Pressure Sore or Decubitus Ulcer or Bed Sore

PRESSURE SORE OR DECUBITUS ULCER OR
BED SORE
PRESENTED BY:
PROF.VIJAYREDDY VANDALI
Dept of Medical-Surgical Nursing
PhD Scholar, M.Sc Nursing, PGDHA, PGCDE
INDIA
INTRODUCTION
Bedsores, pressure sores, or decubitus ulcers. can
happen during prolong bedridden or otherwise unable to move,
unconscious, or unable to sense pain. Pressure injuries are sores
(ulcers) that happen on areas of the skin that are under pressure.
The pressure can come from lying in bed, sitting in a wheelchair,
or wearing a cast for a long time.
Pressure injuries can be a serious problem in
frail, older adults. They can be related to the quality of care the
person receives. Pressure injuries can develop if you must stay
in bed or aren't able to move and aren't turned, positioned
correctly, and given good nutrition and skin care. You are at
higher risk for pressure injuries if you have diabetes, circulation
problems, or poor nutrition.
DEFINITION
BEDSORES — also called pressure ulcers and
decubitus ulcers — are injuries to skin and
underlying tissue resulting from prolonged
pressure on the skin. Bedsores most often
develop on skin that covers bony areas of the
body, such as the heels, ankles, hips and
tailbone.
CAUSES/ETIOLOGY
• Pressure. Constant pressure on any part of your body can

lessen the blood flow to tissues.
• Friction. Friction occurs when the skin rubs against
clothing or bedding. It can make fragile skin more
vulnerable to injury, especially if the skin is also moist.
• Shear. Shear occurs when two surfaces move in the
opposite direction. For example, when a bed is elevated at
the head, you can slide down in bed. As the tailbone
moves down, the skin over the bone might stay in place
— essentially pulling in the opposite direction.
RISK FACTORS
• Immobility. This might be due to poor health, spinal cord
injury and other causes.
• Lack of sensory perception. Spinal cord injuries,
neurological disorders and other conditions can result in a
loss of sensation. An inability to feel pain or discomfort
can result in not being aware of warning signs and the
need to change position.
• Poor nutrition and hydration. People need enough
fluids, calories, protein, vitamins and minerals in their
daily diet to maintain healthy skin and prevent the
breakdown of tissues.
• Medical conditions affecting blood flow. Health
problems that can affect blood flow, such as diabetes and
vascular disease, increase the risk of tissue damage.
STAGES
Pressure injuries are divided into
4 stages
• Stage 1. The area looks red and feels warm to the
touch. With darker skin, the area may have a blue or
purple tint. You may feel that it burns, hurts, or itches.
• Stage 2. The area looks more damaged and may have
an open sore, scrape, or blister. You have a lot of pain
and , and the skin around the wound may be discolored.
• Stage 3. The area has a crater-like appearance because
of damage below the skin's surface.
• Stage 4. The area is severely damaged and a large
wound is present. Muscles, tendons, bones, and joints
can be affected. Infection is a large risk at this stage.
PRESSURE AREAS
• Pressure injuries often happen on the:

