What is Pressure Ulcer ?
Updated: 5 days ago
Pressure ulcer (which commonly known as pressure sores or bed sores) are area of damage to the skin and underlying tissues due to prolonged pressure. Pressure ulcer can affect any parts of the body that put under pressure such as lying or sitting in the same position for too long. The reduction in blood supply to the skin and tissue result from the prolonged pressure and immobility will result in the sore and damage. Pressure ulcer commonly develop in the parts where skin is close to bone, such as hips, base of the spine, ankle, heels and elbows. They normally form gradually but may sometimes develop in a few hours.
In the latest NHMS 2019 report, it is estimated that around 1 in 50 of in Malaysia is receiving care at home in the last 12 months and 10.4% of them are receiving medical treatment such as tube-feeding, wound care, prevention of pressure ulcers and others.
Pressure Ulcer Risk factors:
2. Reduced mobility or immobility (example: due to Parkinson’s disease, stroke, pain and altered level of consciousness)
3. Friction and shear
4. Dehydration and malnutrition
5. Incontinence and excessive moisture
6. Reduced blood supply in the legs
7. Reduced skin sensation (such as neuropathy in diabetes)
8. Certain skin infections
How pressure ulcer developed?
Pressure sore happens when the body part is under pressure for a long time, this causes poor circulation of the blood and hence prevents the delivery of oxygen and nutrients to the tissue and accumulation of waste products. At the beginning, the pressure sore looks like a red patch of skin and when it gets worse, the skin breaks and the sore looks reddish-pink with shallow wound. Sometimes, the pressure ulcer may look like blisters and can burst. While some severe pressure ulcer are deep into the muscle of bones. This kind of deep sores can form scabs.
Pressure ulcers are commonly happen in people who:
1. Are older
2. Unable to move or shift around easily due to medical conditions
3. Are in a nursing home or hospital
How to differentiate the stages of pressure ulcer?
The severity of the pressure ulcers can be described using the National Pressure Injury Advisory Panel (NPIAP) staging system. The severity of the pressure ulcers can range from discoloration of skin initially and further progress to full thickness skin loss and bone damage over time. Pressure ulcers can be divided into 4 stages1,7:
Stage 1: Early symptoms of pressure ulcer which includes discoloration of skin (red patches of the skin) and the discolored skin not turning white when pressed. Pain and itchiness may develop at the affected area with warm, hard or spongy sensation when touched.
Stage 2: An open wound or blisters formed when the pressure ulcers get worse. The wound appears to be pink, red, moist and may present as blisters.
Stage 3: An open wound which involves a deeper layer of skin where fat is visible. Slough may appear. Tunnelling and undermining may occur. Muscle, ligament, tendon and/or bone are not exposed in this stage.
Stage 4: A very deep wound that reaches the muscle and bone. Slough, tunneling and undermining may occur.
Apart from that, there are other types of pressure ulcer, which are:
Deep tissue pressure injury: Maroon or purple localized area of skin or blood-filled blisters due to soft tissue damage from pressure. The area mar be painful, warmer or cooler and firm.
Unstage: An open wound which involves a deeper layer of skin where fat is visible. Slough may appear. Tunneling and undermining may occur. Muscle, ligament, tendon and/or bone are not exposed in this stage.re a few tips that you can use to prevent pressure ulcer
Can pressure ulcers be prevented?
Yes. There are a few tips that you can use to prevent pressure ulcer.
1. REPOSITIONING OR TURNING YOUR BODY
Repositioning is undertaken to reduce the duration and magnitude of pressure over vulnerable areas of the body and to contribute to the patient’s comfort, hygiene and dignity. Repositioned regularly by minimizing shear and friction forces on the skin can prevent pressure ulcer.
2. CHECK PATIENT'S SKIN CONDITIONS EVERYDAY FOR SIGN AND SYMPTOMS OF EARLY PRESSURE ULCER
Identifying at-risk patients and following best practices for pressure ulcer prevention, it may be possible to stop pressure ulcer before they develop and reduce their impact if they occur.
3. HAVE A BALANCED DIET WITH ENOUGH PROTEINS, VITAMINS AND MINERALS
Once a pressure ulcer has developed, nutrition plays a vital role in the healing process. This is because the body needs protein, energy (calories), vitamins and minerals (such as vitamin C, iron and zinc), and plenty of fluids to support the wound healing process.
4. USE APPROPRIATE TYPE OF MATTRESS (SUCH AS PRESSURE RELIEVING MATTRESS).
Increase comfort for an individual suffering from pressure sores. Ripple mattress is one of the method which can help on prevent pressure ulcer. The mattress provides high levels of support for the head and body to relieve any mounting stress on pressure points. Pressure relief mattresses differ from a regular mattress as they have carefully designed air pockets, specifically designed to place less pressure on the main pressure points in the body.
Frequent repositioning and choosing the correct pressure relieving mattress are the most important steps to prevent pressure ulcers. Proper skin care and maintain a balanced diet are just supportive interventions to prevent pressure ulcer. Repositioning and turning your body every 2 hours (from back, to one side then to another side) is important in reducing pressure at an area for too long and to improve the circulation of blood to the area of pressure ulcer. Gentle turning and repositioning are crucial to reduce friction to the skin. Pressure-relieving support surfaces (especially powered active air surfaces) is effective in reducing the incidence of pressure ulcers as compared to a standard hospital mattress. Studies also showed that patient’s satisfaction was higher with the pressure-relieving mattress and the incidence of pressure ulcer is as low as around 7%.
Benefits of using pressure-relieving mattress:
1. Reduced risk of developing pressure ulcer
3. Reduced length of hospitalization
4. Reduced wound care nursing times
5. Reduced the need for long term wound care supplies For more info