Practice Dilemmas: Conditions That Mimic Pressure Ulcers/Injuries— To Be or Not To Be?

Abstract

BACKGROUND: Pressure ulcers/injuries (PU/Is) negatively affect patients by causing pain and increasing morbidity and mortality risks. Care teams have a heightened sense of awareness of the condition and may feel confident in their ability to appropriately identify and manage PU/Is, but the potential for, and consequences of, a misdiagnosis always should be considered. PURPOSE: The purpose of this compendium is to describe and illustrate conditions that may mimic PU/Is. METHODS: Advanced practice wound care nurses were asked to identify and describe conditions that may mimic PU/Is. Permission was obtained from all patients to use their cases and photos in this article. RESULTS: Sixteen (16) different skin and wound presentations resulting from vascular diseases, systemic infections, trauma, cancer, autoimmune disorders, coagulopathies, and multisystem organ dysfunction were identified and described. CONCLUSION: A complete patient history and assessment will help prevent misidentification of the etiology of a skin lesion or wound and misdiagnosis of these lesions as PU/Is.

Sustainable pressure injury prevention

“…An expert such as a certified wound care nurse seeks to identify the aetiology of skin breakdown 26–28. Mislabelling skin breakdown as PIs is common, given the complex nature of skin breakdown 29. Accurate identification of skin breakdown aetiology requires advanced didactic and clinical training 26–28.…”

Relationship between predisposing and facilitating factors: Does it influence the risk of developing peri‐operative pressure injuries?

“…As stage 1 PIs have intact skin, immediately removing or dispersing the pressure on the reddened skin can prevent further injury. PIs over stage 1, however, have damaged skin, and therefore, require a longer time for recovery or wound care 31 . The PI records in this study were based on observations of a patient's skin 30 minutes after surgery and were divided into two groups for analysis: stage 1 and stage 2 or higher.…”

Cutaneous Anomalies of the Critically Ill Patient

“…14 Fournier gangrene is rare, progresses rapidly, and is usually caused by a member of the -hemolytic Streptococcus genus and, less frequently, by Staphylococcus aureus. 15 This necrotizing soft-tissue infection has a mortality rate of 40% and occurs more frequently in men, at a rate of 1.6 cases per 100 000 men. 14 Risk factors for Fournier gangrene include immunosuppression, diabetes mellitus, or localized trauma.…”

“…A magnetic resonance image can help determine the extent of the tissue damage and is more specific to diagnosing Fournier gangrene than ultrasound or computed tomography. 4,15 Laboratory markers can be instrumental in helping detect the disease and its severity. A complete blood cell count can reveal leukocytosis and thrombocytopenia.…”