24. Pressure sores/injuries

Question 1

Aetiology

Answer 1

Sustained/prolonged pressure that can cut off circulation to vulnerable parts of the body. Without adequate supply of blood, body tissues can die. More likely to affect bony parts of the body.

Question 2

Diagnosis

Answer 2

Physical examinations of skin to determine stage. Examine location, appearance and size of wound, and surrounding tissue.
Sometimes imaging tests.

Question 3

Trajectory

Answer 3

Stage 1: Mild, only affects upper layer of skin, discolouration and skin in tact
Stage 2: Damage to top layer of skin, looks like pus filled blister
Stage 3: Second layer of skin, into fat tissue. Death or damage to skin layers.
Stage 4: Death or damage to skin and underlying structures including tendons, muscles and bone

Question 4

Risk factors

Answer 4

Immobility and paralysis, restriction when sitting or lying down, impaired sensation or ability to respond to pain/discomfort. Age, incontinence, compromised blood flow, support surfaces.

Question 5

Signs and symptoms

Answer 5

Are of skin feel warm or cooler, tenderness, swelling, pus, pain or numbness, unusual skin colour change, obvious open wound, necrosis of underlying muscles or structures.

Question 6

Medical treatment

Answer 6

Removal of damaged tissue, wound care (dressings, regular wound cleaning), antibiotics for infection, nutrition improvement, pain medication, education on wound care. Surgery to remove damaged tissue or close the wound.
Prevention: Education on risks, regular position changes, special mattresses to reduce pressure.

Question 7

Co-occurring conditions

Answer 7

Obesity, SCI, sepsis (bacteria entering the blood stream).