Dr. Collins Answers Your Questions
Why Do People Get Pressure Injuries? What Treatments Are Used?
By Nancy Collins, PhD, RDN, LD, NWCC, FAND
Note: In the past, pressure injuries were sometimes called pressure ulcers, bed sores, or decubitus ulcers.
What is a pressure injury?
It is damaged skin, often seen as an open area on the skin but not always. Each year, more than 2.5 million people in the United States develop pressure injuries.
What causes pressure injuries?
Pressure injuries usually develop over bony prominences, such as the sacrum, heels, and hips. They are caused by sustained pressure placed on a particular part of the body. This pressure stops the blood supply to an area of the skin. Blood contains oxygen and other nutrients that are necessary for healthy tissue.
Who is more likely to get a pressure injury?
Risk factors include:
- Elderly individuals
- Immobility (bedridden or rarely out of bed)
- Inability to control bowel and/or bladder function
- Poor nutritional status
- Poor circulation
Do all bedridden individuals develop pressure injuries?
Many immobile patients never develop pressure injuries. However, when individuals have one or more of the risk factors previously mentioned, the chance of developing one increases.
Are all pressure injuries the same?
Pressure injuries are classified differently based on their severity. They are referred to in stages based on how deep they are:
- Stage 1—mildest, often just a reddened or discolored area
- Stage 2—an open sore in the skin
- Stage 3—damage to the tissue below the skin, sometimes referred to as a crater
- Stage 4—often exposure of the muscle, bone, or tendon
Are infections possible?
Yes. That’s why proper cleaning, special wound dressings, and appropriate infection control measures are needed. Symptoms of infection include warmth around the wound, drainage around the wound, a funny smell, or fever.
What treatments are used for pressure injuries?
- Using pillows, foam cushions, or sheepskin to pad the area to relieve pressure
- Treating the pressure injury with ointments and dressings, based on the stage and characteristics of the pressure injury
- Avoiding friction from clothes and sheets
- Offering adequate nutrition and encouraging the best intake of food and fluids possible
- Keeping the area clean and free of dead tissue, called debridement, performed by the wound care team if needed
- Changing position frequently to relieve pressure
Do you experience pain with pressure injuries?
Pain may occur in Stages 3 and 4 pressure injuries. Some individuals with pressure injuries take pain medication, especially during the application of topical medications or changing of bandages.
Does nutrition play a role in treating pressure injuries?
Malnutrition is common among patients with pressure injuries. It also affects pressure injury healing. Individuals who do not eat well may miss key nutrients that are needed for healing pressure injuries. The body needs protein, calories, fluids, and vitamins and minerals for wound healing to occur.
How do you encourage a person to eat more?
A registered dietitian nutritionist (RD or RDN) can determine ways to increase nutrients. One person might benefit from a high-protein shake or a high-protein beverage with medications, while another might prefer a fortified juice drink. People who are not eating or drinking well for an extended period of time may need tube feeding to help provide the nutrients needed for a wound to heal and this option should be discussed with a physician.