How To Prevent Pressure Sores

GENERAL INFORMATION:

What is a pressure sore? Pressure sores are also called decubitus (dee-KU-bi-tus) ulcers or bedsores. A pressure sore is an injury to the skin and the tissue underneath it caused by pressure to the area. People who must stay in a bed or chair most of the time are most likely to get pressure sores. Pressure sores can happen anywhere on your body. They are most common over a bony or firm area, such as a hip, heel, elbow, ear, or ankle. Pressure sores can also happen over pressure points on the back of the head, at the bottom of the spine, or the scapula (shoulder blades). Even the weight of sheets and blankets can cause pressure sores on toes. A pressure sore is a serious problem, and can be difficult to heal.

What causes pressure sores? One or more of the following commonly causes pressure sores:

• Pressure: Pressure on the skin can hurt the skin and the layers of tissue underneath the area. When there is pressure on certain parts of the body, the tissue may not get enough blood. This may cause the tissue to become damaged, and even die. Damage to the tissue and skin from pressure can begin after one or two hours of staying in one position.
  
  
• Shearing, rubbing, or friction: Shearing happens when the skin is dragged across a surface. For example, being moved up in bed may cause skin shearing if the skin is pulled across the bed surface. A person may have friction on their skin, which is when the top layer of skin is removed. This may cause the skin to turn red, or feel like it is burning.

Who is at risk of getting pressure sores? Things that increase your risk of having pressure sores include:

• Being an older adult, or having had a pressure sore in the past.
  
  
• Being unable to move without help, or having movements that you cannot control.
  
  
• Having a severe (very bad) illness, or circulation (blood flow) problems.
  
  
• Having skin that is exposed to frequent wetness. This wetness can be from sweating a lot, from a draining wound, or from urine or BMs.
  
  
• Having to stay in bed or in a chair most or all of the time. This puts pressure on the same areas of skin over and over.
  
  
• Having a loss of feeling to part of the body can allow skin in that area to be damaged without you knowing it. Certain medical problems can cause loss of feeling in some areas of the body. Examples include a stroke, spinal cord problem, or nerve damage from diabetes.
  
  
• Having confusion or decreased mental alertness may make you unable to tell when you need to change positions.
  
  
• Using many medicines, or using a medicine that makes you less alert.
  
  
• Your body needs plenty of fluids and good nutrition to stay healthy and to heal. If you do not have a healthy diet, or do not drink enough liquids, your skin may be injured more easily. Also, losing too much weight can cause you to lose padding over bony areas of your body.

What are the stages of pressure sores? Caregivers use stages to describe pressure sores. How a pressure sore is treated may depend on its stage.

• Stage 1 - The skin is not broken but the color of the skin changes. The skin may turn purple, red, or darker than normal. Red areas that go away after pressure is removed are normal. The skin color changes of a Stage 1 pressure sore do not go away as easily. The redness of a Stage 1 pressure sore is non-blanchable, which means that the skin does not turn pale when you press on it. The skin may also feel firmer, warmer, or cooler than the skin around it. You may feel pain or itching in the area. At this stage, protecting the area from further pressure may treat the pressure sore.
  
  
• Stage 2 - The top layer of the skin and the skin just below it are damaged. The skin may be broken (like a scrape), have a blister, or cave inward.
  
  
• Stage 3 - The damage to the tissue has gone all the way into the fatty layer, and looks like a deep crater. The crater under the skin may be wider than the hole you see at the top of the skin.
  
  
• Stage 4 - The pressure sore is a very deep wound that goes all of the way down into muscle, or to the bone.

How can pressure sores be prevented? It is much easier to prevent a pressure sore than it is to heal one that has already started. Take care to protect your skin from friction, shearing and other stress. Do not massage (rub) the skin over bony areas. Other ways to protect the skin include:

• Check your skin several times a day. Check for redness over bony areas and areas that support a lot of body weight. These areas may include the elbows, heels, buttocks (rear-end), ankles, and hips. You can do this yourself with a mirror, or have someone look for you.
  
  
• Keep your skin dry. Moisture from sweating, wound drainage, or urine can increase the risk of skin damage. You may need to use underpads or briefs that are made of materials that soak up moisture. Underpads, briefs, bedclothes, sheets, and other materials that are next to the skin should be changed often. These items should also be changed right away after becoming wet, such as with BM or urine. Moisture barrier products can help protect areas of skin that are exposed to moisture. For example, someone with diarrhea or poor bladder control may need moisture barrier to the buttocks and groin area. Ask a caregiver if a moisture barrier product should be used.
  
  
• Keep your skin clean. Use mild soaps and warm (not hot) water to gently clean your skin. Do not rub hard or use force when washing your skin, and avoid harsh soaps and products with alcohol. These products can dry out your skin. Put lotion or a moisturizer on your skin often. Use a towel to gently pat your skin dry after cleaning it. Do not rub your skin when drying it with a towel.
  
  
• Other skin care tips:
  
  
  • Keep a written record of skin care and position changes. This will help you and your caregivers prevent pressure sores. This record can include notes about possible skin problems, and what is being done to treat the problem.
    
