Pressure sores. Prevention and step-up management.

The tissue changes that produce pressure sores may be described as occurring in five stages: blanching hyperemia, nonblanching hyperemia, blister and eschar formation, clean ulcer, and infected ulcer. Tissue breakdown is a direct response to external pressure, friction, or shearing force. Prevention of pressure sores comes down to identifying intrinsic and extrinsic risk factors and taking all possible steps to circumvent them. A "step-up" approach to management takes its name from the components surface agents, thermal agents, exposure, ultraviolet light, and pressure redistribution.