Pressure points: Pressure points are the prominent bony areas of the body where there is no rich blood supply nourishment and also the skin layer is too thin.
Pressure sore or decubitus ulcer: The pressure sore is a localized area of tissue necrosis (death) that tends to develop when soft tissue is compressed between a bony prominence and an external surface for a prolonged period. These also called bed sores
Risk Factors for Pressure Sores / Dicubitus Ulcers – Pressure sore or decubitus ulcer and Bed Sore
Impaired Sensory Input: Patients with altered sensory perception for pain and pressure are more at risk for developing pressure sores e.g. paralysed patients, unconscious patients, etc.
Impaired Motor Function: Patients who are unable to change positions independently are more at risk. They can feel the excessive pressure but are not able to change positions and relieve pressure independently, e.g. patients with spinal cord injuries.
Alteration in the level of consciousness:Patients who are confused, disoriented or have changing levels of consciousness are unable to protect themselves from pressure ulcers.
- Confused or disoriented patients may be able to feel the pressure, but may not be able to understand how to relieve it.·
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Patients in a state of coma – may not perceive pressure and are unable to move into a more protective position voluntarily
Patients, whose levels of consciousness change, may easily become confused. So they are unable to find out more protective positions.
Patients with Casts and Traction:Casts and traction reduce mobility of the patient or the extremity. The risk of developing pressure ulcer is more because of the external mechanical force of friction from the surface of the cast rubbing against the skin.
Contributing Factors to Pressure Ulcer Formation
Shearing Force-: is the pressure which is exerted against the skin when a patient is moved or is re-positioned in the bed by being pulled or is allowed to slide down in the bed.
When shearing force is present, the skin and subcutaneous layers adhere to the surface of the bed, and the layers of muscles and even the bones, slide in the direction of body movement
Best Therapeutic Air mattresses - Click Price Moisture: The presence of moisture on the skin increases the risk of ulcer formation Moisture reduces the skin's resistance to other physical factors such as pressure or shearing force. The chance of ulcer formation also increases with the duration of the exposure to moisture.
Poor nutrition: Patients with poor nutrition often experience serious muscle atrophy and decrease in subcutaneous tissue. Because of these changes, less tissue is present to serve as padding between the skin and the underlying bone. Therefore, the effects of pressure are increased on the remaining tissue,
Edema-: Edema increases the risk of pressure ulcers in the affected tissues. Blood supply to the edematous tissues is decreased and waste products remain because of the changing pressures in the capillary circulation and capillary bed.
Anaemia: Patients with anaemia are at risk of pressure ulcer formation. Decreased levels of haemoglobin reduce the oxygen-carrying capacity of the blood and the amount of oxygen available to tissues. Anaemia also alters cellular metabolism and impairs wound healing.
Infection and fever: Infection and fever result from the presence of pathogens in the body. A patient with an infection usually has fever. Infection and fever increase the metabolic needs of the body, making an already hypoxic tissue more susceptible to an ischemic injury. In addition, fever results in diaphoresis (excessive sweating) and increased skin moisture, which further predisposes the client to a skin breakdown.
Impaired peripheral circulation: With impaired peripheral circulation, the tissue becomes hypoxic and more susceptible to ischemic damage
Obesity: Obesity can speed up pressure ulcer development. Adipose tissues in small quantities protect cushioning bony prominence against pressure.
However, in moderate to severe obesity, adipose tissues vascularized and are more susceptible to ischemic damage
Cachexia: Cachexia is generalized ill health and malnutrition, marked by weakness and emaciation.
associated with serious diseases such as cancer and end stage of cardiopulmonary diseases.
This condition clients' risk of pressure ulcers. Basically, the cachexia patient has lost the adipose tissue necessary to prominence from pressure
Old age: Pressure ulcer develops more frequently in older adults over 75 years of age.
Stages of Pressure Ulcers
Stage 1-Reddening of the skin is neither relieved by massage nor by relief of the pressure which has caused it.
Stage II-Superficial tissue damage involving a skin breakdown
Stage III-Ulceration involving the dermis, which may or may not include subcutaneous tissue; stage that produces serosanguinous drainage.
Stage IV: Ulceration into deep structures with the invasion of deep tissue or structures such as fascia, connective tissue, musce or bone.
Prevention of Pressure Sores
There are four major areas of nursing intervention for prevention of pressure sores:
a) Hygiene
b) back care
c) positioning
d) use of therapeutic beds and mattresses.
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