How To Prevent Pressure Ulcers

What is a pressure ulcer?

A pressure ulcer is an injury to the skin or tissue over a bony area. A pressure ulcer is also called a pressure sore, bedsore, or decubitus ulcer. Pressure ulcers may form over the bony areas on the back, hips, heels, buttocks (rear-end), or ankles.

What causes pressure ulcers?

One or more of the following may cause a pressure ulcer:

• Continuous pressure: Pressure happens when you sit or lie on a bony area for too long. Pressure on bony areas slows down or stops the blood from flowing to the skin. Pressure may hurt the skin and the layers of tissue underneath it. This may cause the tissue to become damaged, or even die. Pressure may begin to cause damage to your skin and tissue about two hours after staying in the same position.
  
  
• Shearing or friction: Shearing or friction happens when fragile (delicate) skin is dragged across a surface, such as sheets. This may cause your skin to tear or a blister to form. Sliding up or down in bed or moving from the bed to a chair may tear fragile skin. Muscle spasms may cause your arms or legs to jerk and rub the sheets, causing tears in your skin.

What increases my risk for a pressure ulcer?

• Age: You may be at risk if you are over 65 years old.
  
  
• Incontinence: Incontinence occurs when you cannot control when you urinate or have bowel movements (BMs). Incontinence causes you to leak urine or stool. You may be at risk for pressure ulcers if you sit or lie in urine or stool.
  
  
• Malnutrition and dehydration: Malnutrition means that your body is not getting enough calories and nutrients, such as protein and fat. Dehydration means that your body is not getting enough healthy liquids, such as water. Malnutrition and dehydration may cause your skin to be injured more easily. You may have less padding (tissue and fat) over bony areas of your body. Less padding may increase the pressure over a bony area.
  
  
• Lack of movement: Staying in a chair or in bed most, or all, of the time puts pressure on your bony areas. Increased pressure for long periods of time increases your chance of getting a pressure ulcer. Medical conditions that may lead to a lack of movement include a spinal cord injury, a stroke, or a hip fracture.
  
  
• Numbness: Numbness is when you have decreased or lost feeling in an area of your body. Your skin may become damaged without your knowing it. Medical conditions that may cause a loss of feeling include multiple sclerosis or nerve damage from diabetes.
  
  
• Previous pressure ulcer: You may have a higher chance of getting a pressure ulcer if you have had a pressure ulcer before.
  
  
• Smoking: Smoking harms your body in many ways. Smoking increases your chance of getting a pressure ulcer. You are more likely to have heart disease, lung disease, cancer, and other health problems if you smoke. If you have a pressure ulcer, smoking may keep a pressure ulcer from healing.

What are the stages of a pressure ulcer?

If you get a pressure ulcer, caregivers use stages to describe how severe (bad) a pressure ulcer is. Each stage of pressure ulcers will have different signs and symptoms. The stages of a pressure ulcer are as follows:

• Deep tissue injury: At this stage, the skin is not broken. You may see purple or red skin, or a blister, over a bony area, such as your hip or heel. Your skin may feel warm, spongy, or tight when you touch it.
  
  
• Stage one: At this stage, your skin is not broken, but it may itch or hurt. Your skin may feel warm, spongy, or tight when you touch it. The skin may stay red for more than an hour after pressure is removed from the bony area.
  
  
• Stage two: At this stage, the skin has broken. You may have an open sore and the area around it may be red and raw. Your skin may sink inward and look shiny or dry.
  
  
• Stage three: When the pressure ulcer gets to this stage, the tissue below your skin is damaged. The area looks like a deep crater, or bowl-shaped hole. There may be more damage hidden under the skin than what you can see.
  
  
• Stage four: At this stage, the sore is very deep and your tendons, muscle, and bone may be damaged. You may be able to see the tendons, muscle, and bone in the wound. Tendons are strong tissues that connect muscle to bone.
  
  
• Unstageable: This means it is hard for caregivers to see what stage your pressure ulcer is in. This is normally because there is a lot of dead tissue or scabbing in the wound.

What can I do to help prevent a pressure ulcer?

• Check your skin several times a day: Check for red skin over bony areas. Use a mirror if you have trouble seeing certain areas, or ask another person to look.
  
  
• Eat a healthy diet: A diet high in protein may help prevent a pressure ulcer. This includes foods, such as meat, chicken, beans, milk, yogurt, and cheese. Nutrition shakes may also give you extra calories and protein if you have trouble eating or are underweight. 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 juice. Ask your caregiver for more information about what kind of diet is right for you.
  
  
• Keep your skin clean, dry, and moisturized: Use mild soaps and warm (not hot) water to gently clean your skin. Do not rub hard or use force when washing your skin. Avoid soaps and other products with alcohol in them, because they can dry out your skin. Use a towel to gently pat your skin dry after cleaning it. Do not rub your skin when drying it with a towel. Put lotion or a moisturizer on your skin often.
  
  
• Change your position often: Change your position every two hours if you are in a bed all day. Change your position every hour if you are in a wheelchair all day. Set a kitchen timer to help remind you when it is time to turn. Keep a written turning schedule to help you remember to turn. If you are helping a person move in bed, lift him, do not slide him. Keep the head of the bed as low as possible. This may help prevent damage to the skin from sliding down in bed.
  
  
• Protect the skin over bony areas: Use pillows or foam wedges to keep bony areas from touching one another. 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 so that they are not touching the bed. Remove any extra sheets or bedding from underneath you. Make sure you are not lying or sitting on medical tubing, such as oxygen tubing or IV tubing.
  
  
• Use special equipment and pads: A draw sheet or large pad under you may help others move you up in bed. An overhead trapeze can help you change positions in bed. Special mattresses and overlays may help decrease the risk of pressure ulcers. Examples include a foam mattress pad, or special air or water mattresses. Use seat pads that are specially made to decrease pressure on your buttocks and hips. Do not sit on donut-shaped cushions. Ask your caregiver for more information about special equipment that may be right for you.
  
  
• Change wet bedding and clothes: Change sheets, pads, and bedclothes right away after they get wet, such as with sweat or urine.
  
  
• Lifestyle changes: Avoid drinking alcohol, because it may cause dehydration (not enough fluid in the body). Alcohol is found in beer, wine, whiskey, and other adult drinks. Smoking tobacco can damage your skin and slow wound healing. If you smoke, it is never too late to quit. Ask your caregiver for information if you need help quitting smoking.

For more information:

Contact the following:

• American Academy of Family Physicians
  11400 Tomahawk Creek Parkway
  Leawood , KS 66211-2680
  Phone: 1- 913 - 906-6000
  Phone: 1- 800 - 274-2237
  Web Address: http://www.aafp.org
  

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

When should I call my caregiver?

Call your caregiver if:

• You have a fever.
  
  
• You see red or purple skin over a bony area that does not go away.
  
  
• You see a blister or open sore over a bony area.
  
  
• You have an open sore over a bony area that looks like a deep crater (hole).
  
  
• You have green or yellow drainage or a bad smell coming from a sore on a bony area.
  
  
• You have questions or concerns about pressure ulcer prevention or care.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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