Pressure ulcers

Pressure ulcers dressing

Last Updated December 20th, 2021

Overview of pressure ulcers

Ulcers and sores are very common and may result from a wide range of environmental and clinical factors. According to recent epidemiological findings by Center for Disease Control and Prevention, about 5-10% of the global population suffer from ulcers at some point in time. A very serious form of ulcer is pressure ulcer, which is more common in bed-ridden patients. It is therefore called bed sores in many cases. The recent statistics of NCBI show that there are more than 7.4 million cases of pressure ulcers in the whole world. The elderly patients form a large section of the affected population. 28% of these patients suffer from the initial or the advanced stages of pressure ulcers. Currently it has become a major cause of permanent disability and is even reducing life expectancy in some cases.

 

What are pressure ulcers?

Pressure ulcers bedsoresPressure ulcers are the localized damages of the skin and the underlying tissues that are caused by pressure and friction with a surface. These are also called pressure sores or bed sores or decubitus ulcers. Pressure ulcers result from the pressure applied to the soft tissues that obstruct blood flow to those tissues. Pressure ulcers are more common in people, particularly the aged people who lead a sedentary lifestyle. Patients confined to the bed or wheelchair due to some serious diseases have the likelihood of developing pressure ulcers. A number of other dietary, environmental and clinical factors may also contribute to these types of ulcers. The areas that are commonly affected in such conditions are- the back of shoulders, back of the cranium, pelvic region, elbows, knees and ankles. Most affected are the overlying skin of sacrum, coccyx, heels and the hips.

 

What causes pressure ulcers?

There are three underlying mechanisms that induce the formation of pressure ulcers. These are-

  • External pressure: External pressure exerted on the bony outgrowths causes compression of the blood vessels in that area. This results in obstructed circulation through the capillaries, which in turn results in deficient oxygen supply to the adjoining tissues. The following conditions arise in such cases-
  • Ischemia: Dearth of blood
  • Hypoxia: Low oxygen level
  • Oedema: Swelling of tissues
  • Inflammation
  • Necrosis
  • Ulcer formation
  • Friction: Continuous friction with a surface affects the blood vessels present directly below the skin. This leads to ulcer formation on the elbows and the back.
  • Shear: In this condition, a visible separation of the skin from the underlying tissues occur, wherein the underlying tissues tend to move downward whenever a person tries to get up from the bed and carry out any sort of movement.

Pressure ulcers dressingThere are a few other factors that precipitate the formation of pressure ulcers. These are listed below-

  • Malnutrition (protein and calorie deficiency)
  • Wetness of the skin due to perspiration or incontinence (microclimate)
  • Arteriosclerosis (reduced blood flow to the skin)
  • Neuropathy or paralysis (reduces sensation in the skin)
  • Peripheral Vascular Disease
  • Hypotension
  • Cerebral Vascular
  • Diabetes Mellitus
  • Tobacco smoking
  • Overuse of anti-inflammatory drugs
  • Prolonged stay in humid and sultry environments
  • Low BMI (Body Mass Index)
  • Dry skin
  • Immobility (temporary or permanent)
  • Altered mental condition
  • Bowel or urinary incontinence
  • History of ulcers and sores

 

How do you classify pressure ulcers?

The classification of pressure ulcers is done mainly based on the stage of the disease. These are elucidated below-

  • Stage I: In this type, only the epidermis is affected. A localized reddish patch appears over any bony prominence. Pigmentation appears in the later stages along with a palpable change in the temperature, thickness and texture of the affected skin. In people with a dark complexion, these changes are not so visible.
  • Stage II: The dermis is affected in this case. It is characterized by a loss of thickness of the dermis and the emergence of a shallow open ulcer with a reddish or pinkish wound bed (devoid of the slough). Fluid-filled blisters may gradually appear, which rupture in the later stages, releasing the content.
  • Stage III: Major tissue loss (full-thickness loss) occurs in this case. The subcutaneous fat is exposed and tunnelling may be observed. This stage is more prominent in areas of high adiposity.
  • Stage IV: The bones, tendons and the muscles are exposed in this case. A thickened slough may appear on some parts of the wound. The characteristic features of this stage are the tunnelling and the undermining of the subcutaneous tissues. The ulcers can even penetrate into the muscles, tendons, joint capsules or fascia. This increases the risks of osteomyelitis.
  • Unstageable: Here, the stage cannot be determined easily since a major depth of the wound is covered by slough. The depth and stage of the wound (ulcer) can be determined only after removing the slough completely.
  • Suspected deep tissue injury: This is characterised by a purplish area of discoloured skin (with no breaks) and blood-filled blisters, both arising from pressure and shear stress. The affected tissues are tender, warm and painful compared to the adjoining tissues. This type of deep tissue injury is difficult to detect in individuals with dark complexion. In the advanced stages, slough may form on the wound bed or more layers of underlying tissues may be exposed.

Another classification of ulcers done based on the areas affected is given below-

  • Epidermal
  • Dermal
  • Sub-cutaneous tissue
  • Muscle
  • Bone

 

Treatment & prevention

Pressure ulcer careRepositioning the patient is the first course of action in case the bed-ridden patient has developed pressure ulcers.  Special mattresses, pillows, and cushions can be used that enables one to sit and rest without making the body susceptible to bedsores.  The dressing should be regularly changed so that it doesn’t get infected. In case of spinal cord injury patients who are bed rest, electric stimulation can be used to treat the ulcers. Vacuum- associated suction can also be used to clean the ulcers.

In order to prevent the formation of pressure ulcers, the temperature and moisture levels of the patient’s room can be maintained at an optimal level that prevents drying of skin. One should not apply heating pads on areas where pressure ulcers can develop. It is better to wear silk or similar to silk fabrics instead of cotton or cotton blends in order to prevent friction. These can be also be prevented by using prophylactic dressing on bony projections.

