Which client would be most at risk for a sacral pressure ulcer?

Which client would be most at risk for a sacral pressure ulcer?

• A. Mr. Boston, age 92, who is fully ambulatory but has moderate dementia
• B. Mrs. Colorado, age 85, who is on bed rest and limited ambulation following total hip replacement
• C. Mrs. Carys, age 95, who has a fractured radius
• D. Mr. Cleveland, age 75, who has paraplegia and uses a wheelchair

Answer: (D)

Pressure ulcers form when prolonged unrelieved pressure cuts off blood flow to a body area, especially over bony prominences like the sacrum. When someone has limited or no ability to change position and may have reduced or absent sensation, tissue damage can occur quickly. In this scenario, the client with paraplegia relies on a wheelchair for mobility. Sitting for long periods places continuous pressure on the sacral area, and impaired sensation can prevent noticing early discomfort or pain that would normally prompt a reposition. Added factors such as moisture, friction, and potential nutritional deficiencies further increase the risk. These combined factors make sacral pressure ulcers most likely in this client. The other clients are less at risk because they do not have the same level of chronic, immobile pressure on the sacrum: one is ambulatory though with dementia, another is bed-bound after surgery but may still receive more frequent repositioning, another has a fracture in an upper limb and is not immobile, and the age alone or brief immobility doesn’t surpass the ongoing pressure from sitting in a wheelchair with limited movement.

Pressure ulcers form when prolonged unrelieved pressure cuts off blood flow to a body area, especially over bony prominences like the sacrum. When someone has limited or no ability to change position and may have reduced or absent sensation, tissue damage can occur quickly.

In this scenario, the client with paraplegia relies on a wheelchair for mobility. Sitting for long periods places continuous pressure on the sacral area, and impaired sensation can prevent noticing early discomfort or pain that would normally prompt a reposition. Added factors such as moisture, friction, and potential nutritional deficiencies further increase the risk. These combined factors make sacral pressure ulcers most likely in this client.

The other clients are less at risk because they do not have the same level of chronic, immobile pressure on the sacrum: one is ambulatory though with dementia, another is bed-bound after surgery but may still receive more frequent repositioning, another has a fracture in an upper limb and is not immobile, and the age alone or brief immobility doesn’t surpass the ongoing pressure from sitting in a wheelchair with limited movement.