Factors Responsible for the Development of Pressure Injury

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Introduction and brief overview
Pressure ulcers are necrosis of the cells of the skin and the surrounding tissues and
normally develops as the soft tissues are compresses between the hard surface and a bony
prominence for a prolonged period of time (Tayyib, Coyer and Lewis 2016).
This paper would draw and attention towards the case study of Joseph Russo, who had
been admitted in to the emergency department due to sudden unconsciousness and the
breathing trouble that he had been exposed to. Joseph used to take care of Sophia, who was
unable to take care of herself. Emma and Antonio are their two children, although it is only
Emma that kept contact with their parents. Joseph was transferred to the intensive care unit
for the close monitoring and the ongoing care. Joseph had been unconscious for long four
days and hence was immobilised. Hence, on the eighth day, a fluid filled blister was noted in
the left heel of Joseph that could have been developed due to the prolonged lying in the
supine position without any mobilisation at all.
This paper would discuss about the probable factors behind the occurrence of heel
pressure ulcers, linking to the medical condition of the Joseph Russo, supported by high level
of evidenced based literature. A care plan will also be developed keeping in the mind, the
clinical priorities of joseph Russo.
Search criteria and search terms
Electronic databases like Google Scholar and CINAHL has been used for conducting
search to find the highest level of evidence. Boolean operators like AND , OR has been used
to find the relevant papers. Some of the key words used are – pressure injury AND
hospitalisation, Bedsores OR Pressure injury, Pressure ulcers AND Ageing, Heel pressure

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injury AND immobilisation. The inclusion criteria included English, full text papers within
the years 2014-2018. The exclusion criteria were papers older than 2018.
Factors responsible for the development of pressure injury
Pressure sores or the bed sores are caused by any pressure against the skin that
restricts the flow of blood in the skin. They are painful and are likely to cause uneasiness and
pose a negative outcome on the quality of life. They are also costly to treat (Bhattacharya and
Mishra 2015). The occurrence and the severity of the preventable ulcer is an imperative
indicator of the quality of care. It is crucial to monitor the prevalence and the incidence rate
to ensure that the health care strategies executed are effective (Bhattacharya and Mishra
2015). It is essential to monitor the incidence of the pressure injuries. The frail people are
having an increased risk of developing pressure.
It is evident from the case study provided that Joseph had developed a fluid filled
blister on his left heel. Heel is normally a site, prone to the development of ulcers,
particularly for the people who had been in a supine position or in a semi-recumbent due to
the immobility (Shafipour et al. 2018). There is very small percentage of protective
subcutaneous tissue. No fascia or muscles are present within the heels, and makes it
susceptible to pressure and injury. Pressure injury in the heels remains an irrefutable
challenge for the nurses and the health care teams, as it can be an important cause of pain and
disability in the patient. It can be seen from the case study that Joseph had been hospitalised
for long eight days. Joseph was being ventilated for eight days due to some comorbidities and
he had been immobile for a long period of time. Joseph was also experiencing delirium, due
to which was necessary to keep him immobile and restricted as he can experience slips and
falls and it can further deteriorate the condition. Joseph is an aged patient and the risk of