Pressure Ulcers (PU)
Pressure Ulcers (PU)
Pressure ulcers (PU)-also known as bedsores, pressure sores, decubitus ulcers, or pressure injuries-are localized injuries to the skin and underlying tissue, typically occurring over bony prominences as a result of prolonged pressure, often combined with shear, friction, or moisture17. These ulcers are a significant concern in immobile or bedridden individuals, such as those with paralysis, chronic illness, or after surgery256.
Causes and Risk Factors
- Prolonged Pressure: Constant pressure, especially over bony areas (sacrum, heels, hips, elbows), impedes blood flow, leading to tissue ischemia and cell death1257.
- Shear: Sliding movements stretch and tear blood vessels, worsening tissue damage127.
- Friction: Rubbing against bedding or clothing removes superficial skin layers, increasing vulnerability27.
- Moisture: Incontinence or sweating weakens skin, making it more susceptible to breakdown27.
- Risk Factors: Immobility, poor nutrition, incontinence, reduced sensation, advanced age, vascular disease, and previous pressure ulcers increase susceptibility2567.
Common Sites
- Sacrum and coccyx
- Heels
- Hips
- Elbows, knees, ankles, shoulders, and back of the head7
Stages of Pressure Ulcers
Pressure ulcers are classified by depth and severity37:
| Stage | Description |
|---|---|
| Stage 1 | Non-blanchable redness of intact skin; may feel warm, spongy, or hard; possible pain/itching34 |
| Stage 2 | Partial-thickness skin loss involving epidermis and/or dermis; shallow open ulcer or blister3 |
| Stage 3 | Full-thickness skin loss; damage or necrosis of subcutaneous tissue, possibly visible fat3 |
| Stage 4 | Full-thickness tissue loss with exposed muscle, bone, or tendon; high risk of infection3 |
Symptoms
- Redness or discoloration (may appear as purple/blue in darker skin)
- Localized warmth, swelling, or hardness
- Pain, tenderness, or itching
- Open sores or wounds, sometimes with drainage or foul odor
- In severe cases, visible muscle, bone, or eschar (dead tissue)347
Diagnosis
- Clinical Evaluation: Physical exam, assessment of location, depth, and appearance2.
- Staging: Classifying the ulcer guides treatment and monitoring23.
- Nutritional Assessment: Poor nutrition impedes healing2.
- Further Testing: Blood tests, wound cultures, and imaging (MRI) may be used to assess complications like infection or osteomyelitis2.
Treatment
- Pressure Relief: Regular repositioning and use of specialized mattresses/cushions to reduce pressure6.
- Wound Care: Cleaning, debridement (removal of dead tissue), and appropriate dressings6.
- Infection Control: Topical or systemic antibiotics if infection is present6.
- Supportive Care: Maintaining good nutrition and hydration to promote healing26.
- Surgery: May be required for severe (stage 3 or 4) ulcers that do not heal with conservative measures36.
Prevention
- Frequent repositioning (every 2 hours if bedridden)
- Use of pressure-relieving devices (mattresses, cushions)
- Daily skin checks, especially over bony prominences
- Maintaining skin hygiene and dryness
- Adequate nutrition and hydration
- Avoiding smoking67
Complications
- Local and systemic infections (cellulitis, osteomyelitis, sepsis)
- Chronic pain
- Delayed healing or recurrence
- Increased healthcare costs and hospital stays7
Summary Table
| Aspect | Details |
|---|---|
| Other Names | Bedsores, decubitus ulcers, pressure sores, pressure injuries |
| Causes | Prolonged pressure, shear, friction, moisture |
| Risk Factors | Immobility, poor nutrition, incontinence, vascular disease, reduced sensation |
| Common Sites | Sacrum, heels, hips, elbows, ankles, shoulders, back of head |
| Staging | 1 (redness) → 2 (blister/partial thickness) → 3 (full thickness) → 4 (deep tissue loss) |
| Prevention | Repositioning, pressure-relieving devices, skin care, nutrition |
| Treatment | Pressure relief, wound care, infection control, surgery (severe cases) |
| Complications | Infection, sepsis, chronic wounds, increased healthcare costs |
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Pressure ulcers are preventable injuries that require early identification, risk assessment, and a multidisciplinary approach to management and prevention to reduce morbidity and improve patient outcomes167.
References:
A thorough overview of pressure ulcers-including risk factors, pathophysiology, complications, prevention, and treatment-is provided in “Elucidation about pressure ulcers” (DOI: 10.33448/rsd-v11i16.38341).
