Pressure Ulcers

Pressure ulcers develop in stages, and often in patients who cannot feel them, so usually the first symptom a patient notices is the presence of a fully formed pressure ulcer. Early warning signs to be alert to before the formation of a pressure ulcer include:

• Changes in skin. Any change in the skin could preface the development of a pressure ulcer; changes in color, in texture, in skin temperature, and in sensitivity all arise. The exact details will depend on how the ulcer has formed; friction will make skin raw and red, while shear-induced ulcers may result in bruising while leaving the surface intact.
• Swelling. Swelling in bony areas of the foot should be taken as a major warning sign, as it typically indicates at least minor damage in the underlying tissues.
• Drainage. Patients or caretakers may only notice ulcers due to the presence of drainage on socks or sheets. Drainage can also preface full ulceration, if the injury begins below the surface.

Each of these should be treated urgently, as doing so can prevent the full formation of pressure ulcers. Even in cases which do not develop later into pressure ulcers, these symptoms should be treated as a warning to maintain better habits of adjustment and inspection.

The risk factors for pressure ulcers are relatively straightforward:

• Immobility. Patients with no or limited movement are far more susceptible to pressure ulcers than patients who can get up and move around.
• Poor nutrition. This allows skin conditions to deteriorate faster and more severely when injured.
• Impaired perception of skin. This allows ulcers to fully form or develop in severity without being noticed by patients. Foot ulcers are common with peripheral neuropathy from diabetes, for example.
• Health problems affecting blood flow. Patients who are already prone to poor blood flow must be especially careful about maintaining blood flow when confined to a bed. Some patients may even need to take care with how tightly they lace shoes.

To prevent pressure ulcers as a patient or caretaker, keep these points in mind.

• Mobility. Even minor adjustment of seating or resting position throughout the day can prevent bedsores from forming through immobility.
• Skin care. Hygiene, moisturizing, and other skin care activities can greatly protect against pressure ulcers.
• Nutrition. Good nutrition allows skin susceptible to pressure ulcers to recover quickly and efficiently instead of deteriorating.
• Cushioning. Good cushioning and bedding can reduce the exposure of patients to the three forces responsible for pressure ulcers, when immobile, as can well-fitted socks and shoes in mobile patients susceptible to ulceration.
• Inspection. Inspecting regularly for pressure ulcers can help prevent them from forming and reduce their severity should they occur.

Untreated pressure ulcers can lead to serious, life-threatening complications including infections, sepsis, and certain forms of cancer. If you notice pressure ulcers forming, it’s usually a good idea to check in with a doctor for further instruction—even if they already seem to be healing.