What are Pressure ulcers? You may have heard the term pressure sore, bed sore or decubitus ulcers, that are interchangeably used for pressure ulcers. Pressure ulcers are commonly seen in the elderly and disabled population of patients that are bedridden. Bedridden means that these people are physically unable to reposition themselves or get out of bed on their own. As a result of very minimal movement, prolonged pressure can develop in certain areas of the body, usually the bony prominences. The common areas are the heels, buttocks, tailbone, back of head, hips and ankles. The pressure will eventually restrict blood flow thereby creating different stages of pressure ulcers that would require changes in care management of the wound.
What are the different stages? The stages range from mildest to most severe.
The first stage is called a Stage 1 pressure ulcer. It is characterized by a non blanchable reddening of the skin in the affected area. This means that the affected area remains red when pressed down on and does not turn while. A Stage 2 pressure ulcer is created when the constant pressure leads to further skin breakdown and causes a partial thickness skin loss involving the epidermis and or dermis. With this ulcer, a shallow open area of the skin will reveal a red-pink wound bed. There can be open or ruptured blisters, pain and tenderness and possible swelling and warmth in the area. Stage 3 ulcers occur when the open ulcer extends through the full thickness of the skin and into the fat tissue. It can appear as a deep open wound. Debriding the dead tissue is important in this stage to facilitate wound healing. Lastly, a Stage 4 pressure ulcer is formed when the wound has extended past the full tissue and subcutaneously into the muscle, tendon and even bone. Possible eschar( dead tissue) or slough (yellow or white tissue) may be visible. There is a higher risk of infection with this wound as it can cause osteomyelitis (bone infection) and sepsis.
What causes pressure ulcers to form? There are a number of factors that contribute to the formation of pressure ulcers. The most common is pressure. People that are bedridden and have limited mobility are unable to reposition and offload pressure when laying or sitting by themselves. As a result, blood flow becomes restricted and impaired thereby causing a pressure ulcer. The second common factor that causes ulcers is due to moisture. Incontinence of urine and stool creates a moist environment in which the skin breaks down rapidly, as it makes the skin more susceptible to breakdown from friction and shear forces. Other factors causing pressure ulcers include: Malnutrition, immobility, advancing age, medical devices, obesity, and circulatory health diseases.
How to prevent pressure ulcers from happening? Prevention is key when suspecting a pressure ulcer. It is important to act fast and consistently. The main actions that are under your control include removing the pressure, keeping skin dry, and not applying friction and shearing forces. Here are some practical caring habits that can be implemented in your caregiving routine. - Use a mattress that has an offloading option or reposition the patient from side to side every 1 to 2 hours at minimum. A ROHO mattress is the gold standard if a patient has a significant stage 3 or 4 pressure ulcer as it will automatically offload pressure throughout the day and night. - Change incontinent pads immediately after being wet. If patient is unable to vocalize or comprehend that they have incontinence, check their pad every 2 to 3 hours. If soiled, change immediately. - Apply a barrier protectant lotion to the affected areas if it is a Stage 1 pressure ulcer is noted. - Remove unnecessary blankets and sheets from under the patient. Try to keep the surfaces smooth and wrinkle free. - Use sliding sheets when repositioning or boosting patients up in bed. Two person assist with repositioning is required with bedridden patients for safety for both you and the patient. - Nutrition should be taken seriously. Protein and vitamins should be offered at every meal to help with wound repair. Adequate amounts of these micro and macronutrients are essential in the wound healing process. If there is a lack of nutrients, the body will not prioritize wound healing and therefore significant wound delay will occur.
If a pressure ulcer is formed, how can you treat it? If a pressure ulcer were to develop, you must be able to identify the stage in order to provide the appropriate treatment. For example, a Stage 1 pressure ulcer would simply require you to provide ongoing monitoring for worsening of the skin, and implementing the prevention strategies diligently as mentioned above. For pressure ulcers that have developed into stage 2, 3 and 4. You will need to provide wound care. This should always be done by a health care professional. Care strategies such as cleansing and irrigating the wound with saline, applying packing into the wound, debriding necrotic tissue manually, applying the appropriate wound dressing as there are so many variations of dressings that have special considerations before use. Additionally, wound care management must have a follow up plan such as implementing a dressing change schedule and charting of the characteristics of the wound with each dressing change.
The goals of pressure ulcer management is always to: 1. Heal the skin back to normal functioning 2. Prevent surrounding skin from deteriorating3. Prevent infection
If you or someone you know needs assistance with their pressure ulcer management, we are here to help. We have nurses who are able to provide skilled wound care at various degrees of
need to you in the comfort of your own home .
Modern Day Home Health Care – 778 – 539 – 5300
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