Pressure Ulcers: Stages and Treatments
Pressure ulcers, also known as bedsores, are skin and underlying tissue injuries that result from prolonged pressure. Prolonged pressure can cause the types of wounds that often occur in areas where bones are close to the skin surface, such as the heels, hips, back, and tailbone. The injuries often arise among people who cannot move or change position without help, such as bedridden individuals or patients who use a wheelchair and are confined to it for long stretches.
Understanding how pressure ulcers develop, recognising early indicators, and knowing how to classify and manage them are key to improving patient care and outcomes. Early intervention not only prevents the progression of ulcers but also reduces the risk of infection and long-term complications.
What are Pressure Ulcers?
Pressure ulcers develop when pressure is applied to an area of skin for a long time. The blood flow that nourishes the skin and underlying muscle is restricted; without oxygen and nutrients, the tissue starts to die. This breakdown marks the beginning of what is classified as a pressure ulcer.
Multiple factors may increase the risk of developing pressure ulcers. These include having limited mobility, rubbing one’s skin against bedding, and being exposed for too long to moisture from sweat, urine, or faeces. Those who are bedridden or require a wheelchair for mobility are at particularly high risk of pressure ulcers. Conditions such as diabetes, poor circulation, and malnutrition can also increase the skin’s susceptibility to pressure.
Older adults and individuals with chronic conditions are at higher risk. Their skin is more vulnerable compared to younger adults and can be further compromised by chronic illnesses. Additionally, a reduced immune response can make it more difficult for their bodies to fight off infections.
What are the Signs of Pressure Ulcers?
The management of pressure ulcers hinges upon the early detection of this condition. The visible symptoms can vary significantly depending on the wound’s severity. Here are some common early signs:
- Skin that has red or discoloured patches which do not return to normal colour after pressure is applied
- Swelling or changes to the texture of the skin in areas that bear weight
- A warmth, tenderness, or pain in the affected region
- Open sores, blisters, or wounds that do not heal properly
- Pus-like drainage or an unpleasant odour from the site, which may indicate infection.
Routine skin checks are essential for healthcare professionals and caregivers to perform on individuals with restricted mobility. If skin integrity is compromised, patients may be at risk for a pressure ulcer.
Understanding Pressure Ulcer Staging
The classification system known as pressure ulcer staging determines the severity of a pressure ulcer. This system helps guide treatment plans and ensures clear communication among healthcare providers.
Stage 1
The skin shows signs of redness or discolouration that does not fade after the pressure is removed. The area may feel warmer or firmer than the surrounding skin and could be tender or painful. Although there is no visible wound, underlying tissue damage may already be occurring.
Stage 2
This stage involves partial-thickness skin loss. The ulcer may appear as a blister, scrape, or shallow open sore, and the wound is typically moist and painful. The damage extends beyond the outer layer of skin and may involve the dermis.
Stage 3
This stage has full-thickness tissue loss and may resemble a deep crater. Fat tissue may be visible, and there may be signs of dead tissue or infection. The tissue damage may extend further, but it has not yet involved muscle or bone.
Stage 4
This is the most severe stage, with damage going into muscle, tendons, or bone. Extensive tissue destruction is often visible. Stage 4 ulcers have a high risk of spreading serious complications, including infections, to the bloodstream.
Unstageable and Deep Tissue Injury
Some ulcers cannot be staged due to the presence of slough or eschar (dry scab) covering the wound bed. Others may show as intact yet discoloured skin, suggesting deep tissue injury that will likely worsen. In these situations, additional assessment is necessary.
Recognising Pressure Ulcer Treatment
An effective treatment regimen for pressure ulcers depends on both the specific stage of the ulcer and the patient’s overall health condition. Treatment requires a multifaceted approach, combining several strategies to alleviate pressure, promote healing, and minimise the risk of infection.
Reducing Pressure
The initial step in treatment is to remove pressure from the affected area. Patients are either encouraged or assisted in changing their positions frequently. Supportive devices, such as foam pads, specialised mattresses, and cushions, are used to help distribute weight more evenly and reduce pressure on the body most at risk.
Wound Care
The typical method for cleansing wounds is to use a saline solution, which helps to reduce the chance of the wound becoming infected. Another key aspect of wound care is to maintain a moist environment for the wound, which is conducive to the body’s natural healing processes. The choice of dressing for a wound depends on the size, depth, and condition of the ulcer, with several options available to cover various wound types.
Debridement
Removing dead or infected tissue from a wound is sometimes necessary for proper wound healing; therefore, it should be performed by a skilled professional. Surgeons have various methods at their disposal for debriding a wound. See our guide to wound debridement types and what to expect
While some still rely on the traditional approach of using scalpels and scissors, others may employ moisture-retentive dressings or even the latest ultrasound technology to facilitate the process.
Infection Control
Comprising regular wound inspection, infection control is all about ensuring the wound remains clean. This is achieved by maintaining proper hygiene and using the correct sterile techniques during dressing changes. For some patients, the infection is severe enough that they require a course of antibiotics. Depending on the severity of the infection, they may receive antibiotic treatment in the form of an ointment, a pill, or an IV infusion.
Nutritional Support
Nutrition also plays a crucial role in the treatment of pressure ulcers. Patients should follow a balanced diet rich in proteins, vitamins, and minerals. They should also stay well-hydrated, as hydration supports tissue repair and maintains healthy skin surrounding the ulcer.
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