Preventing Pressure Ulcers
What is a pressure ulcer?
A pressure ulcer, sometimes called a bedsore, is an injury to the skin as well as the tissue under it due to constant pressure. The constant pressure on the tissue over a bony area can squeeze shut the tiny blood vessels that supply your skin and tissue with oxygen and nutrition. If the tissue is starved for too long, it dies and a pressure ulcer starts to form. When constant friction and shearing occur on the skin and tissue, the extra force may increase the shape of a pressure ulcer. Pressure ulcers can appear as a red or purple area on the skin, as a blister or open sore, or as a crater can at times extend deep into the muscle and bone. Pressure ulcer can result in pain, muscle damage and infection.
How do I Heal a Pressure Ulcer?
A pressure ulcer is serious and must not be ignored. With proper care, pressure ulcers can be healed. Treating a pressure ulcer requires three things:
• Relieve the pressure
• Caring for the ulcer
• Having a good diet
Taking pressure off of the sore is the first step toward healing. You can relieve or reduce pressure by:
• Change how you sit or lay often. You should move at least every 15-20 minutes when sitting in a chair and turn at least every two hours while lying in bed.
Maintain good body position when in bed.
• Do not lie on the pressure ulcer.
• Change the way you lay at least every two hours.
• When lying on your side, do not rest directly on your hip bone. A 30 degree position is best. Use pillows or foam pads to keep your knees and ankles from touching each other.
• When lying on your back, keep your heels off of the bed with a foam pad or pillow placed under your legs extending from knee to ankle.
Do not use donut-shaped rings or cushions.
• They can further reduce the blood flow to the tissue.
• When possible, do not raise the head of the bed above 30 degrees.
• This causes increased friction and shearing to the injured tissue. If the head of the bed needs to be raised more than 30 degrees, also raise the knees so as to prevent extra shearing.
Maintain good body positioning when sitting in a chair.
• Avoid sitting directly on a pressure ulcer.
• Make sure your feet sit flat on the floor or wheel chair foot rests.
• Position yourself at a 90 degree angle when sitting in the chair. Your buttocks should be touching the back of the chair.
• The back of your thighs should rest evenly on the seat of the chair.
• Use a special mattress or chair cushion to support your body and reduce pressure on the pressure ulcer. Your doctor, therapists, or wound care nurse can help you to select a proper surface.
Care of the Sore
The three aspects of caring for the pressure ulcer include proper cleaning of the sore, remove any dead tissue, and apply a dressing that helps the ulcer to heal.
• The sore should be cleansed with every dressing change so as to remove old drainage, dead tissue, and other debris. If this is not done, healing may be slowed and an infection may occur. Clean the sore with soap and water or a wound cleanser as directed by your doctor.
• You can remove dead tissue and debris in many ways. A doctor or nurse may suggest wet-to-dry dressings, enzyme ointments to dissolve the dead tissue, or special dressings which when left in place for 2-3 days help your body’s own enzymes dissolve the dead tissue. The choice of the best method for removing dead tissue should be decided by your doctor or wound care nurse.
• Cover the sore with the proper dressing. The choice of dressing is based on a number of factors which include what will best help healing, what will best manage the amount of drainage, how often the dressings need to be changed, and whether the ulcer is infected. Your doctor or wound care nurse will help you get the right dressing.
Good nutrition is very important to heal a pressure ulcer as well as to avoid any new pressure ulcers. Good nutrition includes eating a balanced diet which provides your body with plenty of amounts of fluids, calories, vitamins, minerals, and proteins so that the injured tissues can heal. You and your doctor, dietitian, or nurse should review any other health problems you may have (such as diabetes or kidney problems) before designing a special diet.
How Will I Know if my Pressure Ulcer is Infected?
An infected pressure ulcer demands urgent care. An infected wound will be slower to heal and the infection may spread to other tissue (cellulites), to the bone, or all through the body (sepsis). Notify your doctor if you note any of the following symptoms:
• A change in the color of drainage to green or yellow
• A dramatic increase in the amount of drainage
• Foul odor
• Redness or warmth or increased swelling around the sore
• Pain in the area of the sore
• Fever or chills
• Confusion or difficulty concentrating
• Rapid heartbeat
How Will I Know if the Pressure Ulcer is Healing?
The best time to check the pressure ulcer for healing is after it has been cleansed. You should notice a decrease in the amount of yellow, grey, or black tissue along with an increase in the amount of moist pink tissue. You will note that the sore is smaller and/or less deep. You should see your wound improve every 2-3 weeks. If the wound is not showing improvement, notify your doctor or wound care nurse.
What Signs or Symptoms Should I Report?
Tell your doctor or nurse if:
• The pressure ulcer is larger or deeper.
• There is an increase in the amount of drainage or change in color of the ulcer drainage
• The sore does not show continued healing every 2-3 weeks.
• You feel increased pain around he ulcer.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 01/27/2012
Copyright © 01/27/2012 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6615
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