Why pressure injuries form where they do
Pressure injuries occur when sustained pressure over a bony area, most often the tailbone, heels, hips, or elbows, cuts off blood flow long enough for tissue to break down. Two forces make it worse: shear, the sliding that happens when someone is dragged rather than lifted during repositioning, and moisture from incontinence or perspiration, which weakens the skin surface. Turning schedules, proper lifting technique, and moisture management are as clinically important as any dressing.
What staging tells you, and what it does not
The staging system describes the visible depth of tissue involvement, from Stage 1 (intact skin with non-blanching redness) to Stage 4 (extending to muscle, bone, or tendon), plus unstageable when slough or eschar hides the depth. Staging describes what is visible, not always what lies beneath, which is why a wound can appear to worsen after debridement even though the damage existed already.
Nutrition is part of the treatment
The body rebuilds tissue from protein. Without adequate protein and calories, a pressure injury cannot heal efficiently no matter how well the surface is managed. Because Palm coordinates primary-care context alongside wound care, nutritional risk gets flagged and addressed rather than overlooked as a separate issue.
When a pressure injury signals something more serious
- New or worsening odor from the wound or dressing
- Redness spreading beyond the wound margin since the last check
- Fever, or in older adults a sudden change in alertness or mental status
- Wound edges moving apart rather than toward each other
- Drainage turning cloudy, colored, or foul
In older adults, confusion or increased sleepiness can be the first sign of infection, arriving before fever. Any rapid mental-status change in a person with a pressure injury deserves assessment.