Recognising Pressure Damage for Student Nurses
Learn how to recognise early skin changes associated with pressure, identify patients who may be particularly vulnerable, assess areas at risk and understand when concerns need prompt escalation.
Why does pressure damage occur?
Pressure damage develops when skin and underlying tissues are exposed to pressure, or pressure combined with shear. Risk varies between patients and can change rapidly during illness.
Prolonged loading
Sustained pressure can reduce the ability of tissues to tolerate loading, particularly over vulnerable areas.
Movement within tissues
Sliding or repositioning can contribute to tissue stress, especially where the patient cannot reposition independently.
Risk is individual
Mobility, perfusion, nutrition, moisture, sensation, illness and other factors can influence vulnerability.
Pressure damage is not always an open wound
An important student-nurse skill is recognising concerning skin change before significant tissue breakdown becomes obvious.
New discolouration
Look for a persistent change in skin colour compared with surrounding tissue and the patient's normal skin.
Different from surrounding skin
An affected area may feel unusually warm or cool compared with nearby tissue.
Changes in tissue feel
The area may feel firmer, softer or otherwise different from the surrounding skin.
New discomfort
Tenderness, pain or altered sensation may occur before obvious skin breakdown.
Visible skin damage
Blistering or other new disruption of the skin requires assessment and appropriate action.
Tissue breakdown
Any new wound over an area exposed to pressure should be assessed according to local pressure-ulcer procedures.
Do not rely on redness alone
Pressure-related skin changes can look different across skin tones. Assessment should therefore include colour alongside temperature, texture, pain and comparison with surrounding tissue.
Which areas need particular attention?
Pressure can develop wherever body weight or medical equipment creates sustained loading. The areas at greatest risk depend on the patient's position, mobility and equipment.
Lower back and sacral area
Particularly relevant for patients spending prolonged periods in bed or seated.
Inspect both heels
Heels can experience sustained pressure in patients with limited movement.
Consider positioning
Side-lying positions can increase pressure around the hip and other prominent areas.
Check contact points
Bony areas exposed to repeated or sustained pressure should not be overlooked.
Think beyond the sacrum
The back of the head and ears may become vulnerable depending on positioning and equipment.
Medical equipment can cause pressure
Oxygen tubing, masks, splints and other devices can create pressure at contact points.
Pressure risk can change during admission
A patient who was previously mobile may become much more vulnerable after surgery, acute illness or deterioration. Risk assessment therefore needs to reflect the patient's current condition.
| Factor | What might change? | Why it matters |
|---|---|---|
| Mobility | The patient moves less or cannot reposition independently. | Pressure may remain over the same area for longer. |
| Moisture | Incontinence, sweating or wound fluid affects the skin. | Excess moisture can make skin more vulnerable to damage. |
| Nutrition | Food intake becomes poor or nutritional concerns develop. | Nutrition is relevant to skin integrity and tissue health. |
| Perfusion | Circulation or the patient's overall physiological condition worsens. | Tissue tolerance may be affected. |
| Sensation | The patient cannot reliably feel or communicate discomfort. | They may not recognise the need to reposition. |
| Devices | A new mask, tube, splint or other device is applied. | New pressure points can develop beneath or around equipment. |
Recognition should trigger action
Prevention plans are individualised. Student nurses should understand the patient's pressure-care plan and raise concerns when risk or skin condition changes.
Inspect
Check vulnerable skin areas according to the patient's assessment and local care plan.
Reposition
Support repositioning according to the individual care plan, mobility assessment and local guidance.
Protect
Use prescribed pressure-relieving equipment and protect skin from avoidable moisture and friction.
Escalate
Report new skin changes or increased risk so the prevention plan can be reviewed.
When should you escalate?
- New persistent skin discolouration over a pressure area.
- New pain, tenderness or altered sensation at a vulnerable site.
- Blistering or skin breakdown.
- A significant change in skin temperature or texture.
- Rapidly worsening tissue appearance.
- Damage associated with a medical device.
- A major reduction in mobility or ability to reposition.
- Any pressure-related wound that appears to be deteriorating.
βHis heel looks different todayβ
Example
An older patient has become much less mobile following an acute illness. During personal care you notice a new area of discolouration on one heel.
The skin is intact, but the area feels different from the surrounding tissue and the patient reports tenderness when you examine it.
You recognise: reduced mobility + new discolouration + tissue change + tenderness.
Rather than waiting for the skin to break, you report the change so the patient's skin and pressure-risk management can be reviewed.
Describe what you can see and feel
Example escalation
βI'm concerned about Mr Green's left heel. He has become much less mobile today and there is a new area of discolouration compared with the surrounding skin. The area feels different and he reports tenderness.β
Clear description helps the registered nurse understand both the skin change and the change in risk.
Errors to avoid
- Waiting for the skin to break before reporting pressure damage.
- Looking only for redness and overlooking changes on darker skin tones.
- Checking the sacrum but forgetting heels and device-related pressure areas.
- Assuming yesterday's risk assessment still reflects today's condition.
- Ignoring pain or tenderness when the skin still appears intact.
- Using a fixed repositioning schedule without considering the individual care plan.
- Failing to document and communicate a new skin change.
Risk β inspect β protect β escalate
Recognise pressure damage before skin breaks down
Strong pressure-area care starts with recognising changing risk, inspecting vulnerable skin and acting on early changes rather than waiting for an obvious wound.
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