Compare conditions

Put any two — or three — conditions side by side, adult or pediatric, to spot the look-alike differences fast, row by row.

Skin damage

—

In one line

·Pressure squashes tiny blood tubes in the skin, so oxygen stops reaching the spot and the skin dies.

—

Normal physiology

·Skin stays healthy when pressure is relieved regularly, so blood can flow through the tiny vessels and deliver oxygen and food to every layer.

—

What goes wrong

·When someone cannot move, cannot feel pain, has wet skin, or eats poorly, pressure squashes the blood vessels under the skin and oxygen stops reaching that spot, so the skin starts to die.

—

Hallmark signs

·Red or purple patches that do not turn white when you press them (stage 1 pressure injury)
·Shallow open sore or blister with pink or red base (stage 2 pressure injury)
·Deep crater or hole in the skin showing yellow fat underneath (stage 3 pressure injury)
·Very deep wound exposing muscle, tendon, or bone (stage 4 pressure injury)
·Dark purple or maroon skin, or blood-filled blister (deep tissue injury)
·Wound covered by thick yellow, tan, or black dead tissue so you cannot see the bottom (unstageable pressure injury)
·Pain, tenderness, or warmth over a bony area
·Skin feels softer, firmer, or warmer than surrounding tissue

—

Red flags · escalate now

·Fever, foul-smelling drainage, or spreading redness around the wound (signs of infection that can lead to sepsis)
·Bone visible in the wound or suspected bone infection (osteomyelitis requires weeks of intravenous antibiotics)
·Rapid expansion of a pressure injury despite treatment (suggests continued unrelieved pressure or serious underlying disease)
·Black or very dark brown dry dead tissue covering a large area (eschar may hide deep infection underneath)

—

Workup

·Wound culture (bacterial swab or tissue biopsy from deep in the wound)
·Serum albumin
·Hemoglobin and hematocrit (red blood cell counts)
·X-ray of the bone under the wound
·Red blood cell (Erythrocyte) sedimentation rate (ESR) and C-reactive protein (CRP)
·Blood cultures (two sets from different sites)
·MRI of the affected area (if bone or deep soft-tissue infection is suspected)

—

Treatment

·Turn the patient every 2 hours and use a pressure-redistribution mattress (air, foam, or gel overlay)
·Elevate heels off the bed surface using pillows under the calves, or use heel-suspension boots
·Keep skin clean and dry, change wet linens or diapers immediately, and apply moisture-barrier cream (like zinc oxide or dimethicone) to at-risk areas
·Give high-protein diet (1.25 to 1.5 grams per kilogram per day), plus vitamin C (500 mg twice daily) and zinc (15 to 30 mg daily if deficient)
·Debride (cut away) dead tissue using sharp instruments, enzymes (like collagenase), or autolytic methods (moisture-retaining dressings that let the body's own enzymes dissolve dead tissue)
·Keep the wound bed moist with hydrocolloid, foam, hydrogel, or alginate dressings (not wet-to-dry gauze)
·Start IV antibiotics (vancomycin for MRSA, piperacillin-tazobactam or cefepime for Pseudomonas or mixed infection) if there is cellulitis, osteomyelitis, or sepsis

—

NCLEX trap

·Blanching redness (erythema) is normal — it means blood is still flowing back into the tissue when you lift the pressure. Stage 1 is non-blanching redness: the red does NOT go away when you press it, which means blood flow is damaged and not bouncing back the way it should. That is the first sign the skin is in trouble.
·Do NOT debride stable dry eschar if blood flow to the area is poor (like in someone with peripheral artery disease) — you will make the wound worse and may cause infection. Wait until blood flow improves, or the eschar softens and gets infected, or a vascular surgeon clears it. Timing and blood flow matter.
·Pressure injuries happen because the patient cannot move or reposition themselves, and sustained pressure squeezes blood out of the tissue until it dies. Dirt does not cause pressure injuries — pressure plus time does. Relief from pressure (turning every 2 hours, special mattresses, keeping heels elevated) prevents them.
·If a pressure wound shows signs of infection (warmth, pus, spreading redness, foul smell, fever), you must check if the infection has spread into the bone underneath (osteomyelitis) or into the blood (sepsis). Topical cream will not stop either. The patient may need IV antibiotics, imaging (MRI or bone scan), wound cultures, and sometimes surgery. This is a medical emergency.
·The Braden scale identifies who is at high risk for pressure injury before any sore appears. A score under 16 (or under 18 in some hospitals) means start prevention NOW: turn every 2 hours, use a pressure-redistribution mattress, elevate heels off the bed, keep skin dry, manage incontinence, boost nutrition (protein and vitamin C). Prevention works — it stops pressure injuries before they start.
·Pressure injuries can happen over any bony spot where pressure is high and the patient cannot shift their weight: sacrum, heels, hips (greater trochanter), elbows, shoulders (scapulae), back of the head (occiput), ears, tailbone (coccyx), ankles, and even the spine in thin patients. Check every bony area in anyone who cannot move.

—

Install Maldek by Hill as an app — studies work even offline