 

Dos and Don'ts

Dos
  • When taking care of a bed-ridden person who is likely to develop bed sores, it is important to turn the patient once every two hours.
  • Regularly check for signs of ulceration on the skin for bed-ridden patients.
  • Moisturize and massage dry skin regularly, especially areas which remain stationary.
Don'ts
  • Keep the head of the bed of the patient at an angle greater than 30 degrees.
  • Drag the patient too much while moving him/her. This creates friction and results in inflammation and ulceration of the skin.
  • Use thick dressing over the ulcer wounds. Also, avoid using a lot of padding to put under the patient. Any sort of thick covering or padding will increase pressure ulcers.

 

 

 

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shiitake mushrooms healthy
What are Shiitake Mushrooms and why should you eat them? Shiitake Mushrooms are well known for their smoky and robust taste. However, did you know they are replete…
beta hcg test
Beta hCG Test A Beta hCG test measures the level of human gonadotropin hormones present in the blood that is primarliy…
Tart Cherry: The healthiest excuse for taking that second serving of pie Tart cherry has been traditionally used in delectable desserts such as pies. Recent studies have revealed that its…
yoga health benefits
How to practice yoga for astounding health benefits Can a 5000-year-old system be the ultimate body healer? Did you know yoga can make you smarter and…
Vitamin b12
Vitamin B12 Test Vitamin b12 is an essential nutrient required for healthy functioning of the nervous system and also development of…
Chlorella: Therapeutic powers of the billion-year-old algae now within your reach Chlorella - A billion year old nutrient-rich algae that can potentially ward off cancers and high cholesterol; the…
Chest X-Ray A chest x-ray is a diagnostic test that uses x-rays to visualize the structures inside your chest. It…
social media adddiction
Your health in the age of Social Media: Why is digital detox a necessity? Did you know that more than 400 million people are dangerously addicted to social media? Are you one…
hepatitis B envelope antigen
Hepatitis B Envelope Antigen (HBeAg) The HBeAg or hepatitis B envelope antigen test is a screening test used to diagnose the onset of…
Exercises or diet? Find out the healthiest way to gain weight Tired of being called skinny all the time? Looking for healthy ways to beef up? Why not try…
blood elements analysis
Vitamin Profile Your doctor will recommend you undergo the vitamin profile test if you are showing signs of either vitamin…
woman with abdominal pain holding ovulation calendar
Ovulation – facts to know about ovulation Learn how and when ovulation occurs, demystify common misconceptions, identify symptoms, methods of detection and right period for…
beta 2 glycoprotein 1 igm
Beta 2 Glycoprotein 1 IgM The Beta 2 glycoprotein 1 IgM test detects IgM class of antibodies in the blood.The presence of beta-2…
beta alanine energy powder
Beta-alanine: A powerhouse of proteins to charge up your workout How can a simple amino acid be a crucial health supplement for champion athletes? Find out how you…
apolipoprotein a1 test
Apolipoprotein -A1 (APO-A1) Test Apolipoprotein A-I (Apo-A1) constitutes 70% of protein content in high-density lipoprotein (HDL) and helps in lipid metabolism.
Low fat diets
A complete list of low-fat diets and how to follow them Low-fat diets help you lose weight in a healthy way, but it works only with regular exercise and…
Mood swings
The real reasons for your mood swings and how to overcome them Are you prone to heated moods frequently? Do you also feel bouts of depressive feeling creeping up on…
anti-chlamydia antibody tets
Anti-Chlamydia Antibody -IgG Test Anti-Chlamydia Antibody - IgG test is performed by collection of urine or genital fluids as sample for testing…
Find all the instant ways to get rid of blackheads Blackheads - Not only are they aesthetically unappealing but if left untreated these can cause bacterial overgrowth on…
GM Diet: The fastest way to lose weight or yet another hoax diet? General Motors started this trend of extreme dieting for 7 straight days to ensure its employees were able…
vital organ diseases
Common diseases that could cripple your vital organs Brain, heart, kidney, lungs, and liver - these vital organs are indeed vital for your survival. However, these…
antiHEV IgM test
Anti hepatitis E virus (Anti HEV) IgM Test Anti HEV IgM test determines the level of the IgM antibodies in the blood, The disease is often…
Creatine: Is this the right peak athletic-performance supplement for you? Creatine is the amino acid that boosts our energy. Did you know creatine supplements can help you reach…
Bloodtestalbumin
Albumin Test Albumin test or blood serum test is a liver function test that measures the amount of the protein…
GERD heartburn
Heartburn: What are the exact symptoms and the best home remedies? There are easy home remedies for heartburn, which not only acts as a first aid when you experience…
Balneotherapy jacuzzi
5 things you didn’t know about balneotherapy and how you can do it at home Sauna baths have been popular since a long time. But how much more beneficial can balneotherapy be as…
eating disorder anorexia
Eating Disorders: Lifestyle choice or a psychological condition? Is eating disorder just a harmless bad habit? Or does it represent grim psychological disorders? Do you want…
hidden causes obesity
8 hidden causes of obesity you probably didn’t know! Did you know that around 2 billion people worldwide are either overweight or obese? Are you too a…
myelogram
Myelography Myelography is an important diagnostic tool that is used to investigate and identify abnormalities in the spine and…
tonometry
Tonometry Tonometry uses a device called tonometer to measure the pressure inside the eye. This pressure is depends upon…
shakeology woman
Meal replacement or protein drink? Learn all about Shakeology and its claims Shakeology from Beachbody claims to be the most suitable shake that can aid in weight loss, regulate blood…

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