Pressure Ulcers (Bed Sores)

Pressure Ulcers 1

Pressure Ulcers or Sores, more commonly called Bedsores, are injuries to the skin and tissue underneath resulting from an extended period of pressure on the skin. Bedsore most often develops on skin that covers bony areas of the body, such as the heels, Ankles, hips, and tailbone.

Those who are most at risk for bedsores are individuals that suffer from medical conditions which limit mobility. These people typically cannot change their positions frequently; they may require a wheelchair or are confined to a bed for an extended time.

Unfortunately, bedsores can form relatively quickly and are often difficult to treat. Several things can help prevent some before and help with healing,

Symptoms of Bed Sores

There are four states of bed sores based on their difference. The National Pressure Ulcer Advisory Panel, a professional organization that promotes education and prevention, as well as treatment for Pressure rules, defines each stage as the following:

Stage I

The first stage and the beginning of a pressure sore have the following characteristics:

The skin is not yet broken.

There is some reddish skin color on people with lighter skin color,

The skin does not blanch or lighten when it touched

People with darker skin may have some discoloration; there is not any blanching when the skin is touched

The area may be tender and firm. Soft, warm, cool, or painful compared to the surrounding areas of the skin.

Stage II

The other layer of skin (epidermis ) and part of the underlying layer of skin (dermis ) are damaged or lost.

The wound makes like a fluid-filled blister or a ruptured blister

They would be pinkish or red and shallow

Stage III

At stage III, the ulcer is a deep wound.

The loss of skin will expose some level of fat

The ulcer from a crater-shaped hole in the skin

The bottom of the wound has some dead yellowish tissue.

The damage may extend beyond the primary wound to layers below healthy skin.

Stage IV

Stage IV ulcer shows significant loss of tissue

The wound may expose bone, tendons, or muscles

The bottom of the wound contains dead tissue that can be dark, hard crusty, and yellow.

The damaged tissue often extends beyond the primary wound to layers of healthy skin below.

An unstageable Pressure Ulcer is considered unstable if the surface is covered with black, brown, yellow, or dead tissue. It is not possible to see how deep the wound may be.

Deep Tissue Injury

A deep tissue injury may have the following characteristics:

The skin is purple or maroon, but the skin reposting

A blood-fill blister is present

A shiny patch or a change in skin tone may develop in people with dark skin.

The area is warm or excellent compared to the surrounding skin

The area skin is painful, mushy or film-like

Common Site of Pressure Sore (Bed Sores)

For people who utilize a wheelchair, pressure sores often occur on the skin over the following areas:

Shoulder blades and spine

Back of legs and arms, where the skin rest against the chair

Buttocks and Tailbone

People who are confined to the bed – common sites include the following:

Back of the ears

Hip lower back or tailbone

Back or side of the head

Heels, ankles, and skin behind the knees

Shoulder and shoulder blades.

Etiology of pressure sores, eps8

When should you see the doctor?

You should see the doctor if you see early signs or symptoms of pressure ulcers when you change your position to believe the pressure on the area. You should contact your doctor if you do not see any improvement in 24-48 hours. There can be signs of infection, such as a fever fringe, odor from the sore, and increased heat and redness.

Causes of Bedsores or Pressure Sores

A bedsore is caused by prolonged pressure against the skin, which limits blood flow to the skin and tissues near it. Other factors limit mobility and can put the skin at risk for damage and contribute to the growth of pressure sores. There are three main factors:

Prolonged pressure – when the skin and the tissues beneath are trapped between the surface of a bed or wheelchair and the bone, there is a lot of pressure. It may be greater than the pressure of the blood flowing through the capillaries ( blood vessels) that deliver needed oxygen and essential nutrients for the skin cells. With the blood vessels unable to deliver this oxygen, the skin tissues and cells will become damaged and possibly die. These pressure sores tend to appear in areas where there is no padding with muscle or fat and lie directly over bone, such as the hip, heels, elbows, spine shoulder blades, and tailbones

Friction – Resistance to motions occurs when the skin is dragged across the surface when you change position or the care provider gives you. The friction can be greater if the skin is moist,

Shear – occurs when two surfaces move in the opposite direction. This can happen when your head is elevated on a bed, naturally slides down the bed, or the tailbone moves down the skin over the bone. Essentially there is pulling in the opposite direction, which may cause skin cells and blood vessels to become damaged from sustained pressure.

Risk Factors

People who are in danger of developing pressure sores if they have difficulty moving and are unable to change position while seated or in bed. Immobility may be due to the following:

