A Comprehensive Guide to Pressure Ulcer Care
The fastest-growing segment of our population is suffering from increased rates of obesity, diabetes, and cardiovascular disease. The combination of these issues has resulted in more people needing assistance in pressure ulcer treatment and activities of daily living due to decreased mobility.
A major morbidity of decreased mobility is the development of a pressure ulcer, which is any redness or break in the skin caused by too much pressure on your skin for too long. To let you know that you need to change position, normally the nerves send messages of pain or feelings of discomfort to your brain, but the extent of damage to your spinal cord is too much that it keeps these messages from reaching your brain.
Pressure ulcer care and prevention involve treatment management of local and distant infections, removal of necrotic tissue, maintenance of a moist environment for wound healing, and possibly surgery. With careful planning, you get a guide for what you will actually do to prevent ulcers.
After the potential risk assessment and identification of patient risk factors, it is important to match care planning to those needs. This includes planning for any risks found in the risk assessment tool, such as nutrition, activity, mobility moisture, and friction, as well as any additional risk factors.
About Pressure Ulcers
Pressure ulcers are an injury that break down the skin and underlying tissue. These are typically caused when an area of skin is placed under pressure. They are also termed as bedsores or pressure sores.
Depending on the intensity, pressure ulcers can range in severity from patches of discolored skin to open wounds that expose the underlying bone or muscle. Remaining seated for extended periods of time increases the risk of pressure ulcer development over the buttocks, as the soft tissue in this area is squashed between two surfaces the seat and the bones of the pelvis.
The Development of Ulcer
How long the destruction of the skin takes can often be irrelevant as some pressure ulcers develop quickly and others take longer. The process is dependent on other factors such as health status, disability, ability to change position, and maintaining an upright-seated position without slumping or sliding.
There is a disruption in the flow of blood through the skin because of extra pressure. Without a blood supply, the affected skin becomes starved of oxygen and nutrients and begins to break down, leading to the forming of ulcer.
Especially those confined to lying in a bed or sitting for prolonged periods of time, pressure ulcers also tends to affect people with health conditions that make it difficult to move. Conditions that affect the flow of blood through the body, such as patients suffering from type 2 diabetes, also make the person more vulnerable to pressure ulcers.
Pressure ulcer formation is highly influenced by risk factors, including all conditions leading to immobility, decreased or lack of sensation, as well as malnutrition.
The Symptoms of Pressure Ulcers
Pressure ulcers are grouped by the severity of the symptoms. They range from closed to open wounds and are classified into a series of stages based on how deep the wound is. Stage 1 being the mildest stage and 4 being the worst. This is how the assessment takes place:
- Stage 1: The first sign of a pressure ulcer being formed is when you see a reddened, painful area on the skin that does not turn white when pressed. When you touch the skin it might seem warm or cool to touch, firm and soft.
- Stage 2: The area now turns to be red and irritated, which results in skin blisters or the formation of an open sore.
- Stage 3: In this stage, the tissue below the skin is damaged and now you might be able to see body fat in the ulcer. By this, we mean that the skin now develops an open sunken hole called an ulcer.
- Stage 4: The pressure ulcer has become so deep that now it has caused the skin to damage the muscles and bone, and sometimes to tendons and joints.
Apart from the above-mentioned stages, you might come across two other types of pressure sore that don't fit into the stages:
- Yellow, tan, green, or brown sores are covered in dead skin. Because of the dead skin, it makes it hard to tell how deep the sore is.
- And then you might come across deep tissue injury which develops in the tissue deep below the skin. The affected area may turn dark purple or maroon. Moreover, it may be a blood-filled blister under the skin. This type of pressure ulcer quickly becomes a stage 3 or 4 and requires pressure ulcer care at the earliest.
The areas most affected include the buttocks, elbow, hips, heels, ankles, shoulders, back, and back of the head, where skin covers bony areas with less tissue under the skin to pad the area.
Pressure Ulcer Care and Prevention
To identify the risk factors that place individuals at high risk of developing this type of wound and a care plan for prevention and management, the specialists should be educated about risk assessment and prevention and should inspect patients to prevent pressure ulcers or identify them at early stages. Risk assessment scales and pressure ulcer preventative care may further heighten awareness but have limited predictive ability and no proven effect on pressure ulcer prevention.
After comprehensive assessment, a care plan makes sure the clients are on the right pathway and it includes specific actions that should, or should not, be performed. What's more, all care planning needs to be individualized to fit a patient's needs. That is there is no one-size-fits-all approach, any area of risk should have a corresponding plan of care regardless of the overall risk assessment scale score. In fact, most practitioners and wound care specialists when developing the plan of care, think beyond just a risk assessment scales score to include all the patient risk factors.
For some people, pressure ulcers are an inconvenience that requires minor self-care and nursing. For others, it can be serious if not taken care of well and lead to life-threatening complications, such as blood poisoning or gangrene. A collaborative approach ensures individuals and their caregivers express their needs, concerns, and preferences which are included and addressed in the care plan.
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