Training: Pressure Sores Nursing Staff In-Service
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Physical inactivity has a serious impact on a person’s health. Research has shown that being physically inactive
increases a person’s risk for disease, disability and even death. One concern for people who are inactive is the
possibility of getting pressure sores.
What are Pressure Sores?
A pressure sore is an area of skin that breaks down when you stay in one position for too long without shifting
your weight. This can happen if a person uses a wheelchair, or if they are confined to bed. However, even
people who are able to walk can get pressure sores when they must stay in bed because of illness or injury.
When a change in position doesn’t occur enough, the constant pressure against the skin reduces the blood
supply in that area, and the affected tissue dies. As little as two hours of prolonged pressure may trigger skin
damage. Pressure sores may also be called pressure ulcers or decubitus ulcers.
Are Pressure Sores Serious?
Pressure sores can be extremely serious, depending on how much skin and tissue has been damaged. A pressure
sore start as redden skin, and gets progressively worse, forming a blister, than an open sore, and finally a crater.
Deep sores can go down into the muscle and bone. If pressure sores are not treated properly, they can become
infected. An effected pressure sore can lead to a systemic (entire body) infection that may be fatal.
Where on the body can you get pressure sores?
Pressure sores usually occur over the bony areas. Bony areas are called pressure points because they bear the
weight of the body in certain positions. Body areas would include:
• Elbows
• Heels
• Hips
• Ankles
• Shoulders and Shoulder Blades
• Back
• Back of the Head
The most common area for pressure sores are the heels and hips. However, pressure sores are not limited to
these areas and often occur in other places as well.
What causes a pressure sore?
Pressure:
Pressure on the skin can harm the skin and the layers of tissue underneath that area. When there is pressure on
certain parts of the body, the tissue may not get enough blood. This can cause the tissue to become damaged
and even die. Creases in bed linens and seams on clothing can also cause pressure.
Shearing:
Shearing happens when the skin is dragged across a surface. For example: being moved up in bed can cause
skin shearing if the skin is pulled across the bed surface. Make sure that you can lift the person. This will
prevent the friction and shearing of the skin.
Moisture:
Moisture makes the skin spongy, increasing the risk of bed sores. Moisture can be due to incontinence, not
drying properly after bathing, or sweating. Therefore, ensure that the person is never left in a wet bed or wet
clothing.
Stages of Pressure Sores
Pressure sores are categorized by severity from Stage One (early onset) to Stage Four (most severe stage).
Stage 1 A small area of warm, redden or purple
skin that does not return to its natural skin
color when pressed. This indicates that a
pressure ulcer is starting to develop.
Stage 2 The outer layer of skin breaks down.
Blistering and swelling as well as warmth
and redness may be seen.
Stage 3 The skin breakdown now looks like a crater
where the damage to the tissue below the
skin. The hole or crater has a foul smell.
Stage 4 The pressure sore has become so deep that
there is damage to the muscle and bone,
sometimes tendons and joints. Infection
may occur and may tunnel under the skin
increasing the size of the sore.
How are pressure sores treated?
The following four things may help pressure sores to heal:
1. Relieving the pressure that caused the sore by using pillows, special foam cushions, and sheepskin to
reduce the pressure.
2. Treat the sore based on the stages of the ulcer. The person’s health care professional will give you
specific treatment and care instructions.
3. Improve the person’s nutritional intake. Good nutrition is important because it helps the body heal the
sore. If the person does not get enough calories, protein and other nutrients, their body won’t be able to
heal, no matter how carefully the pressure sore is taken care of.
4. Keep the area clean and free of dead tissue. The person’s health care provider will give you specific
instructions.
As the pressure sore heals, it slowly gets smaller and less fluid drains from it. New tissue starts growing at the
bottom of the sore. This tissue will look light red or pink, and lumpy or shiny. It may take two to four weeks of
treatment before you see signs of healing.
How do you reduce the pressure on a sore?
The person should not lie directly on the pressure sore. Use foam pads, pillows, and sheepskin to take pressure
off the sore. Special mattresses, mattress covers, foam wedges or seat cushions can help support the person in
bed or in a chair to help reduce or relieve the pressure.
When the person is sitting in a chair or wheelchair, have the person sit upright and as straight as possible. An
upright, straight position will allow the person to move more easily and help prevent new sores. If the person
cannot move by themselves, assist the person to another position at least every one to two hours, more often if
possible.
What are the signs of an infected pressure sore?
Signs that a pressure sore may be infected:
• Think yellow or green pus
• A foul odor
• Red and Tender
• Warm and Swollen
Pressure sores that become infected heal more slowly and can spread a dangerous infection to the rest of the
person’s body. Signs that the infection may have spread include the following:
• Fever or Chills
• Mental Confusion
• Difficulty Concentrating
• Weakness
How can we help prevent pressure sores?
Preventing pressure sores is much easier than trying to heal them. The most important step in preventing
pressure sores is to avoid the prolonged pressure on any one part of the body by repositioning the person
frequently. A person at risk of developing pressure sores should be placed on a pressure reducing surface.
Such surfaces would include foam, air, alternating air, gel or water mattresses or pads.
Cleanliness and good skin care are essential for the person. Assist the person to check their body everyday for
red spots, color changes or other signs of sores. Pay special attention to the pressure points we discussed earlier
where sores are most likely to occur.
Is good nutrition important for the healing of pressure sores?
Good nutrition is vital because it helps the person’s body heal the sore. If the person doesn’t get enough
calories, protein and other nutrients, their body won’t be able to heal, no matter how carefully they take care of
the sore.
Pressure sores left untreated or improperly treated can have a devastating effect on a person. The good news is
that nutrition intervention can have a very direct effect on pressure sores, significantly reducing their size in a
relatively short space of time.
Bethesda Lutheran Communities
600 Hoffmann Drive, Watertown, WI 53094 Phone: 800-369-4636
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