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What are the signs and symptoms of pressure ulcers?

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A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

Parts of the body that are not covered by a high level of body fat and flesh (muscle) and are in direct contact with a supporting surface, such as a bed or wheelchair have the highest risk of developing pressure ulcers. Bedbound patients are most at risk of developing bed sores on their:

  • Ankles
  • Back of the head
  • Breasts (female patients)
  • Elbows
  • Genitals (male patients)
  • Heels
  • Knees
  • Rims of the ears
  • Shoulder blades
  • Shoulders
  • Toes

Patients who use a wheelchair have a higher risk of developing pressure sores on their:

  • Buttocks
  • Tailbone
  • Spine
  • Shoulder blades
  • Back of arms
  • Back of legs

Grading the pressure ulcers

Pressure sores are classified into four possible stages, depending on their severity. The National Pressure Ulcer Advisory Panel, USA, defines each stage as follows:

  • Stage I – starts as a persistent area of red skin, which may be itchy, painful and may also feel warm, spongy or firm when touched. Among people of African ancestry, and individuals with darker skin, the mark may seem to have a bluish/purplish cast; it may even look ashen or flaky. As soon as the pressure is relieved, the sore generally goes away rapidly.
  • Stage II – skin loss has already taken place. This could be in the epidermis (the outer layer of skin), or the dermis (deeper down in the skin) – sometimes both. The pressure ulcer is at this point an open sore, similar to an abrasion or a blister. The surrounding tissue may appear red or purple.
  • Stage III – there is now a deep wound, like a crater; the damage has gone below the skin. There is skin loss which occurs throughout the entire thickness of the skin. The underlying muscles and bone are not damaged.
  • Stage IV – the most severe type of ulcer. Skin is severely damaged and there is tissue necrosis (surrounding tissue starts to die). Underlying muscles or bone (or both) may also be damaged. Tendons and joints may also be damaged. At this point there is a serious risk of developing a life-threatening infection.

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