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Diagnosis and Treatment of Pressure Ulcers

Pressure ulcers, also known as bed sores or pressure sores, are painful, open wounds characterized by the breakdown of the skin due to sustained pressure.

According to the Institute of Healthcare Improvement, each year nearly one million people develop pressure ulcers, which results in $1.3 billion in related costs. Further, nearly 60,000 acute care patients die each year from complications related to pressure ulcers. And the pain and suffering caused by pressure ulcers are simply immeasurable.

Causes of Pressure Ulcers

Pressure ulcers are most often caused when something rubs or presses against the skin for an extended period and blood flow to the area is restricted. Once blood flow is restricted to the skin, the skin dies, thereby forming an open ulcer or wound. As such, individuals with limited mobility are most often those who suffer from pressure ulcers.

Individuals at risk of pressure ulcers include those who:

  • Are confined to a wheelchair
  • Are bedridden or stay in bed for an extended period of time
  • Have thin, fragile skin (older individuals)
  • Are unable to move specific areas of the body due to disease or spine or brain injury
  • Suffer from neurological disorders that result in a loss of sensation
  • Suffer from a disease that restricts blood flow, such as diabetes or vascular disease
  • Suffer from urinary or bowel incontinence
  • Are malnourished (poor nutrition and hydration)

Individuals who are in poor health, who suffer from paralysis, who are recovering from surgery, or who are sedated or in a coma are most often affected by pressure ulcers.

Complications from Pressure Ulcers

Pressure ulcers can cause a number of complications, many of which are life threatening, including:

  • Sepsis (infection of the blood stream)
  • Bone and joint infections
  • Cellulitis (can lead to sepsis or meningitis)
  • Cancer (squamous cell carcinoma)

Anyone who is unable to move about freely without restriction may be at risk for a pressure ulcer. Further, individuals who suffer from urinary or bowel incontinence and do not have the skin cleansed immediately may also be at risk for pressure ulcers.

Signs and Symptoms of Pressure Ulcers

The signs of a pressure ulcer are quite distinctive and quite clear, as it often first appears as red, irritated skin that gets progressively worse, or a blister that eventually becomes an open sore.

Pressure ulcers are most common on those areas of the body where individuals have direct contact with other surfaces, such as the buttocks, lower hips or tailbone, ankles, elbows, the spine, shoulder blades, and the back of the head.

Diagnosis for Pressure Ulcers

Pressure ulcers are diagnosed upon examination by a medical professional.

The National Pressure Ulcer Advisory Panel categories pressure ulcers by stage according to severity:

Stage I:  This new bed sore likely has intact skin, although the skin may appear red or purple, and the skin fails to blanch (respond) when touched. The skin may appear firmer or even softer than the surrounding skin, and it may be warm to the touch and painful.

Stage II: The pressure ulcer has become an open wound, and the outer layer of the skin, as well as part of the underlying layer of the skin, is damaged or gone. The pressure ulcer may appear as a shallow, pink wound, or it may look like a ruptured blister.

Stage III: The pressure ulcer is now a deep wound that is characterized by a loss of skin and exposed fat. The ulcer resembles a crater, with the bottom of the wound likely displaying an area of yellow, dead tissue.

Stage IV: This most severe stage is an ulcer that exhibits a large loss of tissue. The wound may reveal muscle, tendons or bone, and the damage extends far below any layers of healthy skin.

Treatment for Pressure Ulcers

Pressure ulcers develop quickly and advance quickly; therefore, proper treatment is crucial. In particular, it is important to seek medical attention as soon as symptoms or signs of a pressure ulcer are present.

Treating pressure ulcers often includes a multi-faceted approach that is overseen by a physician specializing in wound care.

Treatment may involve one or more of the following actions:

  • Relieving pressure by repositioning the individual or by using support surfaces, such as special cushions, pads or mattresses
  • Removing damaged tissue through surgical debridement or mechanical debridement (whirlpool bath, pressurized irrigation, or specialized dressings)
  • Cleaning and dressing the wound with appropriate dressings and special chemical enzymes that allow for natural debridement
  • Cleaning the area with gentle soap and water or a saltwater solution
  • Creating a barrier against infection through the use of appropriate dressings

It is also commonplace for individuals with pressure ulcers to receive both oral and topical pain medications and antibiotics. Paying close attention to proper nutrition and hydration also promotes wound healing.

Preventing Pressure Ulcers

Because pressure ulcers are so difficult to treat and often take months to heal, prevention is vital. In particular, repositioning is the key to preventing pressure ulcers. Frequent repositioning avoids pressure on any one area of the body, and good skin care and nutrition help to keep the skin healthy and less prone to pressure ulcers.

Resources about Pressure Ulcers

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