  1. Paralysis
  2. Sedation
  3. Coma
  4. Recovery after surgery
  5. Injury or Illness that requires bed rest or wheelchair use
  • Pressure Ulcers 3
  • Age – An older Person is likely more fragile, thinner, less elastic. and drier skin than younger adults. Older adults also produce new skin slower, which can make the skin vulnerable to damage.
  • Lack of sensory perception – Individuals with spinal cord injury or neurological disorders and other conditions can lose sensation. The inability to feel pain or discomfort can result in not being as if one person has bedsores or need to change their position.
  • Weight Loss is common during prolonged illness, and muscle atrophy and wasting away are common for people with paralysis. The loss of muscle and fat results in less cushioning between the bone and the bed or wheelchair.
  • Poor hydration and nutrition- People need enough fluids, protein, calories, minerals, and vitamins in their daily diet to maintain healthy skin and prevent the detection of tissues.
  • Excessive moisture or dryness – Skin that becomes moist from sweat or lacks bladder control is at higher risk of injury with increased friction between the skin and clothing or bedding. Dehydrated skin increases friction as well.
  • Bowel incontinence- Bacteria can form from fecal matter, cause severe local infections, and lead to life-threatening conditions that can affect the entire body.
  • Medical conditions can affect the blood flow- Health issues that affect the blood flow, such as diabetes and vascular disease, increase the risk of tissue damage.
  • Smoking – Smoking can reduce blood flow and limits the amount of oxygen in the blood. Smokers tend to develop more severe wounds, and wounds will heal slower.
  • Limited alertness – People who do not have complete mental awareness or have the rawness lessened by trauma, medications, or disease may be unable to take actions to prevent or care for pressure sores.
  • Muscle Spams – People with frequent muscle spasms or involuntary muscle movement may have an increased risk of developing pressure sores from frequent friction and shearing.
Pressure Ulcers 4

Complications from Bed Sores

Sepsis occurs when bacteria entered the bloodstream through broken skin and spread through the body; It is a rapidly processing, life-threatening condition that can cause organ failure.

Cellulitis is an infection of the skin and attached soft tissues. It can cause severe pain, swelling a redness. Individuals with nerve damage often will not feel pain with conditions. Cellulitis can lead to life treating complications.

Bone and joint infections – Infections from a pressure sore can burrow into joints and bones. Joint diseases or aspects can cause damage to the tissue and cartilage. Bone infection or osteomyelitis can reduce the function of limbs and joints. This infection can be life-threatening.

Cancer can cause the development of squamous cell carcinoma that develops inc chronic, nonhealing wounds (Margolin ulcer). This type of cancer is aggressive and usually requires surgery.

Test and diagnosis

Evaluating Bedsore 

The doctor evaluates the sores by:

  • Determining the size and depth of the ulcers.
  • Check if there are any fluids, debris, or bleeding in the wound that can indicate a severe infection
  • Detecting orders that can indicate dead tissue or infections.
  • Check the area around the wound for signs that tissue damage or infection
  • Check for a pressure sore on the body

Questions that the doctor may ask:

  • When did the pressure sore first appear?
  • Have you had any pressure sore in the past?
  • What type of care assistance is available to you?
  • What medication conditions have you been diagnosed with, and what is your daily treatment?
  • What is your regular daily diet?
  • How much water and other fluids do you consume each day?
  • What is the degree of your pain?


The doctor can order the following test

Blood test to check the heat

Tissue cultures indicate a bacterial or fungal infection in the wound to determine what stage the score is in.

Tissue cultures can check for cancerous tissue in a chronic nonhealing wound.

Treatment and Medication

Stage I and II users, heal within a few weeks to months with conventional wound care and ongoing care. Stage III and IV ulcers are more difficult to treat

Reduce Pressure

The first step in treating bedsores is reading the pressure that initiated it in the first place. A few options include the following:

Repositioning: If you have a pressure sore, you must be repositioned regularly and placed in the proper position. If you use a wheelchair, you may need to shift your weight every 16 minutes. You can ask for help to be repositioned every hour or so. If you are restricted to bed, your position must be changed every two hours.

If you have enough strength, you may be able to use devices such as a trapeze bar to reposition yourself. Caregivers can also use bed linens to help move and lift you to reduce friction and shearing.

Using support surfaces

Use a bed mattress and special cushion to help you lie in the correct position, relieve pressure on any sores, and protect your skin. If you are in a wheelchair, use a cushion, the style includes foam, air-filled and water-filled. Select one that suits your condition, body type, and mobility.

Cleaning and dressing wounds include the following:

Cleaning is essential for keeping wounds clean and preventing infection. If the affected skin is not broken ( stage I wound), gently wash it with water and mild soap and pat dry. Clean open sores with salt water or saline solution each time the dressing changes.

Applying to dress: A dressing provides healing by keeping a wound moist, creating a barrier against infection, and keeping the surrounding skin dry. Dressing choice includes gauzes, films, foams, gels, and treated coverings. The medical worker may use a combination of dressings.

Your doctor will select the best dressing for you based on the seriousness, size, amount of discharge, and ease of removing the frequently included sore.

Treatment to Remove Damaged Tissue

The wound must be free of damaged, dead, or infected tissues for pressure sores to heal correctly. Debridement or removing this tissue can be done through various methods, depending on how severe the wound is and the patient’s overall condition.

Surgical debridement – involves cutting away dead tissue

Mechanical debridement loosened and removed wound debris. This can be done through low-frequency mist ultrasound or special dressing, which provides pressure irrigation.

Autolytic debridement aids the body’s natural process of breaking down dead tissue through enzymes. The method may be used on smaller and untreated wounds and involves special dressing to keep the wound from being moist and clean.

Enzymatic debridement invokes using chemical enzymes and appropriate dressing to break down dead tissue.