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How To Prevent Pressure Ulcers


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, or ankles.


The stages of a pressure ulcer:

Caregivers use stages to describe how severe the 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. 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 caregivers cannot decide the stage because dead tissue or scabbing covers too much of the wound.

Check your skin several times each day:

Check for red skin over bony areas. Use a mirror if you have trouble seeing certain areas, or ask another person to look.

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. Put a foam pad or a pillow under your legs from mid-calf to ankle to keep your heels from touching the bed when you lie on your back. Remove 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 primary healthcare provider for more information about special equipment that may be right for you.

Keep your skin clean, dry, and moisturized:

Use mild soaps and warm (not hot) water to clean your skin. Be gentle. Do not rub hard or use force when you wash your skin. Do not use soaps and other products that contain alcohol, because they can dry out your skin. Gently pat your skin dry with a towel. Do not rub with the towel. Put lotion or a moisturizer on your skin often.

Change wet bedding and clothes:

Change sheets, pads, and bedclothes right away after they get wet, such as with sweat or urine.

Eat healthy foods:

Foods that are high in protein may help prevent a pressure ulcer. Examples are meat, beans, and milk. 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 primary healthcare provider tells you not to. Healthy liquids include water, milk, and juice. Ask your primary healthcare provider for more information about the right foods for you.

Follow up with your healthcare provider as directed:

Write down your questions so you remember to ask them during your visits.

Contact your primary healthcare provider 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.

  • 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.

© 2015 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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.

Learn more about How To Prevent Pressure Ulcers (Aftercare Instructions)