Understanding pressure injuries

A pressure injury is an area of damaged skin, and often damaged tissue underneath, that forms where the body rests against a surface for too long. Bed sore, pressure sore, pressure ulcer and decubitus ulcer all mean the same thing. These wounds nearly always sit over a bone that lies close to the skin, such as the tailbone, the hip, the heel, the ankle or the back of the head.

A pressure injury is not always an open sore. It can begin as a patch of unbroken skin that looks or feels different, and it can also be a deep crater. Clinicians describe that range with a staging system based on how many layers of tissue are involved. Staging gives everyone caring for the person a shared language for the wound.

How the care plan is built

Where a pressure injury sits says a lot about what caused it, and the treating clinician reads the location as a clue:

  • Tailbone or buttocks: long hours sitting, or lying with the head of the bed raised
  • Heels: lying on the back with the feet resting on the mattress
  • Hip or outer ankle: time spent on one side
  • Ears, nose or cheeks: pressure from tubing or a mask
  • Back of the head or shoulder blades: lying flat for long stretches

The clinician then looks at the bed, chair or device involved and asks about the daily routine. A care plan that leaves the source of pressure unchanged is unlikely to succeed, whatever dressing is chosen.

Arranging this care in Festus and Crystal City

Around Festus and Crystal City, the nearest equipment supplier may be a long way off, so a specialty mattress, cushion or hospital bed takes planning. Ask at the first visit what to do if a powered air mattress loses power or goes flat, and keep the supplier’s number where every caregiver can find it. Gateway follows up on equipment orders and delivery dates, and confirms ahead of time when a partner clinician can visit that part of the region.

Festus and Crystal City share a border, a stretch of Interstate 55 and the nickname Twin Cities. They sit near the Mississippi River in eastern Jefferson County, well south of the St. Louis metro core, with open country beginning just past the city limits. The towns have their own hospital, schools and main streets, and people here are used to handling things locally. Specialty care is the exception, since much of it is a long drive north. That is why wound care and primary care delivered in the home or a local facility matter so much in this area.

At home between visits

Many people with a pressure injury at home also have a home health agency involved. When that is the case, the wound orders from the treating clinician need to reach the home health nurse, and the nurse’s observations need to reach the clinician. Gateway helps pass that information in both directions so the family is not left carrying messages.

If no home health agency is in place, tell us who is available to help: a spouse, adult children, a paid aide or no one. The treating clinician can decide whether to order home health nursing, and the plan can be shaped around the help that really exists.

For residents of nursing and senior living communities

Assisted living communities are not staffed like nursing homes, and that shapes pressure injury care. Aides may help with bathing and transfers, but skilled dressing changes are often done by a visiting home health nurse or, where the community’s license allows, by its own nurse.

When Gateway arranges a wound visit in assisted living, we ask early who handles each part: dressing changes, repositioning, incontinence care and equipment. The treating clinician’s orders are shared with the community’s nurse or director, the home health agency if one is involved, and the family. A resident who now needs far more hands-on help may prompt a wider talk about the level of care.

What to report and when to call 911

Some of the most useful reports are not about the wound at all. They are about changes that put more pressure or moisture on the skin. Let the treating clinician know when:

  • A new area of discolored skin appears somewhere else on the body
  • The person can no longer shift, turn or tolerate a position they used before
  • Incontinence starts or gets worse, or dressings keep getting soiled
  • An air mattress, cushion or heel protector stops working or is not being used
  • Eating or drinking drops off, or weight is falling

These are not emergencies. Call 911 for chest pain, trouble breathing, heavy bleeding or sudden unresponsiveness.

How primary care fits in

The body builds new tissue from what a person eats and drinks, and a pressure injury raises the demand. Someone who has lost weight, eats only a few bites at meals, has trouble swallowing or has poorly fitting dentures may not be taking in enough protein, calories or fluid to keep up.

A primary care clinician can look for the reason appetite has fallen, review weight over time and decide whether a dietitian or a swallowing evaluation would help. Gateway can arrange primary care in the same home or facility where wound visits take place, so the clinician who orders the dressing and the clinician who looks at nutrition are working from the same information.

Primary care at home in Festus and Crystal City →

How to get started in Festus and Crystal City

Before anything is scheduled, Gateway checks two things for every request for pressure injury care in Festus and Crystal City: whether a partner clinician serves that address and care setting, and what the patient’s plan requires from the treating provider. Neither is assumed. If both line up, we arrange the visit and gather records. If something stands in the way, we say so, and our guide to following up on a request explains what to ask next. Gateway coordinates the care and does not make clinical decisions. Those belong to the treating clinician who sees the wound. Start by calling 314-325-0126, or ask a family member to call for you.

Callers from Festus and Crystal City should be ready with the patient’s address, clear directions if the home is outside town, a phone number with reliable service, and the name of the local doctor. Mention gravel roads, locked gates or dogs. Because the Twin Cities are near the southern end of the area Gateway serves, visits here are planned together with others in Jefferson County, including Imperial and Arnold. That means some days of the week work better than others, and availability is confirmed when you call.

  • County: Jefferson County, Missouri
  • ZIP codes: 63028, 63019
  • Nearby hospitals: Mercy Hospital Jefferson in Festus (not affiliated with Gateway)
  • Nearby communities: Jefferson County, Imperial, Arnold
  • Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation

Other conditions and nearby communities

Read the full guide to pressure injuries, or see everything Gateway arranges on the mobile wound care in Festus and Crystal City page.

Common questions

How do we start pressure injury care for a family member in Festus and Crystal City?

Call Gateway or send the request form with a name and phone number only. You do not need a referral to call. On the phone we will ask where the person lives, how long the sore has been there, which hospital or doctor has seen it and what insurance they have. From there we gather records and work on scheduling with a partner clinician.

Can sitting in a wheelchair or recliner cause a pressure injury?

Yes. Sitting puts much of the body’s weight on a small area under the sitting bones and tailbone, so pressure injuries can form in a chair as readily as in a bed. People who sit most of the day need a suitable cushion and regular changes of position. The treating clinician can advise on the cushion and on how long the person should sit at a stretch.

Should a bed sore be left uncovered so it can dry out?

In general, no. Clinicians usually keep pressure injuries covered with a dressing chosen to hold the right amount of moisture, protect the wound from stool and urine, and cushion it from rubbing. A wound left open to dry tends to form a hard crust that slows new tissue. Follow the treating clinician’s dressing orders and ask before changing anything.

Does Gateway arrange visits inside nursing and rehabilitation facilities in Festus and Crystal City?

Yes. A facility’s director of nursing, wound nurse or social worker can refer a resident, and families can ask on a resident’s behalf. Gateway coordinates with the facility so the treating clinician’s visit fits the unit’s routine and the orders are clear to staff. When the resident is discharged home in Festus and Crystal City, we can check availability to continue care there.

General information to help you talk with your own clinician. It is not medical advice, and the treating clinician makes every clinical decision. For a medical emergency, call 911.