Understanding pressure injuries
Skin and muscle need a steady supply of blood. When body weight presses tissue between a bone and a mattress or seat, the small vessels in that tissue are squeezed shut. If the pressure is not relieved, the cells run short of oxygen and begin to die.
Pressure is rarely the only force at work. Shear happens when the skin stays put while the skeleton slides, as it does when a person slumps down in a raised bed. Friction rubs the surface raw. Dampness from urine, stool or sweat weakens the outer layer so it breaks more easily. A healthy person shifts without thinking, even in sleep. A pressure injury forms when illness, weakness or numbness takes that automatic movement away.
What an assessment covers
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.
Pressure injury and bed sore care in University City
In the older single-family homes common across University City, the bedrooms are often upstairs, and a person with a pressure injury may have started sleeping in a living room recliner. Recliners put steady weight on the tailbone and heels, and a spouse of the same age may not be able to help with turning. A home visit lets the treating clinician see that setup directly and write orders that fit it, including whether a different sleeping surface should be considered.
University City begins where the Delmar Loop meets the St. Louis city line and runs west toward Interstate 170. Delmar Boulevard and Olive Boulevard carry traffic through it, and Clayton, Olivette and Overland are next door. This inner-ring suburb is dense by St. Louis County standards, with houses set close together and some residents who do not drive. For an older adult in an upstairs flat, or a person recovering from surgery, the hard part of an appointment is often the stairs and the ride, not the visit itself. Care at home removes both.
When care happens at home
Dressings are only part of what a pressure injury needs at home. The treating clinician may also order a pressure-redistributing mattress or overlay, a wheelchair cushion, heel protection or a hospital bed. Gateway follows up on those orders with suppliers and lets you know what to expect about delivery.
Dressings usually arrive in quantities meant to last until the next order. Check the box against what the clinician ordered, store it somewhere clean and dry, and tell us before the last few are used. Once equipment arrives, keep the instructions and the supplier’s phone number handy. Tell the clinician if a mattress feels flat, a cushion has shifted or the person will not tolerate it.
For residents of nursing and senior living communities
In a skilled nursing facility, pressure injury care is a shared job. Facility nurses do the daily dressing changes and repositioning, the attending physician oversees the resident’s overall care, and a partner wound clinician can see the resident on site, often during scheduled wound rounds.
After each visit, measurements, staging and updated orders go to the nursing team so the chart and care plan match what the clinician found. Gateway coordinates the rounding schedule, the list of residents to be seen and the supply follow-up. Staff can also call Gateway between rounds when a resident’s wound changes.
Changes to report
Pressure damage can start before the skin opens. Check the tailbone, hips, heels and other bony areas when you help with bathing or dressing, and tell the treating clinician or nurse if you see:
- A patch that stays red, purple, maroon or darker than nearby skin after the pressure is off
- Skin that feels warmer, cooler, firmer or softer than the skin around it
- A blister, a shiny area or a shallow break
- A spot the person says is sore, burning or itchy
Call 911 if the person has trouble breathing, chest pain, or is suddenly very hard to wake.
Why primary care matters here
Tissue under pressure survives on blood flow, so anything that reduces circulation or the oxygen carried in the blood makes a pressure injury more likely and harder to close. Diabetes, peripheral artery disease, heart failure, chronic lung disease and anemia are common examples. Heels are especially sensitive to poor circulation in the legs.
These conditions are managed in primary care. When the wound clinician and the primary care clinician can see each other’s notes, a wound that has stalled can prompt a fresh look at blood sugar, circulation or blood counts. Gateway arranges both kinds of visits and helps keep records moving between them.
Arranging pressure injury care in University City
People asking about pressure injury care in University City usually want to know what the first visit involves. Before it, Gateway collects the records the treating clinician asks for and confirms the time and place with you. During it, the clinician looks at the wound and the skin around it, measures it, asks about your health and medications and explains what they recommend. Afterward, the orders go to whoever does the daily care, supplies are requested and a follow-up is planned. Our guide to how mobile wound care visits work has more. To begin, call 314-325-0126. Whether a visit can be arranged is confirmed for your location.
A few things make a University City request go smoothly. Have the street address and unit number, a phone number that will be answered, the name of the regular doctor and any hospital paperwork. Tell us about stairs, locked entries and where a visitor can park. Gateway also coordinates care nearby in Clayton and Central County, Overland, the Central West End, Ladue and Creve Coeur. Availability is confirmed by location and care setting, so we will ask whether the patient is at home or in a facility.
- County: St. Louis County, Missouri
- ZIP codes: 63130
- Nearby hospitals: Barnes-Jewish Hospital; SSM Health St. Mary's Hospital in Richmond Heights; Mercy Hospital St. Louis in Creve Coeur (not affiliated with Gateway)
- Nearby communities: Clayton and Central County, Overland, Central West End, Ladue, Creve Coeur
- Care settings: Private homes, skilled nursing, assisted living, memory care and rehabilitation
Related care in University City
Read the full guide to pressure injuries, or see everything Gateway arranges on the mobile wound care in University City page.
- Diabetic foot ulcers
- Venous leg ulcers
- Arterial and mixed wounds
- Non-healing wounds
- Post-surgical wounds
- Reopened (dehisced) surgical wounds
- Surgical site infections
- Skin tears and traumatic wounds
- Wounds with lymphedema
- Skin graft aftercare
- Wound VAC (NPWT) follow-up
- Pressure injury and bed sore care in Clayton and Central County
- Pressure injury and bed sore care in the Central West End
- Pressure injury and bed sore care in Ladue
- Pressure injury and bed sore care in Creve Coeur
Common questions
Does Gateway work with nursing homes and assisted living communities in University City?
Yes. Gateway arranges for partner clinicians to see residents with pressure injuries in skilled nursing, assisted living, memory care and rehabilitation settings, either one resident at a time or through regular wound rounds. Facility staff can refer a resident, and families can ask the facility to contact us. Availability for a specific building is confirmed when the request comes in.
What should we have ready before the first wound care visit?
Have a current medication list, any hospital or rehab discharge papers, the insurance cards and the dressings you are using now. Write down when the sore was first noticed and how it has changed. Jot down your questions too, including who to call between visits. If several people share caregiving, try to have the main helper present to hear the plan.
How do you spot early pressure damage on darker skin?
Redness can be hard to see on dark skin, so color alone is not a reliable guide. Look for a patch that appears darker, purplish or ashen compared with the skin around it, and use touch as well. An area that feels warmer, cooler, firmer or puffier than nearby skin, or that the person says is tender, should be reported to the treating clinician.
Who decides how my wound is treated during a home visit in University City?
The treating clinician does. That partner clinician examines the wound, makes the diagnosis, writes the orders and adjusts the plan over time. Clinical decisions belong to the treating clinician. Our part is the coordination around the visit in University City: scheduling, records, supplies, follow-up and keeping your family and other doctors informed.
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.