Pressure Ulcers
Pressure ulcers, also called pressure sores or bedsores, occur as a direct result of unrelieved pressure on the body's tissues. This can cause serious harm to a patient, whose condition can rapidly deteriorate if measures are not taken to treat the damaged tissue.
What Causes Pressure Ulcers?
When tissues are subject to pressure, they become distorted and compressed. If this is not alleviated, the blood flow will become disrupted and the tissue will not receive enough oxygen. Subsequently the tissue will start to break down, while the build up of waste products may also cause tissue necrosis, clinical infection and septicaemia.
Pressure ulcers usually occur in one of three ways:-
- Pressure where the weight of the body presses down on the skin. This can either be from a prolonged period of low pressure, or a short period of unrelieved high pressure;
- Shear where the layers of skin are forced to slide over one another, for example while being pulled up in bed;
- Friction where the skin is subject to rubbing.
Pressure Ulcer Grades
Pressure ulcers range from mild tissue damage to severe wounds that expose muscle and bone. In order to classify the extent of a patient's injury, there are four different grades of pressure ulcer:-
Grade 1 Skin is in tact but discoloured. Tissue not affected by blanching (this is when light finger pressure applied to the skin in healthy people blood is temporarily prevented from flowing but returns within seconds, but in those with pressure sores the skin does not turn white, indicating a sore.)
Grade 2 Damage to the tissue is superficial and presents as an abrasion, blister or shallow crater. Skin may feel slightly thick, and there may be some loss or damage to the epidermis.
Grade 3 Skin will feel very thick, and there will be a loss of subcutaneous tissue but not extending to the underlying fascia. By this stage the pressure ulcer presents as a deep crater.
Grade 4 Skin will feel very thick and there will extensive loss of tissue, with damage and necrosis extending to underlying tissue.
Assessing Pressure Ulcers
The key to the prevention of pressure ulcers lies in the nurse's ability to assess and identify those patients at risk of developing pressure ulcers. This should be done within six hours of a patient's first episode of care, and can be calculated according to certain categories, such as: mobility, diet, moisture on the skin (such as urine), weight, age and other health conditions.
If a patient is at risk of developing pressure ulcers, nurses should then carry out thorough inspection in good light of all skin surfaces once a day for signs of redness and discolouration. Attention should specifically be paid to the bony prominences of the body, such as the sacrum, buttocks, hips, heels, ankles, elbows and the back of the head.
If these measures are enforced, then a patient's condition can be continually monitored. This in turn will allow any pressure ulcers that begin to form to be treated quickly, effectively reducing the risk of any serious damage occurring. Should medical staff fail to assess and identify a patient at risk of developing pressure sores, however, then there has been a breach of duty of care. This has the potential to cause serious harm to a patient, and may lead to a successful medical negligence claim.
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