Virtual Medical Centre

Pressure Ulcers

• What is Pressure Ulcers?
• Who gets Pressure Ulcers?
• Predisposing Factors
• Progression
• Probable Outcomes
• How Will Pressure Ulcers Affect Me?
• Clinical Examination
• How is Pressure Ulcers Diagnosed?
• How is Pressure Ulcers treated?
• Pressure Ulcers References

What is Pressure Ulcers?

Pressure ulcers occur when an area of skin breaks down when you stay in one position for too long, most commonly involving bony areas such as around the heels, hips, elbows and back. People who are exposed to developing pressure ulcers include: those who are in a wheelchair or are bedridden (eg after surgery or injury), the elderly and if you are unconscious and stay in a particular position for a long period of time. The constant pressure produced against the skin reduces the blood supply to that area, and the affected tissue dies.



Common sites for pressure ulcer development include:

Lateral position


Supine position


Prone position


Many factors are important in contributing to the formation of pressure ulcers, including:

• pressure
• friction
• shearing forces
• moisture

Pressure
Pressure is one of the most important external factors that contributes to the development of pressure ulcers. When tissue becomes caught between two hard surfaces, cells are deprived of oxygen and nutrients and waste products build up within the cells. If the pressure is relieved to the tissues the blood supply is returned to the area, thus oxygen and nutrients are returned to the cells and waste products are removed. If this pressure is not relieved, death of tissues will occur resulting in destruction of the tissues.

Pressure ulcers usually start as areas of red skin that can deteriorate to form blisters and deeper sores. To demonstrate the effects on pressure on healthy skin, we asked our medical model to lay on her side on the floor for five minutes. The images below show the reddened areas of skin over her upper arm and thigh.



You may be able to note the affected area more easily on the thigh than on the arm (probably because the arm is more pigmented from sun exposure than the thigh). Here are the same two pictures, with the reddened areas highlighted:



Friction
This occurs when two surfaces rub together. An example of friction is when we move up and down in bed, with our skin rubbing against the sheets. Friction may remove the superficial skin layers, making the skin more prone to breakdown.

Shearing
A shearing injury occurs when there are two forces pulling in different directions.

Important sources of shearing injury are:

• dragging or sliding a patient across the bed
• raising the head of the bed more than 30 degrees.

Who gets Pressure Ulcers?

The majority of pressure ulcers occur in patients in hospital. Around seventy percent occur in the first two weeks of hospitalization and seventy percent of these are seen in patients admitted for problems with the bones (orthopedics). About twenty - thirty percent of pressure ulcers occur in the community.

Predisposing Factors

There are many factors that can put you at a higher risk for developing pressure ulcers. These include:

• Being unable to move certain parts of your body properly.
• Paraplegia
• Severe physical disease
• Arthritis
• Surgery and post operative states
• Intensive care
• Plaster casts

• Decreased sensation (feeling in the limbs)
• Neurological disease
• Diabetes
• Coma

• Disease of the vessels: these diseases prevent areas of the body from receiving proper blood flow.
• Atherosclerosis
• Diabetes
• Vasculitis
• scleroderma

• Inadequate nutrition
• Anaemia(low levels of red blood cells)
• Hypoalbuminaemia (low levels of albumin, a protein produced by the liver).
• Vitamin C / Zinc deficiency

Progression

For pressure ulcers to develop, there must be both forces applied to the skin from the outside, plus predisposing factors that you may have, interacting to produce tissue damage. Factors from the outside environment that can lead to development of pressure ulcers include: increased pressure, rubbing (friction), shearing forces and prolonged areas of wetness. These are described in the introductory section. Factors that you may have contributing to development of ulcers include: inability to move properly, poor nutritional status, poor blood supply to various body areas, incontinence (inability to retain urine or faeces), and diseases affecting the neurological system.