    
  • Do not use water-filled gloves or sheepskin (real or fake) when treating or preventing pressure sores.

What can I do to prevent pressure sores if I must stay in bed?

• Change positions frequently. When in bed, change the position of your entire body at least every one to two hours. Setting a kitchen timer may help remind you when it is time to turn. You may also want to make a written turning schedule to help you remember to turn. If you are helping a person move in bed, do not slide him. Lift him to prevent putting stress on the skin. You may use cornstarch on the sheets to help keep the skin from dragging on the sheets during movement. The head of the bed should be raised as little as possible, for as short a time as possible. This may help prevent damage to the skin from sliding down in bed. Talk to caregivers if you have breathing problems, or other health conditions that are more comfortable when you sit up.
  
  
• Protect the skin over bony areas. Do not rest directly on your hipbone when lying on your side. You can lean back into a pillow or foam wedge behind your back when lying on your side. This may decrease the pressure put directly on your hipbone. Use pillows or foam wedges to keep bony areas from touching one another. For example, put a pillow or foam wedge between your knees to keep them from pressing on one another. Keep your heels from touching the bed when lying on your back. Do this by putting a foam pad or a pillow under your legs from mid-calf to ankle. The pad or pillow should raise the heels enough to allow a piece of paper to slide between them and the bed. Never put a pillow under your knees.
  
  
• Using special equipment and pads. Using a "turn sheet" or a mattress pad under your buttocks and upper body may help others move you up in bed. An overhead trapeze can help you to change positions in bed. Special mattresses and overlays may help decrease the risk of pressure sores. Examples include a foam mattress pad, or special air or water mattresses. Ask your caregiver for more information about special equipment that may be right for you.
  
  
• Other tips for protecting your skin while in bed: Keep the bottom sheet of the bed free of wrinkles. Make sure there are no hard items in the bed, such as crumbs or hairpins. Avoid clothing that has buttons, zippers, or thick seams that could put pressure on your skin. Ask your caregiver for more information about exercises you can do in bed. Exercising helps the blood flow to your skin. If you are at high-risk of getting pressure sores, do not sit in a chair for longer than two hours at a time. If you use a lift or a sling to move in bed, remove the sling and equipment from underneath you right after you are moved.

What can I do to prevent pressure sores while I am in a chair or wheelchair?

• Pay special attention to your positioning. Sit up straight in a chair or wheelchair. Change your position every hour. If you can move yourself in the chair, shift your weight from one side to the other every 15 minutes. Setting a kitchen timer may help remind you and caregivers when it is time to change positions. Make sure your feet are supported, and not hanging freely. Ask your caregiver for more information about exercises you can do while in the chair. Exercising helps the blood flow to your skin.
  
  
• Use special equipment and pads. Use seat pads that are specially made to decrease pressure on your buttocks and hips. These pads are made of things like foam, gel, water, or air. Do not sit on donut-shaped or ring cushions.

Can what I eat and drink help prevent or treat pressure sores? Eating the right amounts of protein and calories (energy) is very important to prevent or heal pressure sores. Eat regular meals and snacks each day. Drinking plenty of liquids may also help to prevent or heal pressure sores. Drink at least eight (8-ounce) cups of healthy liquids each day, unless your caregiver tells you not to. Healthy liquids include water, milk, and juices. Eat foods that are high in protein each day. Examples include meat, poultry, fish, dairy products (milk, yogurt, and cheese), and beans. You may also try nutrition shakes for extra calories and protein if you have trouble eating or are underweight. Eating foods that are good sources of vitamin C and zinc may also help to heal or prevent pressure sores. Some good sources of vitamin C are oranges, broccoli, and strawberries. Oysters, red meat, nuts, and poultry are examples of foods that are high in zinc. Ask your health caregiver or dietician (deye-e-TISH-an) for more information about what kind of diet is right for you.

When should I call a caregiver? If you have any signs of skin damage, call a caregiver right away. Signs of skin damage may include:

• Skin color changes, such as areas of redness, or purple or blue areas. These areas may be harder to find on dark-skinned people.
  
  
• Skin over a bony area that feels firmer, warmer, or colder than the skin around it.
  
  
• Calluses, cracked skin, or dry areas.
  
  
• Skin that caves inward, begins to swell, or has a blister. The skin may have a new shiny appearance.

Risks: Preventing pressure sores is very important. Pressure sores can be hard to heal once they start. They can cause pain and discomfort. If a pressure sore gets bad, you may need to stay in the hospital. You may get a bad infection (in-FECK-shun) because of your pressure sore. A pressure sore can take weeks to months to heal, or may not heal at all. A pressure sore can be very serious, even life threatening.

For more information:

• Wound Ostomy and Continence Nurses Society
  Web Address: www.wocn.org
  

• American Academy of Wound Management
  1255 23rd St. NW, Suite 200
  Washington, DC 20037
  Phone: 1-202-521-0368
  Web Address: http://www.aawm.org
  

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

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