Treating Pressure Sores
What is a pressure sore?
A pressure sore is an injury to the skin and the tissue under it. Pressure sores, also known as pressure ulcers, decubitus ulcers, and bedsores, are most often caused by constant pressure. The pressure on a small area of the body can squeeze shut tiny blood vessels that supply your skin and tissues with oxygen and nutrients. If tissue is starved for too long, it begins to die. A pressure sore starts to form.
Pressure sores are labeled from Stage I (early signs) to Stage IV (worst).
- Stage I: A reddened area will form on the skin. When pressed, it does not turn white. This means that a pressure sore is starting to form.
- Stage II: The skin blisters or forms an open sore. The area around the sore may be red and irritated.
- Stage III: The skin breakdown now looks like a crater or hole. There is damage to the tissue below the skin.
- Stage IV: The pressure ulcer has become so deep that there is damage to the muscle and bone. Sometimes tendons and joints are damaged also.
How can I heal a pressure sore?
A pressure sore is serious. It must not be ignored. With proper treatment, most pressure sores will heal. Healing pressure sores depends on three things: pressure relief, care of the sore, and good nutrition.
Pressure relief
Taking pressure off the sore is the first step toward healing. You can relieve or reduce pressure by
- Using special surfaces, such as special beds, mattress overlays, or seat cushions, to support your body.
- Changing positions often. You should move at least every 15-20 minutes while seated in a chair and at least every 2 hours while lying in bed.
Care of the sore
The three aspects of caring for a pressure sore include
- Cleaning the sore so it is free of dead tissue, excess fluid drainage, and other debris. If this is not done, healing can be slowed. An infection may result.
- Removing dead tissue and debris. After the sore is cleaned, a doctor or nurse may suggest a wet-to-dry dressing. They may also suggest enzyme medicines to dissolve dead tissue. A special dressing may be left in place for a few days to help your body’s own enzymes dissolve dead tissue.
- Dressing the pressure sore. The choice of dressing is based on what will best aid healing, how often dressings will be changed, and whether the sore is infected.
Good nutrition
Eating a balanced diet will help your pressure sore heal. It will also prevent new sores from forming. You and your doctor, dietitian, or nurse should review any other health problems you have (such as diabetes or kidney problems) before designing a special diet.
How can I maintain good body positioning while in a bed or a chair?
Your position is important to relieve pressure on the sore and prevent new sores. You need to change positions often whether you are in a bed or a chair.
In bed
- Do not lie on the pressure sore. Use foam pads or pillows to relieve pressure on the sore.
- Change positions at least every 2 hours.
- Do not rest on your hipbone when lying on your side. A 30-degree position is best.
- When lying on your back, keep your heels up off the bed by placing a thin foam pad or pillow under your legs from mid-calf to ankle.
- Do not use donut-shaped (ring) cushions. They reduce blood flow to tissue.
- Use pillows or small foam pads to keep knees and ankles from touching each other or the bed.
- Raise the head of the bed as little as you can. Raise it no more than 30 degrees.
- Use the upright position during meals to prevent choking.
In a chair or wheelchair
- Use cushions designed to relieve the pressure on sitting surfaces.
- Avoid sitting directly on the pressure sore.
- Bend at the waist at a 90 degree angle. Keep your ankles in a comfortable position on the floor or footrest. Rest your elbows, forearms, and wrists on arm supports.
- If you cannot move yourself, have someone help you change your position at least every hour. If you can move yourself, shifting your weight every 15 minutes is even better.
How will I know if my pressure sore is infected?
Healing may slow if the pressure sore becomes infected. Infection from the sore can spread to other tissue (cellulitis), to underlying bone (osteomyelitis), or throughout the body (sepsis). These complications demand medical attention. If you note any of the signs of infection listed below, call your doctor right away. These signs include
- Thick green or yellow drainage.
- Foul odor.
- Redness or warmth around the sore.
- Pain in the area of the sore.
- Swelling around the sore.
- Fever or chills.
- Weakness.
- Confusion or difficulty concentrating.
- Rapid heartbeat.
How will I know if my pressure sore is healing?
The best time to check the healing of your pressure sore is after cleaning it. Signs of healing include decreased size and depth of the sore and less drainage. You should see signs of healing in 2 to 4 weeks. Infected sores may take longer to heal.
What signs or symptoms should I report?
Tell your doctor or nurse if
- The pressure sore is larger or deeper.
- More fluid drains from the sore.
- The sore does not begin to heal in 2 to 4 weeks.
- You feel increased pain around the sore.
- You see signs of infection.
References
AHRQ, Agency for Healthcare and Quality, United State Department of Health and Human Services, Consumer Guideline Number 15, AHCPR Pub. No. 95-0654:
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: 05/14/2013
Copyright © 05/14/2013 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#6616
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