Assessing and Treating Pressure Injuries in Patients

• Pressure injuries are one of the most common complications of hospitalized patients, especially those in the ICU who are sedated, paralyzed, or bedridden for long periods of time. 
• Most pressure sores usually happen over bony prominences such as heels, sacrum, tailbone, hips, ankles, earlobes, or elbows. 
• With the use of special mattresses, pressure-relieving materials, topical ointments or dressings, incontinence pads, and other management strategies, pressure injuries can be treated effectively. 

Pressure injuries are one of the most common complications of hospitalized patients, especially those in the ICU who are sedated, paralyzed, or bedridden for long periods of time. Patients who are unable to change positions can quickly develop these injuries.  

They can develop over hours or days and lead to an increased risk for infection and longer hospital stays. In some cases, these sores may never heal completely and cause the patient added discomfort and distress, reinforcing just how crucial preventative care is.  

In this blog, we are taking an overall look at pressure injuries, also called bedsores, and how you as a healthcare worker can assess, monitor, and care for these injuries to the skin—the largest organ of the body.  

What Is a Pressure Injury?

A pressure injury, decubitus ulcer, or bedsore is an injury to the skin that happens when various kinds of force, friction, or shear are applied to the skin. It could be a constant force or pressure applied onto the skin or a dragging or shearing force between the skin and another surface.  

There are several stages of pressure injury with different management. Most pressure sores usually happen over bony prominences such as heels, sacrum, tailbone, hips, ankles, earlobes, or elbows. 

What Are the 5 Different Stages of a Pressure Injury? 

Stage 1

This stage is called a nonblanchable discoloration of the skin. The skin appears red or pink in those with lighter skin tones and blue or purple in those with darker skin tones. The skin does not blanch or turn white when pressed with a finger. 

Stage 2

This stage involves superficial damage to the top layer of the skin. It may look like a blister or a skin tear. At this stage, the epidermis can repair itself.

Stage 3

This stage involves the subcutaneous layer of the skin. The wound is open, extending deeper to the fatty layer of the skin, though muscles and bone are not showing. 

Stage 4

This stage is the most severe wherein the wound extends down to the bone and muscles. 

Unstageable

Some injuries cannot be recognized or do not fit into the other stages. These wounds are not clear or when the base of the sore is covered with a thick layer of tissue, exudates or pus. 

This stage is the most severe wherein the wound extends down to the bone and muscles. 

Deep Tissue Injury

This stage is when an injury is suspected but there is no skin tear or open wound but the tissues beneath the skin are injured. They may look hyperpigmented, dark red, purple, or a blood-filled blister.  

How Do I Assess A Pressure Injury?

When a patient enters the unit, the nurses must assess the patient‘s skin and look for existing pressure sores. They should note the location, stage, measurement and its characteristics in their assessment.  

Nurses should also recognize the risk factors for developing pressure injuries. They should determine the patient‘s mobility status, nutritional status, incontinence status, and previous pressure ulcers.

Managing Pressure Injuries

There are various management strategies for pressure injuries, depending on the stage and severity of the injury. These strategies include: 

Special Mattresses

There are pressure reduction surfaces for each type and severity of pressure injuries. Some of these special surfaces include dynamic mattresses, low air loss mattresses, and air fluidized mattresses. 

Pressure-Relieving Materials

Waffle boots protect the heels and ankles. Special pillows support the elbows and applying foam dressings on bony prominences such as the tailbone. Additionally, there are medical devices, such as BiPap (non-invasive ventilation) or face masks, to prevent medical-related pressure injuries. 

Topical Ointments and Dressings

Topical ointments and medicated dressings for can be used to treat patients with different types of ulcers after a consultation from a wound care nurse or physician. 

Incontinence Pads

These help absorb moisture from the patient’s skin to prevent moisture-related skin injuries. Appropriate perineal care should be done every after incontinence and make sure the skin is kept dry. 

Repositioning

Patients should be turned every 2 hours and skin should be monitored to prevent constant pressure to the skin. 

Diet and Nutrition

 Maintaining an adequate nutrition or supplement promotes the healing of wounds.  

Monitoring Pressure Injuries

Monitoring bedsores is important to ensuring injuries do not progress.  

Some ways to monitor these pressure injuries include: 

• Routine skin assessment: Skin assessment is performed by the bedside nurse every shift or by the wound care nurses at least every week. 
• Alert new injuries: Any new wounds or progressing wounds should be escalated to the doctor and referred to the wound care nurses. The family or significant other should also be notified of the changes in condition of the patient.  
• Document injuries: This should be documented on the patient‘s clinical record to monitor its progress. The plan of care will then be updated as appropriate. 
• Monitor diet: The dietitian will also be notified so appropriate interventions can be initiated to help optimize the patient’s nutrition for a faster wound healing. 
• Utilize technology: There are also wearable tools that monitor the patient‘s turn frequency which alerts the nurses or other staff to ensure that patients are being repositioned in bed every 2 hours. 

The Bottom Line

In conclusion, pressure injuries are a common and potentially dangerous complication of hospitalized patients, particularly those who are immobile for long periods. Preventative measures such as regular skin assessments, repositioning, and proper nutrition can help prevent the development of these injuries. It is crucial for healthcare workers to be aware of the different stages of pressure injuries, as well as how to assess and manage them properly.

Regular monitoring of pressure injuries through skin assessments, documentation, and the use of wearable technology can also ensure that these injuries do not progress and are managed appropriately. By implementing these preventative and management measures, healthcare workers can ensure the best possible outcomes for their patients. 

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