Overview of Wound Pressure Injury Management(Archived)
Pressure injuries, once called pressure ulcers, decubitus ulcers, or bed sores, are wounds that typically happen when your skin breaks down because of constant pressure. It’s often caused by a part of your body, usually a bony area, continuously pushing against an outside surface. This results in an injury to your skin, as well as the soft tissues beneath it, as their normal structure and function are disrupted.
A variety of factors can interfere with how well these wounds heal. These include having an infection, chronic illnesses like diabetes, getting older, not getting enough certain nutrients like vitamin C, taking certain drugs like steroids, and not getting enough oxygen and blood flow to the injured area. This can happen if you’re exposed to cold temperatures or if you have low oxygen levels, a condition known as hypoxia.
Pressure injuries specifically occur when pressure, typically from being in one position for a long period, is put on your skin, soft tissue, muscle, and bone. In these cases, the outside pressure is so great that it disrupts the normal blood flow, which can cause damage to these tissues.
Anatomy and Physiology of Wound Pressure Injury Management(Archived)
Older people or those who have to spend a lot of time in bed are likely to get bed sores, also known as pressure ulcers. Most pressure ulcers are actually found on the hip and buttocks area. They can also appear on the skin under a nose or throat tube. They are found slightly more often in women than in men. Pressure ulcers happen when skin is rubbed or put under pressure for too long, especially when it’s over bony parts of the body. This can be made worse by:
- Fragile skin that breaks easily
- Poor blood flow
- Loss of muscle
- Spinal cord injuries
- Not getting enough nutrients
- Wet skin from not being able to control going to the toilet
To understand how a pressure ulcer happens, you need to know a bit about the skin. The top layer you can see and touch is called the epidermis. Just below that is the dermis, and then a layer of small blood vessels (capillary bed) that supply the top two layers with blood. Below that, there’s a layer of fat (subcutaneous tissue), and then muscle and bone. When someone sits in a chair for too long, the tailbone (coccyx) can press upwards into these bottom layers of skin. The hard surface of the chair can also put pressure on the skin and bone. If there’s too much pressure for too long, the skin can’t get enough blood and pressure ulcers can form.
It’s also important to stop injuries from friction and sheer force. This can happen when a patient slides down in bed. If the tailbone moves up and the skin moves down (in other words, they’re moving in different directions), the small blood vessels that keep the skin healthy can tear. This stops blood from getting to the skin, leading to a pressure ulcer. Pressure ulcers have different stages based on how deep the damage is:
- Stage 1: The skin looks red
- Stage 2: The skin is red and has a scrape (partial thickness loss) that includes the top layer and some of the second layer
- Stage 3: A deep wound (full thickness ulcer) that may go as deep as the fat layer
- Stage 4: A very deep wound (full thickness ulcer) that goes as deep as the muscle or bone.
The most common places to get pressure injuries are the tailbone, heels, hip bone, and sitting bone (this is very common in people who can’t move their legs).
Why do People Need Wound Pressure Injury Management(Archived)
Pressure ulcers, sometimes known as bedsores, are painful and potentially dangerous skin conditions that need to be treated efficiently. Interestingly, the same methods used to avoid getting pressure ulcers can also be used in their treatment. Hospitals routinely screen new patients on their vulnerability to pressure ulcers as a standard protocol.
Two common tools used in this screening process are the Braden Scale and the Norton Scale.
The Braden scale looks at six factors to determine a patient’s risk:
1. Sensory perception: How well the patient can feel
2. Moisture: How damp the skin is
3. Activity: How much the patient moves
4. Mobility: How well the patient can physically move
5. Nutrition: The quality of the patient’s diet
6. Friction/shear: How often the skin is scraped or rubbed
In each of these categories, a score of 1 indicates a high risk, whereas a score of 4 means there is no problem. The highest possible overall score is 23 and the lowest is 6. Those with lower scores are at a greater risk of getting pressure ulcers.
The Norton Scale is another risk assessment tool focusing on five factors:
1. Physical Condition: The overall health of the patient
2. Mental Condition: The patient’s mental status
3. Activity: How active the patient is
4. Mobility: The patient’s ability to move without assistance
5. Continence: The patient’s ability to control bladder and bowel functions
Like the Braden scale, each category is scored from 1 to 4, with 1 being a high risk and 4 indicating no problem. The highest possible score is 20, and the lowest is 5. Any score 16 or below suggests increased risk, while a score of 12 or below is considered high risk.
Alongside these scales, some preventative measures against pressure ulcers include maintaining a nutritionally balanced diet, repositioning to relieve pressure, maintaining cleanliness and moisture control, using special mattresses, and implementing appropriate skin care. Adequate nutrition, involving enough calories, fluids, protein, vitamin C, and zinc is important for both the prevention and recovery of pressure ulcers. In cases where the patients are unable to consume food normally, a tube might be required for feeding, because without it, the wound recovery process could get delayed.
