How To Prevent Pressure Ulcers

WHAT YOU SHOULD KNOW:

• 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. Pressure ulcers are caused by pressure, shearing, or friction to the skin. Pressure slows down or stops the blood flowing to the skin. Shearing or friction causes the skin to tear or blister when the skin is dragged across a surface. People who are in a bed or wheelchair most, or all, of the time are at high risk. Adults over 65 years of age and people who have trouble moving are also at high risk.
  
  
• There are many things you can do to help prevent a pressure ulcer. Keep your skin clean and dry and check it every day for areas of redness. Change your position often. Pad your bony areas with special pads while in bed or the chair. These special pads may be filled with foam, air, gel, or water. Eat a diet high in protein and calories and drink lots of healthy liquids, such as water. Taking these steps may help prevent a pressure ulcer.

AFTER YOU LEAVE:

Take your medicine as directed:

Call your primary healthcare provider if you think your medicine is not working as expected. Tell him if you are allergic to any medicine. Keep a current list of the medicines, vitamins, and herbs you take. Include the amounts, and when, how, and why you take them. Take the list or the pill bottles to follow-up visits. Carry your medicine list with you in case of an emergency. Throw away old medicine lists.

Ask for information about where and when to go for follow-up visits:

For continuing care, treatments, or home services, ask for more information.

The stages of a pressure ulcer:

If you get a pressure ulcer, caregivers use stages to describe how severe (bad) 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, 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.

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
  

CONTACT A 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.

Copyright © 2012. Thomson Reuters. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

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 (Discharge Care)