VNJ Volume 40 (4) August 2025

Plus-Hex CLINICAL

Introduction

The veterinary nurse( VN) plays a leading role in wound management and will often oversee or assist with wound care. While this aspect of nursing can be incredibly rewarding, it can also present challenges, especially when wound healing is prolonged or complicated.

A decubitus ulcer, also known as a pressure sore or pressure ulcer, is a wound that can develop over a bony prominence, such as in the hip or elbow area, when the area is in prolonged contact with a hard surface.

The sore can develop thickened areas and sometimes fluid-filled pouches called hygromas. It may become infected and painful, and can go on to develop into a chronic wound [ 1 ].

Recumbent patients and those with decreased muscle mass and mobility have a higher likelihood of developing a pressure sore.

It is important to understand the risk factors for decubitus ulcers in order to prevent them from developing. The Braden scale [ 2 ] is a helpful tool used in human medicine, which can be adapted for animals( Table 1 [ 3 ]). It identifies six common risk factors: sensory perception, moisture, activity, mobility, nutrition, and friction and shear [ 2 ].

Using the scale, VNs can score certain parameters to predict whether a patient is at risk of decubitus ulcers, with a total score of less than 12 indicating that the patient is at serious risk of developing decubitus ulcers and should be monitored carefully [ 3 ].

Table 1. Braden scale for predicting risk for decubitus ulcer development( adapted for animals) [ 3 ].

Risk factor Scoring for each risk factor

Sensory perception	1. Completely limited	2. Very limited	3. Slightly limited	4. No impairment
Ability to respond to pressure-related discomfort	Unresponsive, no reaction to painful stimuli OR limited ability to feel pain over most of the body	Responds only to painful stimuli OR has sensory impairment limiting ability to feel pain or discomfort over half of the body	Responds to voice. Will move if encouraged OR sensory impairment limits the ability to feel pain in one or two limbs	Moves self with or without help. No sensory deficit
Moisture	1. Constantly moist	2. Very moist	3. Occasionally moist	4. Rarely moist
Degree to which skin is exposed to moisture	Dampness is detected every time the patient is turned	Skin is often but not always moist	Skin is occasionally moist	Skin is usually dry

Activity	1. No movement 2. Slight movement	3. Walks occasionally	4. Walks frequently
Degree of physical activity	Ability to walk is severely limited. Cannot weight bear	Walks short distances. Spends most of the time lying down

Mobility Ability to change and control body position	1. Completely immobile Does not make even slight changes to body position without assistance	2. Very limited Makes slight changes to body position	3. Slightly limited Makes frequent though slight changes to body position	4. No limitation
Nutrition Usual food intake pattern	1. Very poor Never eats much food offered OR is nil by mouth or receiving IV fluids	2. Probably inadequate Rarely eats much, only about one-third of food offered	3. Adequate Eats over half of most meals	4. Excellent
Friction and shear	1. Problem Requires maximum assistance when moving. Spasticity, contractures or agitation lead to almost constant friction	2. Potential problem Moves feebly. Skin probably rubs on bedding	3. No apparent problem	_

The patient is assessed in six categories. Decubitus ulcer risk increases as the score decreases. 15 – 16 = mild risk, 12 – 14 = moderate risk, < 12 = serious risk. IV, intravenous.

Volume 40( 4) • August 2025

VNJ Volume 40 (4) August 2025 | Page 35