Pressure Injuries, Wounds, and Advanced Practice Procedures

A set of vocabulary cards covering key terms related to pressure injuries, wound care, debridement, dressings, and related procedures.

Pressure injury

Localized damage to skin and underlying tissue caused by prolonged pressure, typically over a bony prominence; terminology changed from pressure ulcer to pressure injury by NPIAP in 2016.

NPIAP

National Pressure Injury Advisory Panel, the organization that standardizes terminology and classifications for pressure injuries.

Pressure-induced skin injury

Ulcers caused by ischemic damage from prolonged pressure, including associated shear and friction forces.

Braden Scale

A tool used to predict pressure sore risk across six categories (sensory, moisture, activity, mobility, nutrition, friction/shear).

Braden Scale categories

Sensory perception, moisture, activity, mobility, nutrition, friction/shear—the six domains scored by the Braden Scale.

Braden score (≤18 high risk)

A total score of 18 or less on the Braden Scale indicates high risk for developing a pressure injury.

Pressure Injury Classification System

NPIAP system used to classify and stage pressure injuries (I–IV and other designations).

Stage I

Intact skin with non-blanchable erythema over a bony prominence; may be difficult to assess in darker skin.

Stage II

Partial-thickness skin loss with exposed dermis; moist, pink/red wound bed; may include a blister.

Stage III

Full-thickness skin loss with visible subcutaneous tissue; may see fat but no bone, tendon, or muscle exposed.

Stage IV

Full-thickness tissue loss with exposed bone, tendon, or muscle; undermining and possible tunneling.

Unstageable

Full-thickness tissue loss where depth cannot be confirmed due to eschar or slough covering the wound.

Deep Tissue Injury

Purple or maroon localized skin area that may indicate underlying soft tissue damage; may be painful and firm.

PUSH tool

Pressure Ulcer Scale for Healing; observational tool measuring surface area, exudate, and wound tissue type to track healing (score 1–17).

Surface area (Length × Width)

Measurement of the wound’s greatest length and greatest width to calculate area in square centimeters (cm2).

Exudate amount

Estimated drainage from a wound, categorized as none, light, moderate, or heavy.

Epithelium (epithelial tissue)

The outermost cell layer that covers wound beds and regenerates during healing.

Eschar

Necrotic tissue that is black, brown, or tan and adheres firmly to wound bed or edges.

Slough

Yellow or white tissue adherent to the wound bed, often stringy or thick and mucinous.

Granulation tissue

Pink or beefy red, moist tissue with a granular appearance indicating new vascularization.

Stage-specific care

Care strategies tailored to the injury stage (I–IV), including wound care and removal of contributing factors.

Wound dressings

Materials applied to wounds to maintain a moist environment, manage exudate, and protect the wound.

Foam dressing

Absorbs exudate, conforms to wound bed, often with low-adherence properties; suitable for high-exudate wounds.

Hydrocolloid dressing

Dressing with a gel or foam in a self-adhesive carrier; creates a moist environment and traps exudate.

Hydrogels

Water-rich dressings that rehydrate dry wounds and help control moisture to prevent maceration.

Alginate dressings

Seaweed-derived dressings that form a gel on contact; good for moderate-to-high exudate and wound packing.

Silver dressings

Antimicrobial dressings containing silver to reduce bioburden in colonized or infected wounds.

Honey dressings

Dressings using medical-grade honey; provide moist wound environment and antimicrobial effects.

Enzymes (collagenase, fibrinolysin)

Topical enzymatic debridement agents used to liquefy necrotic tissue in wounds.

Negative Pressure Wound Therapy (NPWT)

Therapy applying subatmospheric pressure to the wound to reduce edema, promote perfusion, and enhance granulation.

Debridement

Removal of necrotic, ischemic, or infected tissue to promote wound healing.

Irrigation

Low-pressure cleansing of the wound with warm saline or water to reduce bacterial load and debris.

Jet Lavage

High-pressure water stream used to debride and clean a wound.

Surgical debridement

Sharp removal of devitalized tissue with a scalpeI or scissors; often used for infected or large necrotic areas.

Autolytic debridement

Selective debridement using the body's enzymes aided by moist wound environments like hydrogels or semipermeable films.

Enzymatic debridement

Application of exogenous enzymes to digest necrotic tissue when surgery isn’t suitable.

Biological debridement

Use of maggot therapy to debride necrotic tissue in wounds.

Punch biopsy

A 3-mm circular skin punch used to obtain tissue for biopsy; requires aseptic technique and labeling.

Lidocaine 1% (plain)

Local anesthetic with rapid onset (2–5 minutes) and variable duration (30 minutes–2 hours); plain form has no vasoconstrictor.

Epinephrine contraindications

Do not use lidocaine with epinephrine on areas at high risk of ischemia (tip of nose, ears, fingertips, toes, penis).

Digital nerve block

Local anesthesia technique delivering lidocaine around the digital nerves to numb a finger.

Static infiltration

Infiltration technique where anesthetic is injected to numb wound edges, then moved to adjacent areas.

Continuous infiltration

Anesthetic is injected while the needle is withdrawn to create a continuous line of anesthesia.

Nonabsorbable sutures

Sutures that are not absorbed by the body and may require removal; examples include Ethilon, Prolene, silk.

Absorbable sutures

Sutures that are gradually absorbed by the body (e.g., catgut, Vicryl, PDS).

Suture sizes (USP)

Suture diameters classified by USP; higher zeros indicate smaller diameters; common skin sutures range up to 5-0 or 6-0.

3-0 to 5-0 skin sutures

Common suture sizes used for skin closure; smaller numbers denote finer sutures for cosmetic areas.

Evert edges

Technique to turn wound edges outward to ensure precise approximation and minimize gap.

Suture removal timing by location

Typical removal times vary by site: facial sutures ~5 days, scalp ~7–14 days, extremities ~7–10 days.

Clenched-fist injuries

High-risk wounds involving the hand from a clenched fist; high infection risk—refer to ED/hand surgeon.