Pressure ulcers, also known as bedsores, develop when skin and underlying tissue is damaged due to prolonged pressure, friction, or moisture. They typically form over bony areas of the body. Factors that increase risk include immobility, incontinence, poor nutrition, aging, and chronic diseases. Pressure ulcers are staged from I to IV based on the depth of tissue damage. Prevention focuses on relieving pressure through repositioning, special beds and cushions, and keeping skin clean and dry. Treatment may include dressings, debridement, and medications to promote healing.

1. PRESSURE
SORES (BEd
SORES)
Presented by:
Ms.CELINE ANTONY

2. What are Pressure Ulcers?
An area of localised damage to the
skin and underlying tissue caused
by pressure, shear, friction and/or a
combination of these
European Pressure Ulcer Advisory
Panel EPUAP (2003)

3. Area of skin breaks down when
no movement occurs
Commonly referred to as bed sores,
pressure damage, pressure injuries and
decubitus ulcers........

4. Pressure Ulcer Risk Factors
• Internal/patient-related
factors:
• Systemic disease: metabolic,
neurological, vascular, terminal
illness
• Reduced mobility or immobility
• Sensory impairment
• Psychological e.g. depression

5. • Anaemia
• Malnutrition
• Level of consciousness
• Extremes of age
• Previous history of pressure
damage or poor skin condition
• Acute or chronic oedema
• Dehydration/fluid status- sweat,
incontinence

6. External factors:
Pressure - support surfaces,
change of position
Shear - positioning, mobility
Friction - moving and handling
techniques, patient education,
splinting, casts, positioning

7. Other factors
- Moisture - incontinence,
sweating, pyrexia, wound
exudates
- Medication

8. Age: Older patients may have poor
circulation- less O2 to the tissue
Lack of Mobility:
Pressure ulcers form when a patient is
left in one position
in bed for too long.

9. Poor Appetite: Pts who are dehydrated
or have a poor appetite are at risk for
pressure ulcers.
Unwanted Moisture: Patients that are
incontinent of urine or stool or those
who sweat are at risk for a pressure
ulcer

10. Pressure Ulcers in the Past
Patients who have had a pressure
ulcer in the past are at greater
RISK of getting another one.

11. Who’s at Risk?
Bedridden/wheelchair bound
Fragile skin/Older age
Chronic disease that prevents blood
flow
Spinal Cord Injury/Brain Injury
Alzheimer’s Disease

12. Pressure Points on
the human body:

13. Supine position (lying on
back)

14. Prone position (lying on
stomach)

15. Lateral postion (lying on side)

16. Sitting position

17. Pressure Ulcer Staging
Stage I
Epidermis;
nonblanching erythema
Dark Skin

18. Partial thickness skin loss involving
epidermis, dermis, or both. The ulcer is
superficial and presents clinically as an
abrasion, blister, or shallow crater.
Stage II

19. Full thickness skin loss involving
damage to, or necrosis of,
subcutaneous tissue/fascia
Stage III

20. Full thickness skin loss with
extensive destruction, tissue
necrosis, or damage to fascia +
bone, tendon, muscle, cartilage.

21. • The National Pressure Ulcer Advisory Panel
has redefined the definition of a pressure ulcer
and the stages of pressure ulcers
• Suspected DTI
• Stage I
• Stage II
• Stage III
• Stage IV
• Unstageable

22. Suspected deep tissue injury
Purple or maroon localized area of
discolored intact skin or blood-filled
blister due to damage of underlying soft
from pressure and/or shear.
Unstageable
• Full thickness tissue loss in which the
base of the ulcer is covered by slough
(yellow, tan, gray, green or brown)
and/or eschar (tan, brown or black) in
the ulcer bed. from pressure and/or
shear*.

23. EffEctivE managEmEnt
of a prEssurE ulcEr

26. The Braden Scale

28. Braden Scale Norton Scale
Activity  
Mobility  
Incontinence 
Sensory Perception 
Moisture 
Friction & Shear 
Nutrition 
Physical Condition 
Mental Condition 

29. Methods Used To Prevent
Pressure Ulcers
Identify areas where pressure ulcers
most frequently occur.
Keep skin clean and dry
Reposition residents at least every two
hours
Keep linen dry and free of wrinkles and
objects that cause pressure to the skin
Clean urine and feces from skin as
soon as possible

30. Make sure clothing and
shoes do not bind or
constrict
Pat skin dry when
bathing; never scrub
Encourage adequate
nutrition and fluids

31. Massage pressure
points when the
resident is
repositioned
Report any changes
in skin condition
immediately

32. PillowsPillows
Water bedsWater beds
Bed cradleBed cradle elbow protectorselbow protectors
Flotation padsFlotation pads
pressure mattresspressure mattress
Preventive
Devices

33. Treatment
Relieve pressure in area (pillows,
cushions)
Physician can treat depending on stage
Avoid further trauma
Prevent infection by properly cleaning
open ulcers
Medication to promote skin healing

34. Calcium alginates or other fiber gelling
dressings: Absorbs drainage and turns to a
gel to maintain a moist wound bed
Impregnated gauze: Used for packing, can
deliver antimicrobial, medications and
moisture, for partial or full-thickness wounds.
Hydrocolloid: Contains gel-forming agents

35. Antimicrobials: Controls or decreases
bioburden (e.g., silver dressings,
hydrofera blue, cadezomer iodine,
honey)
Debridement is the removal of necrotic
tissue or contaminated foreign matter.

36. DO NOT…
Massage the area
Damage tissue under the skin
Use donut-shaped or ring-shaped
cushions
Interfere with blood flow

37. Documentation of assessment, plan
of action and re-assessment is your
only proof of good care.
If it is not written down
,
it never happened!

38. European Pressure Ulcer Advisory
Panel

39. Thank you for your
Time & aTTenTion!