Pressure Ulcers: Causes, Assessments, and Treatments
By Danielle Base
Gel Ovations
Specialist Occupational Therapist and Moving and Handling Practitioner
The term Pressure Care applies to pressure ulcers, also known as pressure sores and bedsores, that result due to forces of shear, friction, stress, and pressure on the skin. This pressure loading on the skin reduces blood flow and oxygen availability to certain body tissues resulting in pressure ulcers of varying degrees of severity.
A pressure ulcer is an area of localised damage to the skin when a hard bony area covered by a thin layer of tissue is exposed to a hard surface for a long time. You are susceptible to pressure ulcers if you:
- Stay in bed for long periods of time in the same position.
- Sit in an armchair or wheelchair for long periods of time in the same position.
- Cannot move certain body parts without aid.
- Have a disease that affects blood flow.
Some age groups are at a greater risk of developing pressure injuries compared to others. Older people with long-term medical illness are at a higher risk of developing pressure ulcers due to reduced mobility and their aging skin.
Individuals who have conditions that cause movement problems are also at high risk of developing pressure ulcers. These include:
- Motor Neurone Disease
- Multiple Sclerosis
- Parkinson’s Disease
- Spinal Cord Injury
- Heart Failure
- Kidney Failure
Health conditions like diabetes and arterial diseases can also result in severe pressure issues, as the blood and oxygen supply can be restricted making the skin more vulnerable.
Immobility, poor circulation, obesity, malnutrition, and previous tissue damage with other associated health problems are the major risk factors of pressure ulcers.
People who have limited mobility and movement need special attention to prevent pressure ulcers and should be subject to pressure distributing and relieving therapies.
Pressure care also involves:
- Skincare
- Avoid/Reduce friction
- Adequate nutrition
- Wound healing
- Nursing staff education
- Managing urinary incontinence
- Use of pressure cushions pads and mattresses
- Treating underlying illness and critical risk factors
Pressure Ulcer Assessment
Pressure ulcers are assessed by healthcare professionals using certain tools to ascertain the size, type, location, stage and grade of ulcers.
After the medical assessment, treatment methods are suggested based on the grading of the ulcers.
Pressure grading tools provide a complete assessment of severity of the sores and categorise ulcers grading from redness to extensive tissue damage.
Physical methods to control the generation of pressure ulcers work by redistributing and reducing the pressure at vulnerable sites of tissue damage.
Judy Waterlow MBE
Immobility, poor circulation, obesity, malnutrition, and previous tissue damage with other associated health problems are the major risk factors of pressure ulcers.
People who are immobilised need special attention to prevent pressure ulcers, and should be subject to pressure distributing and relieving therapies.
Pressure care also involves:
- Skincare
- Avoid friction
- Adequate nutrition
- Wound healing
- Nursing staff education
- Managing urinary incontinence
- Use of pads and mattresses
- Treat underlying illness and critical risk factors
It is vital to reduce the patient’s risk factors as much as possible. If a pressure ulcer has occurred, do not rub or aggravate the area in any way.
Use special equipment such as a pressure mattress, pads such as Gel Ovations Dimensional Gel Pads, or cushions to reduce the pressure first.
The Waterlow Scale
One of a number of such tools in use is the Waterlow pressure ulcer risk assessment scale, designed by Judy Waterlow MBE, while working as a Clinical Nurse Teacher. The tool was originally designed for use by her students.
There are now calls for Judy Waterlow to be officially recognised for her work, with a campaign to have a hospital named after her.
In operation, the Waterlow scale helps healthcare professionals to calculate the risk of a patient developing a pressure ulcer and intended for use by nurses, healthcare professionals, and doctors.
The Waterlow scaling tool contains seven indices:
- Build/weight
- Height
- Visual assessment of the skin
- Sex/age
- Continence
- Mobility
- Appetite.
The Waterlow Manual provides complete and concise guidance on the use of the Waterlow scoring system and also identifies risk at three categories:
- Score indication 10 -14, “at-risk”.
- Score sign 15 -19, “high risk”.
- Score sign 20 and above, “very high risk”.
The Waterlow Pressure Ulcer Score Card
It not only illustrates the associated risk by risk assessment scoring system but also provides guidelines on nursing care and preventive aid methods.
Pressure ulcers are treated differently depending upon their severity. It is better to cure ulcers based on a daily assessment of sores using certain grading and treatment tools.
Treatment and Cure
Tissue viability nursing teams also play a vital role in pressure care. They provide expert advice, competent practices, prevention tips, and treatments to reduce needless skin breakdown. There are several advanced techniques and technologies that can prevent pressure injuries.
Patient monitoring systems are now used to record positions and movements in patients via wireless sensors. These monitoring systems also monitor additional factors such as motion and heat to assess the further treatment strategy in a way to reduce the risk.
Pressure mapping technologies measure the amount of pressure on different parts of the body. It helps the clinicians to determine accurately the areas that are at a higher risk for breakdown.
The best cure for pressure care is support and movement. Special pressure mattresses, cushions, and pads improve the location and positioning of pressure ulcers. Pressure care deals with prevention and cure.
Advanced treatment techniques involve:
- Debridement
- Bacterial management
- Exudate management
- Monitored healing
- Adjunctive therapies
- Pads such as Gel Ovations products
Using special mattresses or pads to cover the pressure points optimises the patient’s static environment to lessen the pressure injuries.
Gel ovations pressure relief products are easily available and recommended by Worldwide healthcare professionals.
These products relieve pressure, provide softness and comfort against pressure sores.
Gel Ovations include a wide range of gel-based products to protect users of specialist seating, wheelchairs, and shower chairs. These products provide an essential interface between patients and equipment, offering both comfort and abrasion reduction.
They are composed of soft, semi-solid medical grade silicone or polyurethane gel to distribute pressure. Gel Ovation Dimensional pads come in a wide variety of shapes and sizes.
Using new technologies such as Gel Ovations pads save patients from the continuous pain and discomfort associated with pressure ulcers, reducing the pressure and shear forces that cause and exacerbate these most debilitating injuries.
END
Sources
http://www.healthcareimprovementscotland.org/our_work/patient_safety/tissue_viability.aspx
http://judy-waterlow.co.uk/index.htm
https://www.nhsinform.scot/illnesses-and-conditions/skin-hair-and-nails/pressure-ulcers
https://acmobility.com.au/gel-ovations-pressure-relief-solutions/?page_id=%222053
https://www.woundsource.com/pressure-ulcers
https://litfl.com/pressure-areas-and-pressure-ulcers/
https://www.jaad.org/article/S0190-9622(19)30091-X/fulltext
https://www.hopkinsmedicine.org/gec/series/wound_care.html
