Pressure ulcers

• Common sites for pressure ulcers


  • Bony prominences
  • Elbow
  • Ears
  • Shoulders
  • Lower back & buttocks
  • Inner knees
  • Heels
• Ways to prevent pressure ulcers

  • Proper nutrition and hydration
  • Rotation every 2 hours
• Influencing factors of pressure ulcers


  • Duration (length of time)
  • Intensity (amount of pressure)
  • Tolerance of subcutaneous tissue
• Contributing factors of pressure ulcers


  1. Shearing force: pressure exerted on the skin when it adheres to the bed and the skin layers slide in the direction of body movement

  2. Friction: 2 surfaces rubbing against each other

  3. Excessive moisture
• Examples of risk factors


  • Prolonged surgery
  • Low diastolic pressure
  • Diabetes mellitus
  • Immobility
  • Advanced age
• Stages of Pressure ulcers

  4; 4 being the worst
• 4 stages of pressure ulcers


  1. Stage I: Intact skin with non-blanch-able redness (prevention starts here)

  2. Stage II: Partial skin thickness loss if dermis (blister formation)

  3. Stage III: Full thickness loss involving damage or necrosis of subcutaneous tissue

  4. Stage IV: Full thickness loss can extend to muscle, bone, and supporting structures
• Clinical manifestations of infection


  • Leukocytosis
  • Fever
  • Increased ulcer size, drainage, or odor
  • Pain
  • Necrotic tissue
  • Healing by secondary intention
• Osteomyelitis


  Infection in bone
• If there is drainage

  Get wound culture
• Assessment of a pressure ulcer


  Standing order
• Lab value evaluated for impaired skin integrity


  Pre-albumin (protein-level; healing)
• Best type of treatment


  Prevention & Education
• Areas assessed for prevention


  • Sensory perception
  • Moisture
  • Activity
  • Mobility
  • Nutrition
  • Friction and shear
• Braden score scale


  • 15-18 at risk
  • 13-14 Moderate risk
  • 10-12 high risk
  • < 9 very high risk
• Skin care interventions for pressure ulcers


  • Remove excessive moisture
  • Avoid massage over bony prominences
  • Turn every 1-2 hours (without shearing)
  • Use lift sheets
  • Position pillows on elbow and heel protectors
  • Cleanse skin if incontinence occurs
  • Use specialty beds
• Normal levels for Serum Albumin


  3.8-4.5 g/dL (38-45 g/L)
• Normal levels for Pre-albumin


  20 mg/dL (200 mg/ L)
• Preventative measures regarding nutrition and pressure ulcers


  • Adequate nutrition (2,000- 3,000 calories)
  • Multi-vitamin
  • Vitamin C (wound healing)
  • Calories rich in protein and minerals