding the causes, prevention, and management of these injuries is crucial for patient care.

Definition of Pressure Ulcers

A bed sore is a localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of prolonged pressure, or pressure in combination with shear.

Common Sites for Pressure Ulcer Development

• Sacrum (lower back)
• Heels
• Hips
• Elbows
• Ankles
• Back of the head
• Shoulder blades

Stages of Bed Sores (Pressure Ulcers)

1. Stage 1: Red, unbroken skin that doesn’t blanch when pressed.
2. Stage 2: Partial-thickness skin loss (blister or open sore).
3. Stage 3: Full-thickness skin loss with damage to subcutaneous tissue.
4. Stage 4: Full-thickness tissue loss with exposed muscle, bone, or tendon.

Prevention Strategies for Bed Sores

1. Regular Repositioning

   • Change the patient's position every 2 hours in bed.
   • Change position every 15–30 minutes when sitting in a chair.

2. Skin Care and Hygiene

   • Keep skin clean and dry.
   • Use moisture barriers for incontinence management.
   • Inspect skin daily, especially over bony areas.

3. Nutrition and Hydration

   • Ensure adequate intake of protein, vitamins (A, C, zinc), and hydration to maintain skin integrity and promote healing.

4. Use of Support Surfaces

   • Utilize special mattresses, cushions, and pads designed to reduce pressure.
   • Consider foam, gel, or air overlays.

5. Mobility and Activity

   • Encourage or assist with mobilization and exercises.
   • Use physical therapy if needed.

6. Avoid Friction and Shear

   • Use draw sheets or lifting devices to reposition patients, avoiding dragging.
   • Elevate the head of the bed no more than 30° to prevent sliding (shear force).

Management and Treatment of Pressure Ulcers

General Principles

• Relieve pressure from the affected area immediately.
• Keep the sore clean and covered with appropriate dressings.
• Maintain good nutrition and hydration to support tissue repair.

Medical Treatment Options

1. Cleaning the Wound

   • Use saline or specialized wound cleansers.
   • Avoid harsh antiseptics (like iodine or hydrogen peroxide) that can damage healthy tissue.

2. Debridement

   • Removal of dead (necrotic) tissue, which can be achieved through surgical, enzymatic, or autolytic debridement methods.

3. Dressing Selection

   • Use moist wound dressings such as hydrocolloids, hydrogels, alginates, or foam dressings.
   • The dressing type must be selected based on the wound stage and the amount of exudate (drainage).

4. Pain Management

   • Use analgesics as needed (e.g., NSAIDs or opioids) to manage wound pain during dressing changes or movement.

5. Antibiotics

   • Topical or systemic antibiotics are used only if there is a confirmed infection; they are not routinely used for uninfected ulcers.

6. Surgery

   • Advanced Stage 3 or 4 cases may require surgical repair, flap procedures, or skin grafts.

Monitoring and Documentation

• Document the ulcer's location, stage, size, exudate characteristics, odor, and tissue type accurately.
• Regularly evaluate the healing progress.
• Watch closely for signs of infection (increased redness, warmth, swelling, purulent drainage, or fever).

Summary Table: Pressure Ulcer Care

This information provides a comprehensive foundation for pressure ulcer care. Consult a healthcare professional for specific treatment plans.