A pressure sore, also known as a decubitus ulcer or bedsore, is localized damage to the skin and underlying soft tissue. It usually develops over a bony prominence as a result of sustained pressure, or pressure combined with shear and friction. In Nigerian clinical settings, patients with impaired mobility, such as those recovering from severe strokes or trauma in orthopaedic wards, are at high risk. These lesions range from mild skin redness to deep craters exposing muscle and bone. Early detection is vital because untreated sores can quickly progress to severe infections, sepsis, and prolonged hospital stays.
Pressure points shift depending on the patient's primary position. When a patient lies on their back in the supine position, vulnerable areas include the occiput, scapulae, elbows, sacrum, and heels. In the side-lying position, pressure concentrates over the ears, acromion process, ribs, greater trochanter, knees, and ankles. Patients sitting in wheelchairs frequently develop sores at the ischial tuberosities, sacrum, and coccyx. Nurses must inspect these specific anatomical zones routinely during every shift change.
The development of a pressure sore relies on mechanical forces and physiological vulnerabilities.
Pressure injuries are categorized into stages based on the depth of tissue destruction observed during physical assessment.
Nurses use tools like the Braden Scale during admission to evaluate sensory perception, moisture, activity, mobility, nutrition, and friction/shear.
Managing an established pressure sore requires a coordinated, multidisciplinary approach. The primary step involves pressure relief by repositioning the patient and using specialized support surfaces. Wound care protocols mandate thorough cleansing with normal saline, avoiding harsh antiseptics like hydrogen peroxide that damage fragile new tissue. Debridement removes necrotic tissue to promote healing, which can be autolytic, enzymatic, or sharp. Dressings are chosen based on exudate levels, keeping the wound bed moist while protecting the surrounding skin from maceration. Nutritional support rich in proteins and vitamin C is essential for cellular repair.
Prevention remains the gold standard in nursing practice, saving patients from pain and hospitals from prolonged care costs. Nurses must turn bedbound patients every two hours and encourage wheelchair-bound patients to shift weight every fifteen minutes. Keeping skin clean and dry, especially after episodes of incontinence, prevents moisture-associated skin damage. Barrier creams protect the epidermis from moisture. Using pillows or foam wedges to keep bony prominences from direct contact with each other is equally effective. Finally, documenting risk assessments and turning schedules ensures consistent care across all nursing shifts.