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Skin, Wounds and Nutrition Part 2. Pressure Ulcers. Pressure Ulcer Definition (NPUAP) A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction. Pressure Ulcer.

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pressure ulcers
Pressure Ulcers

Pressure Ulcer Definition (NPUAP)A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.

pressure ulcer
Pressure Ulcer

A number of contributing or confounding factors are also associated with pressure ulcers; the significance of these factors is yet to be elucidated.

who gets pressure ulcers
Who Gets Pressure Ulcers?
  • People who are immobile for extended periods
    • Older adults
    • Paralyzed
    • Comatose
pressure ulcers1
Pressure Ulcers


  • Neuropathic: interruption of autonomic reflex and circulatory reflex
  • Shear: mechanical force on epidermis
  • Direct pressure: capillary closing pressure 32 mmHg
  • Maceration / contamination



Small Vessel Thrombosis

Cell Death

Pressure Ulcers


Stages of Severity

National Pressure Ulcer Advisory Panel

Revised Definitions

February 2007

pressure ulcer1
Pressure Ulcer

Suspected Deep Tissue Injury: Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.

pressure ulcer2
Pressure Ulcer

Stage I:Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.

pressure ulcer3
Pressure Ulcer

Stage II:Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.

pressure ulcer4
Pressure Ulcer
  • Stage III:Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling
pressure ulcer5
Pressure Ulcer
  • Stage IV:Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.




Nutritional Status

Patient at Risk





management prevention
Management - Prevention

Recognize at risk

  • Mobility
  • Activity
  • Sensory perception
  • External apparatus
prevention strategy
Prevention Strategy
  • Pressure relief
  • Clean, intact skin
  • Nutrition
  • Movement
  • Patient/family education
management prevention1
Management - Prevention

Avoidance Pressure

  • Turning
  • Mattress overlay
  • Air/water bed
  • Air fluidized
the enemies
The Enemies
  • Pressure
  • Friction/shear
  • Heat
  • Moisture
high interface pressure
High Interface Pressure
  • Pinches off capillary blood vessels that transport oxygen and nutrients to tissue
  • Without blood flow, tissue quickly dies and decomposes, forming a pressure ulcer