We recognize that managing patient pressure injuries is a difficult job. What makes it even more difficult is trying to communicate some of the issues involved to the patients and their families who do not have a good grasp of medical terms, much less the nomenclature commonly used by wound care professionals. In fact, it may very well be the case that some of your co-workers in other disciplines may not fully understand some of the terms you use on a daily basis.
Here is a list of selected terms that we think may enhance the ability of your patients and their family members to understand the conditions and therapeutic measures that are being employed to provide proper care for recovery.
To begin with there are a number of terms that are often used interchangeably, but do not always mean the same thing, e.g., bed sore, decubitus ulcer, pressure ulcer, pressure sore, etc.
Pressure injury is the currently preferred term to describe damage to a localized area of the skin and/or soft tissue of a patient due to prolonged pressure typically occurring over a bony prominence or related to the use of a medical device and may include injury caused by shearing forces or friction as well as pressure. The use of the term “pressure injury” is preferred because it includes intact skin as well as ulcerated skin and damage caused by factors other than the patient just lying in bed for a long time.
STAGING TERMS
At the NPIAP 2016 Staging Consensus Conference, the National Pressure Injury Advisory Panel (NPIAP) met to discuss the redefinition of pressure injuries. The conference was attended by more than 400 medical professionals, who voted and reached consensus on the following updated definitions (which can be found in the official NPIAP Pressure Injury Stages document).
Stage 1 Pressure Injury: Non-blanchable erythema of intact skin
This stage is defined by superficial reddening of the skin that doesn’t turn white when touched. In darkly pigmented skin, the injury will have a red, blue, or purple color. If the cause of a stage 1 PI is not relieved in due time, it will worsen and become an ulcer.
Stage 2 Pressure Injury: Partial-thickness skin loss with exposed dermis
This stage exhibits all the signs of a stage 1 pressure injury, but the damage is more severe. The epidermis has been worn through in places to expose the dermis, which is the sensitive layer of skin in which blood vessels and nerve endings are found. In stage 2, the wound bed is moist, pink, or red, but is not severe enough to expose adipose (fat) and deeper tissues.
Stage 3 Pressure Injury: Full-thickness skin loss
At this stage, adipose tissue is visible in the wound bed, with granulation tissue and rolled wound edges often presenting. The depth of the wound may vary depending on anatomical location, with areas of deeper adiposity being particularly prone to deeper wounds. Dead and dying tissue (slough and eschar) may be visible, and undermining or tunneling can occur.
Stage 4 Pressure Injury: Full-thickness skin and tissue loss
Here the ulcer has deteriorated enough to expose layers of muscles, tendons, cartilage, or bone. As in stage 3, a wound’s edges are often rolled, with slough, eschar, and undermining and/or tunneling occurring frequently.
Unstageable Pressure Injury: Obscured full-thickness skin and tissue loss
These pressure injuries can’t be categorized, as the extent of the damage is obscured by slough or eschar. If this dead or dying tissue can be removed effectively, the injury will either be at stage 3 or stage 4.
Related: Caring for pressure injuries can be difficult and time-consuming, placing caregivers at risk of injuries such as back-strain and fatigue. For more information on how pressure injuries can be prevented and treated for improved patient outcomes, read our comprehensive article ‘Everything You Need to Know About Pressure Injury Prevention & Treatment in Hospitals’.
PREVENTION and TREATMENT TERMS
Here is a list of terms that may not be included in other glossaries or terminology lists, but which are still important for the patient and family members to understand.
Acclimatization
The process of adapting to a new set of circumstances by an individual organism such as when the organisms of an infected pressure injury adapt to a new set of stable environmental factors.
Allostasis
The ability of an organism to anticipate repetitive environmental changes and accommodate for them.
Alternating Pressure Mattress
A bladder-type of mattress with air channels that are alternately inflated with air flow to redistribute the pressure over different parts of the patient contact surface.
Atraumatic therapies and devices
Therapies and therapeutic instruments/devices that minimize wound risk and are unlikely to cause tissue injury or damage.
Braden Scale
A validated assessment tool used to assess and predict the risk of patients developing pressure injuries. It ranges from a low risk of 3 and 4 to a high risk of 1.
Decompensation
The functional deterioration of a structure or system that had been previously working with the help of allostatic compensation.
Envelopment
A support surface that can conform or mold to the irregularities of a patient’s body to prevent pressure injuries from occurring or worsening.
Lateral Rotation
Movement of the patient from one side to the other, generally to address breathing and circulation issues.
Low-air-loss mattress
A bladder style mattress that utilizes small pin holes in the mattress bladder to circulate cool air to the skin surface to help with microclimate regulation.
Microclimate
The humidity and temperature levels immediately surrounding a particular area such as the pressure injury site.
Pressure redistribution
A technology that increases airflow support to the patient’s area of greatest need; particularly beneficial to heavier patients.
Shear forces
This refers to the strain put on tissues that can cause them to stretch and tear when being pulled in different directions; such as can occur when a patient is being slid on a bed or being repositioned.
Therapeutic support system
This refers to a methodology and technology designed to reduce or, if possible, eliminate the damaging effect of pressure on fragile skin and subdural tissues and to return them to normal.
While you now have a new understanding of the terms and descriptions used to describe pressure injuries and the challenges associated with them, we desire to further empower healthcare providers with the tools that can support their patient care approach in preventing and/or treating pressure injuries. The new Airisana™ Therapeutic Support System provides caregivers a unique approach to pressure reduction and microclimate management. Its innovative design was informed by the insight of healthcare specialists and delivers the transformative power of 5 therapeutic mattresses in 1 device. Click here to learn more about the Airisana® Therapeutic Support System.
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