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Pressure injuries
A pressure injury forms when prolonged pressure and shear over a bony prominence cut off blood flow to the tissue; prevention (risk assessment, repositioning, a pressure-redistributing surface, nutrition and moisture management) matters more than any dressing, and treatment starts with offloading.
Why it matters in the exam
The exam describes a wound and asks for the stage: intact skin with non-blanchable redness (1), partial-thickness skin loss with exposed dermis (2), full-thickness skin loss with visible fat (3), exposed tendon, muscle or bone (4), a wound covered in slough or eschar that cannot be staged, and a deep tissue injury with a purple-maroon colour. Candidates are also asked about the Braden scale and what must not be done, such as removing stable dry eschar on the heel.
Recurring points: a non-healing stage 4 wound or one with exposed bone suggests osteomyelitis — diagnosed by bone biopsy or MRI, not by a wound swab; a wound is not reverse-staged as it heals ("healing stage 3", not "stage 2"); and adequate protein and energy are part of treatment.
Pressure injuries are regarded as a marker of quality of care in hospitals and institutions, and most can be prevented. The common sites are the sacrum, the heels, the hips (trochanters) and the buttocks, and in a seated patient — the area over the ischial tuberosities. The exam also asks about risk factors: immobility, urinary and faecal incontinence, undernutrition, reduced sensation, diabetes and peripheral arterial disease, and about dressings: a moist dressing suits a clean wound, and an absorbent dressing a wound with heavy exudate.
Key points
- Prevention: Braden, repositioning, pressure-redistributing mattress, nutrition and moisture management.
- Stages 1–4, "unstageable" and deep tissue injury.
- Treatment: offloading, removal of dead tissue, a moist environment.
- Non-healing stage 4 — suspect osteomyelitis; bone biopsy and MRI.
- Wounds are not down-staged; stable heel eschar stays.
Summary table
| Stage | What is seen | Exam note |
|---|---|---|
| 1 | Intact skin, non-blanchable redness | In dark skin — colour change, warmth or firmness |
| 2 | Partial-thickness loss, exposed dermis, intact clear blister | No visible fat; do not confuse with moisture damage |
| 3 | Full-thickness skin loss, visible fat, slough possible | No exposed tendon, muscle or bone |
| 4 | Full-thickness tissue loss with exposed tendon, muscle, cartilage or bone | Suspect osteomyelitis |
| Unstageable | Base covered by slough or eschar | Stable dry eschar on the heel — do not remove |
| Deep tissue injury | Non-blanchable purple-maroon area, intact skin or blood blister | May evolve quickly into a deep wound |
Free exam questions
אסכיאלי משמאל. לציין בעברו קשירת עורק 4 , סובל מפצע לחץ דרגה 20 בן profunda femoris באיזור משמאל. לשיחזור הפגם במטופל זה איזה מהמתלים הבאים הוא המתאים ביותר? (the question as examined, in Hebrew)
- א. Gluteal thigh flap
- ב. Gracilis flap
- ג. Rectus femoris flap
- ד. Vastus lateralis flap
נער בן 15 עם פגיעת חוט שדרה על רקע MMC (Meningomyelocele) מציג בביקורת מרפאה פצעי לחץ חמורים בעכוז, בהערכת גורמי הסיכון איזה מהבאים פחות רלבנטי ? (the question as examined, in Hebrew)
- א. האם מתגורר בביתו או במסגרת חוץ ומי המטפל העיקרי
- ב. האם משתמש באורטוזות עמידה ו/או הליכה כגון RGO
- ג. האם קיימת בנוסף מוגבלות שכלית התפתחותית וחומרתה
- ד. האם שולט על סוגרים, ובאיזה ציוד עזר משתמש
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Sources
- EPUAP/NPIAP/PPPIA International Guideline — Prevention and Treatment of Pressure Ulcers/Injuries, 3rd edition (2019) — Risk assessment, support surfaces, nutrition and wound care
- NPIAP pressure injury staging system, 2016 — Stage definitions
- Geriatrics Review Syllabus (American Geriatrics Society), 11th edition (2022) — Pressure injuries and wound care
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.