Pressure Ulcers

Pressure ulcers develop when pressure from the weight of the body pinches an area of skin between a bone and the surface the person is resting upon. Blood vessels within the skin become blocked, shutting off blood flow to the area. Where there is no blood—there is no oxygen. Where there is no oxygen—tissue death occurs.

THE STAGES OF A PRESSURE ULCER

Stage I: The affected area is red and tender, but the skin is intact.
Stage II: There is a blister or a shallow open wound that is pink or red.
Stage III: The area begins to look like a crater, extending deeper into the skin.
Stage IV: The wound extends into the muscle and perhaps even the bone.
Suspected Deep Tissue Injury: An area of unbroken skin that is purple or maroon—or a blood-filled blister—may indicate damage that is deep under the skin.
Un-Stageable: Pressure sores are un-stageable when there is a layer of dead tissue (can be yellow, tan, gray, green or brown, or black) inside the wound.

COMMON LOCATIONS FOR A PRESSURE ULCER

90% are below the waist, generally on hips or buttocks
Heels, ankles
Shoulder blades
Elbows
Back of the head
Spine, especially the tailbone

TIPS FOR PREVENTING A PRESSURE ULCER

Report any changes that affect a client’s skin to your supervisor. These changes include dry skin, very moist skin, redness, warmth, tenderness, rashes, bruises, new incontinence, changes in appetite or fluid intake, and complaints of pain or discomfort.
Avoid “sheet burn” by NOT dragging a client across the bed. Ask the client to help, if possible, or get a coworker or family member to assist you in moving the client. Always move on the count of three so that you are all working together.
Use pillows and pads to help position clients comfortably in their beds or chairs. Place the pillows so that they minimize pressure on bony parts of the body.
Whenever you re-position your clients, take the opportunity to check their skin for any changes. Keep an eye out for dry patches, redness, tenderness or bruises.
Keep incontinent clients as dry and clean as possible. It is extremely important for a client to stay dry to prevent pressure ulcers. Wet skin can become brittle, making it tear more easily. Soiled or wet clothing can rub against the skin, creating an ulcer.
It’s much easier, cheaper, and causes a lot less pain to prevent a pressure ulcer than it does to treat it.