A pressure ulcer is damage that occurs to the skin and underlying tissue. The skin can become red, broken or ulcerated. Pressure ulcers are caused by:
Pressure- The weight of the body pressing down on the skin
Shearing- The layers of the skin are forced to slide over one another or over the deeper tissues, e.g. when you slide down, a bed or chair.
A combination of pressure and shear.
Who is at risk?
Anyone can be at risk of a pressure ulcer, but some are at greater risk than others. Those who are particularly at risk are people:
Who have problems moving and need help to change position
Whose skin is continually moist e.g. incontinence
Who have a poor diet and do not drink enough fluids
Who have problems feeling pain or sensation
Who are seriously unwell
Who are very old or very young
Who have or have had pressure ulcers in the past
Your nurses will assess your risk. This will include assessing your skin.
Where do pressure ulcers develop?
Pressure ulcers usually develop over bony areas of the body. The most common site of pressure ulcers are:
Bottom
Heel
Back
Other sites are shown below. Pressure ulcers can also develop under equipment such as masks or tubing, so it is important to check these areas too.
What are the signs of pressure ulceration?
Early signs of damage may be redness or discolouration over bony areas. This can be more difficult to see in darker skin tones. Stinging and burning may also be felt in the skin.
We categorise the severity of skin damage. From category 1(a), Skin that is red, that does not go pale when pressed; to category 4(b), where there is severe skin damage that leaves an open wound extending to the muscle or bone.
(A)
(B)
Preventing pressure ulcers
There are several important aspects to preventing pressure ulcers. These include:
Repositioning- Changing your position regularly allows sufficient blood flow to get to your skin to keep it healthy. If you are unable to move yourself, staff will assist you to do so. If you are mobile, walk around as often as you can. If you are in bed or sitting in a chair, you will be advised to turn and change your position.
Skin assessment
Staff will assess your skin for signs of damage. If you notice pain, discomfort or discolouration, please inform your nurse or other member of the healthcare professional team.
Incontinence
It is important your skin is kept clean and dry. Skin that is moist is more at risk of breaking down. This may be due to incontinence, sweating or a weeping wound.
Staff will provide care to manage moisture on the skin. Please discuss with your nurse.
Nutrition
Eating well and drinking enough is very important. Your diet will be assessed and this will be discussed with you. If needed, you will be referred to a dietician.
Equipment
All of our mattresses help to reduce pressure when you are in bed. If you have a significant risk and have limited movement in bed you may be provided with an air mattress. If you have problems moving your legs you will be encouraged and supported to keep your heels off the surface of the bed with pillows under your legs or a special boot.
Using an air mattress does not remove the need for you to reposition. When sitting out of bed a pressure reducing foam or air cushion may be provided to help reduce pressure when seated.
Managing pressure ulcers
Pressure ulcer management is complex. This can be complicated by any underlying health issues. You may therefore have different members of the clinical team give advice and support.
Depending on the severity of the pressure ulcer, you may require various dressings or therapies to help support wound healing. It is important to continue to change your position regularly, eat well and keep your skin healthy. You may need additional equipment such as pressure-relieving air mattresses or specialist seating.
Please discuss your individual plan of care with your health care professional team.