When a Person Should Avoid Wound Pressure Injury Management(Archived)
If you’re treating pressure sores, there are certain things you should avoid doing. These include using harsh soaps, substances that can irritate the skin, roughly removing dead skin (called aggressive debridement), and lying on hard mattresses. All of these can make the sores worse and slow down the healing process. This is particularly true for older people who need to stay in bed a lot.
Equipment used for Wound Pressure Injury Management(Archived)
There are various tools available to assess health risks, but the most commonly used ones are the Braden and Norton Scales, mentioned earlier. These scales help doctors evaluate your health condition by scoring several factors. This can be compared to how a weather forecast predicts the chance of rain based on different weather conditions.
Who is needed to perform Wound Pressure Injury Management(Archived)?
The team that handles wound care is in charge of looking after any patient who has pressure sores. The team usually includes your main doctor, a skin specialist and/or a plastic surgeon (a doctor who can fix or improve the look of parts of the body), a nurse, a nurse assistant, a dietitian (a food and nutrition expert), and a physical therapist (a professional trained to improve how your body moves and feels). Checking a patient’s skin every day is necessary, especially if the person is likely to get skin damage, as shown by the Braden and Norton scales. These scales are tools that health care professionals use to evaluate a person’s risk of developing pressure sores.
How is Wound Pressure Injury Management(Archived) performed
Proper positioning is really important for protecting the skin and is particularly necessary for those who can’t move themselves. It’s best to avoid placing any pressure, or causing rubbing or pulling on the skin when arranging them. An effective way to do this is to move the patient every 2 hours. This pause allows areas under pressure to recover. This can be done using pillows or wedges to keep the patient on their side. Placing pillows between their legs and beneath their calves can help relieve pressure from their back, buttocks, knees, and heels.
Keeping clean and dry is especially important for patients who can’t control their bladder or bowel (incontinent). Wetness can damage the skin and cause it to break down, so it’s crucial to keep the patient dry at all times. This is usually the job of the nursing assistants. If patients develop skin damage due to wetness, it’s generally because the nurse hasn’t properly managed and overseen the nursing assistants.
An air mattress is a tool that can help protect the skin. It’s continually filled with air to keep the skin from breaking down and they’re used to prevent pressure sores (ulcers) in patients who face a high risk, or those who already have ulcers. Patients who score 12 or less on a tool known as the Braden scale (measuring pressure sore risk) should be put on an air mattress. Their skin should also be checked at least daily, or every work shift. It’s important to ensure at-risk patients are always clean and dry. Soaps, alcohol-based lotions and hot water should be avoided, as these can make the skin dry and leave a soapy residue that hampers the growth of normal skin bacteria.
Having weekly rounds is a good way to keep a check on issues connected with wounds and skin health. A team of medical professionals, including a wound care doctor, a nurse, and a nursing assistant, should thoroughly assess all patients when they are admitted. Pressure sores need to be examined and the right care chosen according to the patient’s needs. For the prevention and treatment of pressure sores, it’s important to understand what they are, how to check them, and how to get help from the whole wound care team. Removing dead tissue (debridement) can speed up healing by stopping harmful germs from growing.
There have been some reports that treatments like laser sessions, ultrasound, growth factors derived from platelets (a kind of blood cell), and high concentrations of oxygen can bring about some improvement in healing pressure injuries. This appears to be particularly effective for severe pressure sores (stage III and above). That said, more research is needed to fully understand these therapies.
Possible Complications of Wound Pressure Injury Management(Archived)
Despite receiving excellent care at a top-quality hospital, there can still be serious complications from pressure injuries. These injuries, especially severe ones in stages III and IV, can lead to a range of health issues. These include cellulitis, a common and serious skin infection; osteomyelitis, a bone infection; necrotizing fasciitis, a rapid spreading skin infection, also known as ‘flesh-eating bacteria’; gas gangrene, an infection that produces gas in tissues; and septicemia, a serious bloodstream infection.
What Else Should I Know About Wound Pressure Injury Management(Archived)?
Pressure sores, also known as bed sores, are often identified by a doctor simply by looking at your skin. They might also gently touch the area of your skin that’s red and tender. This process is called inspection and palpation. Your doctor might also look at other skin injuries to understand how your body is reacting to injury.
Sometimes, conditions like diabetes or a spinal cord injury can make you more likely to get pressure sores. So, your doctor might also look at your overall health and medical history.
Preventing and treating bed sores is a big deal because they can cause very serious health problems. Therefore, it’s important to address them immediately to avoid potential danger.
