Pressure Injuries
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Pressure injuries are very common among older adults. They are painful and debilitating and can lead to serious, even life-threatening infections.
Causes of Pressure Injuries
Immobility is the number one cause of pressure injuries. When a person sits or lies in a position too long without moving, the weight of their body puts pressure on the skin and muscles. The pressure can be from a bone pressing against another part of the body or from a mattress or chair. This unrelieved pressure cuts off the blood supply to the skin. Without a blood supply, the skin – and eventually the muscle under it – dies, and a pressure injury forms.
The amount of pressure needed to cause a pressure injury ranges from a small amount of pressure for a
long time to high pressure for a short time. Pressure injuries can also be caused when the skin is weakened by the following.
- Friction
- Too much moisture on the skin
- Dryness and cracking
- Irritation by urine, sweat, or feces
- Malnutrition and/or dehydration
- Certain chronic conditions or diseases – especially those that limit circulation
High Risk for Pressure Injuries
Clients who are fully or partially immobile or with weakened skin are at high risk for getting a pressure injury. This includes clients:
- in wheelchairs or who spend a lot of time in a chair or bed;
- who have had a pressure injury in the past;
- who are paralyzed;
- who have incontinence;
- with poor nutrition and/or dehydration;
- with a chronic illness, like diabetes, that decreases circulation;
- with cognitive impairments that make them forget to move;
- who have a decreased ability to feel sensations;
- who are obese or too thin.
What Pressure Injuries Look Like
What a pressure injury looks like depends on how severe it is. The first signs of a pressure injury include the following.
- Redness on unbroken skin lasting 15-30 minutes or more in people with light skin tones. For people with darker skin tones, the injury may appear red, blue, or purple. If in doubt, compare the area to the other side of the client’s body.
- Any open area – it may be as thin as a dime and no wider than a Q-tip.
- An abrasion/scrape, blister, or shallow crater.
- Texture changes – the skin feels “mushy” rather than firm to the touch. This is especially true on heels, elbows, and hips.
A pressure injury can sometimes look like a gray or black scab. Beneath the scab is a pressure injury. If you notice a scab over a pressure point, report it to the appropriate person in your care setting immediately. Do not remove the scab. If a pressure injury is beneath it, this could cause damage or lead to infection.
Pressure Points
What to do if you see a problem
Anytime you see redness on unbroken skin or feel heat in the area lasting 15-30 minutes or more – especially at a pressure point:
- reposition the client off of the red area immediately to remove pressure from the area;
- report it to the appropriate person where you work (make sure you know ahead of time who to report to about this kind of situation); and
- document your concerns in the client’s records or in progress notes.
Do Not:
- massage the area or the skin around it;
- use a heat lamp, hair dryer, betadine, or other wound treatments that could dry the skin out more, causing further injury; or
- use lotions or creams that keep the skin overly moist; this too can cause skin breakdown.