• Buttocks area, on the tailbone or hips
• Heels of the feet
• Shoulder blades
• Back of the head
• Backs and sides of the knees
PATHOPHYSIOLOGY
SYMPTOMS
• Warning signs of pressure ulcers are:
• Unusual changes in skin color or texture
• Swelling
• Pus-like draining
• An area of skin that feels cooler or warmer to
the touch than other areas
• Tender areas
• Pain
DIAGNOSIS
• MRI
• Erythrocyte sedimentation rate
• Bone biopsy to diagnose the extent of the
wound and the bacteria present. If more than
10(5) bacteria are present, surgical
debridement should be performed,
COMPLICATIONS
• Cellulitis. Cellulitis is an infection of the skin and
connected soft tissues. It can cause warmth, redness and
swelling of the affected area. People with nerve damage
often do not feel pain in the area affected by cellulitis.
• Bone and joint infections. An infection from a
pressure sore can burrow into joints and bones. Joint
infections (septic arthritis) can damage cartilage and
tissue. Bone infections (osteomyelitis) can reduce the
function of joints and limbs.
• Cancer. Long-term, non-healing wounds (Marjolin's
ulcers) can develop into a type of squamous cell
carcinoma
• Sepsis. Rarely, a skin ulcer leads to sepsis.
TREATMENT
• Reducing pressure
• The first step in treating a bedsore is reducing the
pressure and friction that caused it. Strategies include:
• Repositioning. If you have a pressure sore, turn and
change your position often. How often you reposition
depends on your condition and the quality of the
surface you are on. Generally if you use a wheelchair,
try shifting your weight every 15 minutes or so and
change positions every hour. If you're in a bed, change
positions every two hours.
• Using support surfaces. Use a mattress, bed and
special cushions that help you sit or lie in a way that
protects vulnerable skin.
• Cleaning. If the affected skin is not broken, wash it with
a gentle cleanser and pat dry. Clean open sores with water
or a saltwater (saline) solution each time the dressing is
changed.
• Putting on a bandage. A bandage speeds healing by
keeping the wound moist. This creates a barrier against
infection and keeps the surrounding skin dry. Bandage
choices include films, gauzes, gels, foams and treated
coverings. You may need a combination of dressings.
• Removing damaged tissue
• To heal properly, wounds need to be free of damaged,
dead or infected tissue. Removing this tissue
(debridement) is accomplished with a number of methods,
such as gently flushing the wound with water or cutting
out damaged tissue.
• Drugs to control pain. Non-steroidal anti-inflammatory drugs — such as
ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) — might
reduce pain. These can be very helpful before or after repositioning and
wound care. Topical pain medications also can be helpful during wound care.
• Drugs to fight infection. Infected pressure sores that aren't responding to
other interventions can be treated with topical or oral antibiotics.
• A healthy diet. Good nutrition promotes wound healing.
• Negative pressure therapy. This method, which is also called vacuum-
assisted closure (VAC), uses a device to clean a wound with suction.
SURGERY
• A large pressure sore that fails to heal might require surgery. One method of
surgical repair is to use a pad of your muscle, skin or other tissue to cover the
wound and cushion the affected bone (flap reconstruction).
NURSING DIAGNOSIS/MANAGEMENT
1. Impaired Skin Integrity related to

malnutrition and pressure ulcers as evidence
by disruption of epidermal and dermal tissues.
2. Risk for infection related to wound
3. Risk for ineffective health maintenance
related to disease condition
4. Anxiety related to treatment and recovery.
PREVENTION
• Shift your weight frequently. If you use a wheelchair, try
shifting your weight about every 15 minutes. Ask for help
with repositioning about once an hour.
• Lift yourself, if possible. If you have enough upper body
strength, do wheelchair pushups — raising your body off
the seat by pushing on the arms of the chair.
• Look into a specialty wheelchair. Some wheelchairs allow
you to tilt them, which can relieve pressure.
• Select cushions or a mattress that relieves pressure. Use
cushions or a special mattress to relieve pressure and help
ensure your body is well-positioned. Do not use doughnut
cushions, as they can focus pressure on surrounding tissue.
• Adjust the elevation of your bed. If your bed can be
elevated at the head, raise it no more than 30 degrees. This
helps prevent shearing.
REFERENCES
1.https://www.hopkinsmedicine.org/healthlibrary
/conditions/dermatology/bedsores_85,P00260
2. https://www.mayoclinic.org/diseases-
conditions/bed-sores/diagnosis-treatment/drc-
20355899
THANK YOU

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PRESSURE SORE OR DECUBITUS ULCER OR

• Pressure. Constant pressure on any part of your body can

• Pressure injuries often happen on the:

1. Impaired Skin Integrity related to

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