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Pressure Sores

SOURCE

Source: Fish DN. Skin and soft-tissue infections. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=146071658. Accessed May 16, 2017.

CONDITION/DISORDER SYNONYMS

  • Decubitus ulcer.

  • Bed sore.

  • Pressure sore.

DEFINITION

  • Damage to underlying soft tissue from pressure and/or shear.

ETIOLOGY

  • Most pressure sores colonized by bacteria; bacteria frequently infect healthy tissue.

  • Cultures reveal polymicrobial growth:

    • Aerobic Gram-positive and Gram-negative bacteria.

    • Anaerobes.

PATHOPHYSIOLOGY

  • Factors that predispose to formation of pressure sores:

    • Paralysis.

    • Paresis.

    • Immobilization.

    • Malnutrition.

    • Anemia.

    • Infection.

    • Advanced age.

  • Factors critical to formation of pressure sores:

    • Pressure.

      • Areas of highest pressure generated over bony prominences.

      • Degree and length of time are important.

    • Shearing forces.

    • Friction.

    • Moisture from incontinence and perspiration.

      • When combined with other forces, it increases the risk of pressure sore formation 5-fold.

EPIDEMIOLOGY

  • Most common among:

    • Chronically debilitated.

    • Elderly.

    • Spinal cord injury.

PREVENTION

  • Prevention is single most important aspect in management of pressure sores.

    • Minimize friction and shearing forces by proper positioning.

    • Keep surface relatively free from moisture through skin care and prevention of soilage.

    • Most important factor: pressure relief, even for 5 min once every 2 hours.

RISK FACTORS

  • Immobilization in bed or wheelchair.

  • Altered mental status.

  • Incontinence.

  • Malnutrition.

CLINICAL PRESENTATION

SIGNS AND SYMPTOMS

  • Comorbid conditions may mask typical signs and symptoms of infection.

  • Clinical signs of infection in surrounding tissue:

    • Redness.

    • Heat.

    • Pain.

    • Swelling.

  • Signs of infection may be present.

    • Purulent discharge.

    • Foul odor.

    • Fever.

    • Leukocytosis.

TABLE 1.aPressure Sore Classification
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TABLE 1. Pressure Sore Classification
Suspected deep tissue injury Area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. Area may be preceded by tissue that is painful, firm, mushy, boggy, warmer, or cooler as compared with adjacent tissue.
Stage 1 Pressure sore generally reversible, limited to epidermis, and resembles abrasion. Intact skin with nonblanchable redness of localized area, usually over bony prominence. Area may be painful, firm, soft, warmer, or cooler as compared with adjacent tissue.
Stage 2 Stage 2 sore also may be reversible; partial thickness loss of dermis presenting as shallow open ulcer with red pink wound bed. May also present as intact or open/ruptured serum-filled blister or as shiny or dry shallow ulcer.
Stage 3a Full-thickness tissue loss. Subcutaneous fat may be visible, but bone, tendon, or muscles not exposed. May include undermining and tunneling. Depth of ulcer varies by anatomical location; ...

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