A pressure injury is damage to skin and deeper tissue from constant pressure or shear, and in wheelchair users it most often forms over the sitting bones, tailbone and sacrum. People with spinal cord injury may not feel the warning pain, so daily skin checks and regular pressure relief are essential.
Key symptoms
- Red or purple area that stays after pressure is removed
- Open sore or blister over the buttocks or sitting bones
- Drainage, odor or a wet seat cushion
- Spasms, sweating or autonomic dysreflexia in spinal cord injury
What you find on exam
- Stage the wound: 1 to 4, unstageable or deep tissue injury
- Measure length, width, depth and tunneling
- Wound bed, edges, drainage and surrounding skin
- Seating, cushion, transfer technique and continence
Tests
- Braden scale for risk
- Nutrition review and weight; albumin alone is not reliable
- Wound culture only with signs of infection, ideally from tissue
- MRI or bone biopsy if osteomyelitis is suspected
Treatment basics
- Offload pressure: pressure-relieving cushion and weight shifts every 15 to 30 minutes when seated
- Moist wound care with suitable dressings; debride dead tissue
- Protein, calories and fluids; manage incontinence
- Antibiotics for infection; surgical flap for deep stage 4 wounds
- Teach daily skin checks with a mirror
Red flags
- Fever, spreading redness or foul drainage
- Exposed bone or deep tunneling
- Pounding headache with high blood pressure (autonomic dysreflexia)
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Sources: NCCPA PANCE Content Blueprint; NCSBN 2026 NCLEX-RN Test Plan; AHRQ Health Literacy Universal Precautions Toolkit (Teach-Back). Written by Making Synapses. Making Synapses is not affiliated with these organizations.