2. Definition
A pressure sore is an “ischemic necrosis and
ulceration of tissues overlying a bony
prominence that has been subjected to
prolonged pressure against an external
object( eg: bed, wheelchair, cast, splint)”
3. Causes of bed
sores
The etiological factors in the occurrence of bed
sores are:
1. Friction: the skin contact with a rough or hard
surface causes skin irritation and leading to the
inflammation and sore. This may occur due to:
a) Wrinkles in the under sheet of patient
b) Carelessness giving and removing of bed pans..
c) Leaving bread crumbs, orange seeds and food
particles on the bed.
d) Rubbing two skin surfaces together
e) General restlessness of patient
4. 2) Moisture: the contact of skin with moisture form a long
period, results in skin tissues softening causing tissue
damage. This may be due to:
a) Severe perspiration
b) Bed wetting
c) Incontinence of urine and stool
d) Improper drying of patient
5. 3) Pressure : pressure causes failure in circulation weight
bearing organs and results in tissue death or damage due
to:
a) Infrequent change of position
b) Casts or splints
c) Restraints or bandages
6. 4) Predisposing factors: the conditions which encourage skin breakdown
in a patient are:
a) Immodility : continuous pressure over any body parts impairs
circulation to that part and can cause breakdown and eventual
ulceration
b) Impaired sensory input: patients with impaired sensory input for pain
and pressure, eg: paralyzed patients, unconscious patients are more
prone to develop pressure ulcers.
c) Impaired motor function: patients with impaired motor function, eg:
patient with spinal cord injuries are more prone to develop pressure
ulcer.
7. d) Incontinence : if the patient is unable to control the bladder or bowel
functions, skin breakdown is likely to occur due to the presence of moisture
and bacteria on the skin
e) Emaciation: an emaciated patient may be prone to skin breakdown over bony
prominence (heels, elbows and coccyx)
f) Obesity: an obese patient may have many skin folds where perspiration and
bacteria may contribute to skin breakdown.
g) Edema: edema increases the risk of pressure ulcers in the effected tissues
h) Anemia: patients with anemia are more prone to develop pressure ulcers
because of reduced amount of oxygen available to the tissues
8. i) Age related skin changes: an older person’s skin is very
thin and inelastic. The sweat and oil glands are less
active. Thin, dry skin is more susceptible to pressure
areas and skin breakdown.
j) Any diseases or condition that affects circulation: any
diseases or condition that affects circulation can
encourage skin breakdown in a patient who is confined to
bed.
9. Stages
The stages of pressure ulcer (decubitus
ulcer) are:
1. Stage 1: skin is intact, erythematous
and does not blanch. Skin may be firm
or boggy, warm or cool to the touch,
painful or itchy. Indicators in darker
skin are a dark red, blue or purple
area, edema, induration or hardness.
18. Pressure prone
areas
The body parts/sites/pressure
points prone to bedsores in
different position are as
follws:
In Supine Position
I. -Occiput
II. -Scapula
III. -Sacral region
IV. -Elbows
V. -Heels
19. In Side Lying Position
I. Ears
II. Acromion process of the shoulder
III. Greater trochanter of hip
IV. Medial and lateral condyles of knee
V. Malleolus of ankle joint
20. In Prone Position
I. Ears
II. Cheeks
III. Breasts in females
IV. Genitals in males
V. Knees
VI. Toes
VII.Anterior superior spinous process
22. Role of nurse in prevention of pressure
sores
Personal hygiene: maintain the personal hygiene
of the patient keep clean, smooth and tight
sheets under the patient to prevent skin
irritation. Keep the patient dry and change the
linen when it is wet or soiled to prevent moisture.
If splints or plaster casts are applied to patients
use cotton padding, keep the bottom sheet of the
patient free from food crumbs or foreign bodies
to prevent friction.
23. Positioning: patients prone to sores must be
identified and examined daily for the signs of
bedsores. Positioning are used to reduce pressure
to the skin, so the standard interval of 1 1/2 to 2
hours for changing the patient position helps the
patient position helps to prevent the development
of pressure sore.
24. Therapeutic beds ( or mattresses): special beds
or mattresses are designed to reduce the hazards
of immobility to the skin. After assessment to the
patient therapeutic measures such as altering air
mattresses, water mattresses are used to disperse
and evenly distribute the client’s body weight.
