Explain Like I'm Five: Pressure Ulcers

Pressure ulcers are wounds that develop in a patient's skin, mostly where weight is distributed on a surface. There are a large number of factors that can make a patient vulnerable to pressure ulcers:

Immobility, such as that related to bedrest
Poor nutrition, because patients who don't eat, don't heal
Confusion or an uncooperative patient
Incontinence
Excessively moist or excessively dry skin
Age
Smoking
Diabetes or other circulatory diseases

All pressure ulcers begin as non-blanchable erythema. This means that the area is reddened and, when pressed, does not lose its color. Healthy skin will blanch, meaning it temporarily turns pale or even white. The fact that skin does not perform this color change means that it is a Stage 1 ulcer.

Note the following stage descriptions:

Stage 1: Non-blanchable, no open skin

Stage 2: Open skin blister, no depth, may be drainage

Stage 3: Full-thickness tissue loss, some depth and possible tunneling

Stage 4: Exposed muscle, fat, or bone, tunneling, and undermining

So what can you do to prevent pressure ulcers?

Turn patients frequently, every 2 hours if possible.
Encourage patients to eat high-protein meals for skin healing.
Perform wound care exactly as ordered by the MD.
Be alert for foul-smelling drainage or other signs of infections that could quickly turn into sepsis.
Change incontinent patients at least every 2 hours.
Use pillows or other pressure-relieving surfaces.
Moisturize dry skin and frequently shower moist skin.
Encourage hydration.

Even if you implement all of the above suggestions, some patients will still continue to develop pressure ulcers. In that case, your goals should shift to infection prevention and pain management.

Want to know more? Where does the term "decubitus" come from anyway?

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