Stop The Pressure
What is Pressure Injury?
Pressure injuries typically appear in the form of a sore, or ulcer, on areas of the skin that are regularly exposed to pressure. These injuries are commonly referred to as pressure ulcers, pressure sores, and bedsores. Pressure injuries are classified by the following stages:
 | Stage 1 – The skin’s outermost layer, the epidermis, develops a reddened area that can be warm or cold to touch. Highly pigmented skin may not show visible blanching or redness, but the colour and texture will likely differ from that of the surrounding area. At this point, there are no breaks in the skin, but the patient will likely express feeling pain in the affected area. |
 | Stage 2 – A serum-filled blister will appear and the wound expands into the dermis, causing even more tenderness in the area. At this stage, skin appears shiny or dry, without slough or bruising. As skin cells continue to deteriorate and die, the damage can become irreversible. |
 | Stage 3 – The sore permeates deeper, penetrating the subcutaneous fat layer beneath the skin and forms a small crater. |
 | Stage 4 – The pressure injury expands into muscle and bone, causing extensive damage to deeper tissues, tendons, and joints. Exposed bone and tendon may lead to osteomyelitis and other serious infections. As tissue damage occurs, the patient may begin to feel less pain in the affected area. |
Pressure injuries form quickly, starting as what seems like a small bruise or red spot, deteriorating all the way through the skin and down to the bone. Patients with stage 4 pressure injuries are at high risk for sepsis which can be fatal. Pressure injuries greatly affect one’s overall quality of life and greatly extended hospital stays and require an extensive amount of nursing time and the enormous cost to heal.
Common indications of pressure injuries may include the following:
- Pain, tenderness, or localized swelling over a bony area
- Discoloured skin
- Serum-filled or broken blisters
- Colder or warmer areas of skin in comparison to adjacent tissues
- Dry or shiny patches
Most commonly, pressure injuries will appear on the sacrum, heel, shoulder and elbow. They may also occur on the ear, ribcage, hip, knees, or even the tops of the toes. Location all depends on daily activity and how often pressure is applied to an area.
References:
Agrawal, K., & Chauhan, N. (2012, May). Pressure ulcers: Back to the basics. Indian Journal of Plastic Surgery. Thieme Medical Publishers. https://doi.org/10.4103/0970-0358.101287
Bhattacharya, S., & Mishra, R. (2015, January 1). Pressure ulcers: Current understanding and newer modalities of treatment. Indian Journal of Plastic Surgery. Medknow Publications. https://doi.org/10.4103/0970-0358.155260
Boyko, T. V., Longaker, M. T., & Yang, G. P. (2018, February 1). Review of the Current Management of Pressure Ulcers. Advances in Wound Care. Mary Ann Liebert Inc. https://doi.org/10.1089/wound.2016.0697
This “Stop the Pressure” educational series, ebook, and an additional presentation, are prepared based upon the Clinical Practice Guideline for the Prevention and Management of Pressure Injury 2019.
References:
Australian Commission on Safety and Quality in Health Care. Safety and Quality Improvement Guide Standard 8: Preventing and Managing Pressure Injuries (October 2012). Sydney: ACSHQC; 2012. (June 2017).
Clinical Excellence Commission (AU). Pressure Injury Prevention Project. (Accessed June 2017)
Miles SJ, Fulbrook P, Nowick T, Franks C. Decreasing pressure injury prevalence in an Australian general hospital: A 10-year review. Wound Practice & Research: Journal of the Australian Wound Management Association 2013;21:148–56
Australian Commission on Safety and Quality in Health Care. National Safety and Quality Health Service Standards (second edition). Sydney 2017
Australian Wound Management Association. Pan Pacific Clinical Practice Guideline for the Prevention and Management of Pressure Injury 2019
 | Written by Kaleigh H. Wellhofer B.S. Clinical Neuroscience, B.S. Psychology |
Kaleigh studied Clinical Neurosciences and Psychology at Virginia Tech, in the United States, with an additional minor in Professional & Technical Writing. She spent two years at the Carilion Research Institute, studying potential treatment options for acquired epilepsy. During that time, Kaleigh presented her research at various conferences all over the world. She then went on to volunteer as a medical outreach professional in rural areas of Cambodia, where she oversaw the development of mobile medical clinics, taught oral hygiene in local schools, and assisted doctors with patient care. Back in the States, she has worked for major pharmaceutical companies, private practices, and research establishments as both a clinical consultant and a technical writer.