- A localized area of skin or underlying tissue injury resulting from pressure and/or shear
- Usually over a bony prominence (e.g., sacrum, calcaneus, ischium)
- Classified in stages according to the National Pressure Injury Advisory Panel (NPIAP):
- Stage I: nonblanchable erythema—intact skin with nonblanchable redness; darkly pigmented skin may not have visible blanching.
- Stage II: partial-thickness skin loss—shallow open ulcer with a viable red-pink, moist wound bed, without slough; or intact or open/ruptured serum-filled blister
- Stage III: full-thickness skin loss—subcutaneous fat may be visible, but bone, tendon, or muscle is not exposed; slough, if present, does not obscure depth of tissue loss.
- Stage IV: full-thickness tissue loss—exposed bone, tendon, or joint; slough or eschar may be present but does not completely obscure wound base.
- Unstageable: depth unknown—base of the ulcer is covered by slough and/or eschar in the wound bed.
- Suspected deep tissue injury: depth unknown—purple or maroon area of intact skin or blood-filled blister. Pain and temperature change precede skin color changes.
- Synonyms: decubitus ulcer; bedsore; pressure injury, pressure sore
Etiology and Pathophysiology
Complex process of risk factors interacting with external forces (pressure and/or shear, friction, and moisture) (3)
- Mobility impairment
- Reduced skin perfusion
- Sensory impairment
- Medical devices
Commonly Associated Conditions
- Advanced age
- Hip fractures
- Cerebrovascular and cardiovascular disease
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