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Integumentary Disorder: Pressure Injuries

Through the protection of skin, mucous membranes, glands, hair, and nails, the integumentary system provides an essential protective function. These functions serve to deter pathogen invasion, sense environmental changes, maintain water balance, and temperature regulation. Alterations in any of these functions can lead to a range of skin conditions, mild to severe. The focus of this discussion is a type of localized damage to the skin and underlying soft tissue resulting from sustained pressure known as pressure injuries.

Pathophysiology Mechanisms

While pressure injuries are commonly associated with the elderly and nursing homes, they can occur in any patient with limited mobility, circulatory alterations, impaired sensory, skin integrity issues, chronic diseases, and can be caused by medical devices. For example, a patient who has suffered a stroke and experiences weakness to one side has impaired mobility and decreased sensation on the weak side, they will be at high risk of sustaining a pressure injury due to prolonged pressure on bony prominence areas like heels, sacrum, and elbows. Tissue hypoxia occurs when the sustained pressure is greater than the arteriolar pressure of the skin (Dluglasch, & Story, 2024). Additionally, the small vessels are compressed leading to reperfusion and adding injury to the damaged tissue. The injury is augmented when the pressure is not relieved leading to deep tissue and muscle damage.

Clinical Manifestations

Additional factors such as shearing forces, maceration from moisture, and abrasions from friction impair skin integrity therefore facilitating the formation of pressure injuries. Tissue hypoxia resulting from sustained pressure can cause varying degrees of injury, classified by depth and involved components, stage one (superficial epidermis damage) through four (tissue loss down to muscle or bone). Sensation in the area with pressure injury is impaired, the patient may not feel discomfort and unaware of skin damage. Alternatively, deep tissue injuries can manifest as non-blanchable redness with intact skin and can exhibit pain (Dluglasch, & Story, 2024). Once the epidermis is affected, depth of the injury can be visualized, measured, and classified accordingly.

Complications

Implications to treat pressure injuries with appropriate interventions and wound care can avoid complications. Pressure injuries can be serious, creating increased risk of infection, decreased mobility, emotional distress, and cause pain impacting health and quality of life, health costs, and need for additional healthcare resources. Management strategies include prompt wound care, increase turning and repositioning, maintain skin integrity, and adequate nutritional intake. A study on hospitalized older adults and pressure injuries reveal complications from longer hospital stays, cardiovascular issues, and infections are more likely to develop (Itoh et al., 2025). Additional studies on wound complications after surgical closure of pressure ulcers showed obese patients experienced decreased oxygen perfusion to the wound tissue hence preventing collagen delivery and leading to delayed wound healing (Garg et al., 2025).

References

Dluglasch, L., & Story, L. (2024). Applied Pathophysiology for the Advanced Practice Nurse. Jones and Bartlett Learning, 2nd edition, p 656 657.

Garg, S. P., Sandepudi, K., Shah, K. V., Putnam, G. L., Chintalapati, N. V., Weissman, J. P., & Galiano, R. D. (2025). Evaluating the Effect of BMIs on Wound Complications After the Surgical Closure of Pressure Injuries. Surgeries (2673-4095), 6(1), 5.

Itoh, S., Yokota, S., Yotsu, R. R., Tanaka, S., Abe, K., Kodama, K., Nakagawa, R., Nabetani, Y., Kobayashi, K., Murata, T., Takeda, T., Matsumura, Y., & Kikuchi, M. (2025). Factors associated with pressure ulcers among middle-old and oldest-old inpatients in an acute care hospital. Scientific Reports, 15(1), 23538.

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