Pressure Injuries and Disparities in Health Care: Important Terms to Know

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Erythema: A result of injury or irritation that causes dilation of blood capillaries and manifests as patchy reddening of the skin. Occurs after a patient/resident is exposed to unrelieved pressure for 2 hours. It can be identified as a deep, localized redness; can also be blue or purple.

Hyperemia: The condition of having excess blood in vessels that supply an organ or area of the body. Occurs after patient/resident is exposed to 30 minutes of unrelieved pressure. It can be identified as a localized, non-blanchable redness.

Perfusion: The passage of blood through arteries and capillaries into tissues or organs. When insufficient, there is an increased chance that the patient may have complications.

Periwound: The tissue immediately surrounding the wound itself. Ideally, this tissue should provide a barrier to the wound and prevent the wound from increasing in size, although many chronic wounds display periwound edema and swelling with discoloration.

Pressure injury: An injury of localized damage to the skin and underlying soft tissue, usually over a bony prominence or related to a medical or other device. The injury can manifest as intact skin or an open ulcer and may be painful. The injury occurs because of intense and/or prolonged pressure or pressure in combination with shear. The tolerance of soft tissue to pressure and shear may also be affected by microclimate, nutrition, perfusion, comorbidities, and condition of the soft tissue.

Pressure injury stage 1: Pressure injury characterized by intact tissue with localized, non-blanchable redness, which may manifest differently in individuals with darkly pigmented skin. Visual change in the wound may be preceded by blanchable erythema or changes in sensation, temperature, or firmness of the tissue area. Color change of the injured area does not include purple or maroon. These color changes may indicate deep tissue pressure injury.

Pressure injury stage 2: Pressure injury characterized by partial-thickness skin loss with dermis exposure with the wound bed manifesting as viable, red, or moist. Adipose and deeper tissues are not visible, and granulation tissue, slough, and eschar are not present. Wounds may also manifest as an intact or ruptured blister.

Pressure injury stage 3 and 4: Pressure injury involving full-thickness skin loss potentially extending into the subcutaneous tissue layer. The wound often manifests with granulation tissue and epibole (rolled wound edged) and may have slough and/or eschar. Stage 4 pressure injuries are ulcers with full-thickness skin and tissue loss, exposing underlying fascia, muscle, tendon, ligament, cartilage, or bone. Wounds frequently manifest with tunneling and/or undermining.

Pressure injury, unstageable: Pressure injury with full-thickness skin and tissue loss in which slough or eschar obscures the extent of tissue damage. If slough or eschar is removed from the wound, the injury will manifest as a stage 3 or stage 4 pressure injury.

Pressure mapping: Technology that can be used to determine areas of high pressure on the body, thus allowing clinicians to determine what areas need to be offloaded and/or protected.

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Pressure redistribution: Redistribution to spread pressure more evenly across the surface of the cushion or mattress. This reduces the amount of pressure put on any one part of the body (particularly hardened, rigid areas).

Tissue ischemia: The condition in which oxygen levels are reduced below the standard range as the result of compromised circulation. Occurs after a patient/resident is exposed to unrelieved pressure within 2-6 hours.

Tissue necrosis: The condition in which the tissues within the area of pressure die as a result of lack of blood flow to the tissue. Tissue is no longer viable and can manifest as either slough or eschar. Occurs after a patient/resident is exposed to unrelieved pressure for over 6 hours.

Turgor: Skin elasticity, tested by pulling up the skin on the back of the hand. If the skin is slow to return to the original state, it is a sign of dehydration, which puts the patient at higher risk of pressure injury development.

The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.

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