Pressure ulcers associated with immobility

Pressure ulcers, also known as pressure sores or bedsores, are ulcerations where parts of tissue are compressed between bony prominences. The pressure between bony prominences and soft tissues, combined with friction, shear forces, and moisture, creates sensitive and injury-prone regions, and in more severe cases, even necrosis.

The buttocks, back, heels, shoulders, ears, and sides of the knee are the most commonly prone regions to the development of pressure ulcers, as they are typically areas in constant contact with a rigid surface. However, any region in rigid contact, rubbing, and friction against a surface is at risk of injury.

Initially, the affected area usually shows redness and sensitivity to touch, and may also swell. As the injury progresses, the skin becomes darker until an open wound forms. In these areas, the skin typically appears moist and cool to the touch, may have an odor, and may secrete fluids. In advanced stages, the injury becomes deeper, causing pain and infection.

These injuries often occur in individuals over 65 years of age with impaired tissue circulation, associated with immobility, malnutrition, and loss of sensitivity. Diagnosis is often clinical, and the prognosis depends on early identification of risk, as well as treatment through pressure reduction, avoiding friction and shear forces. Immobility is one of the main predisposing factors for pressure injuries.

IMMOBILITY AS A RISK FACTOR

Reduced mobility is one of the main risk factors for the development of pressure injuries, making it important to have preventive and treatment measures for patients who are unable to move freely.

Immobility reduces circulation, preventing tissues from oxygenating. Inadequate oxygenation makes tissues less nourished and, therefore, more sensitive. In addition to oxygen inefficiency, tissues subjected to friction in bed stimulate the dermis, increasing sensitivity and the risk of ulcers. Being bedridden and in the same positions for extended periods increases tissue temperature, making circulation ineffective. This lack of oxygen and tissue nutrition releases inflammatory factors that alter vascular permeability, causing edema and worsening ischemia. Ischemia leads to cell death, releasing more inflammatory factors. The increased inflammatory state disrupts the balance of proteins in the tissues necessary for dermal protection, increasing tissue destruction. Once larger and more intense, the ulcer becomes a gateway for infectious microorganisms that proliferate in the area, increasing the risk of local and systemic infection.

PREVENTION AND TREATMENT

A detailed and ongoing assessment is part of the measures to prevent pressure injuries. For example:

• Daily assessment of reddened areas over bony prominences that, when pressed, do not whiten.
• Observation of the appearance of blisters, depressions, or wounds on the skin. Documenting all observed changes.
• Positioning bedridden patients with reduced mobility at least every 2 hours to relieve pressure.
• Guiding and ensuring the mobilization of wheelchair users in a seated position every 1 hour.
• Using items that can help reduce pressure, such as pressure-reducing cushions and mattresses, foam padding, among others.
• Ensuring a nutritional plan with the necessary amount of calories, proteins, vitamins, and minerals.
• Providing and encouraging adequate daily fluid intake for hydration.
• Keeping the skin clean, dry, and hydrated.
• Preventing dermatitis associated with incontinence by avoiding contact with urine and feces, cleaning after eliminations, and using barrier creams if necessary.
• Not massaging areas with signs of ulceration.
• Avoiding the use of ring-shaped cushions, as they do not ensure the principle of pressure distribution. Instead, using cushions that provide pressure relief composed of gel and/or air.

Once installed, the treatment should follow the stage of the injury, but in general, it should avoid increasing the affected area, keeping it clean and dry. Additionally, preventing the cause of pressure, adjusting and positioning patients in the best way possible, and using appropriate dressings also prevent the enlargement of the injury, drain secretions, and block the entry of bacteria. The use of pressure-relieving cushions through air and/or gel compositions also reduces friction and should be employed.

Therefore, it is essential to consider immobility as a cause of numerous negative consequences, such as pressure ulcers, and to continually strive for the improved quality of life for bedridden patients through prevention, care, and resources.