Pressure Injury

Key Features

Essentials of Diagnosis

• Examine at-risk patients on admission to hospital and daily thereafter

• Pressure injury should be described by one of six stages:

  • Stage 1: Non-blanchable erythema of intact skin

  • Stage 2: Partial-thickness skin loss with exposed dermis

  • Stage 3: Full-thickness skin loss

  • Stage 4: Full-thickness skin and tissue loss

  • Unstageable: Obscured full-thickness skin and tissue loss

  • Deep tissue: Persistent non-blanchable deep red, maroon or purple discoloration

General Considerations

• Incidence rates range from 12% to 16% of hospitalized patients and vary according to patient characteristics

• The primary risk factor for pressure injury is immobility

• Other contributing risk factors include

  • Reduced sensory perception

  • Moisture (urinary and fecal incontinence)

  • Poor nutritional status

  • Friction and shear forces

Clinical Findings

Symptoms and Signs

• The skin overlying the sacrum and hips is most commonly involved, but bedsores may also be seen over the occiput, ears, elbows, heels, and ankles

Differential Diagnosis

• Herpes simplex virus

  • In immunocompromised patients, particularly if there is a scalloped border, representing the erosions of herpetic vesicles

• Skin cancer

  • In the perianal area, a nonhealing injury may be cancer

• Pyoderma gangrenosum

  • Rapidly expanding injury associated with inflammatory bowel disease

• Ecthyma gangrenosum

  • Ulcerating lesion, commonly due to Pseudomonas, observed in neutropenic patients

Diagnosis

Laboratory Tests

• Based on clinical appearance

• Suspect an alternative diagnosis if injuries not healing properly

Treatment

Medications

• See Table 4–3

• The type of dressing that is recommended depends on the location and depth of the injury, whether necrotic tissue or dead space is present, and amount of exudate

Surgery

• Established ...