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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, or ankles.

What causes pressure ulcers?

  • 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 can begin to cause damage to your skin and tissue within 2 hours.

  • Shearing or friction: Shearing or friction happens when delicate skin is dragged across a surface, such as sheets. This may cause your skin to tear or a blister to form. Fragile skin can tear if it is moved up or down in bed or moved from the bed to a chair. Your skin can also tear when muscle spasms cause your arms or legs to jerk and rub the sheets.

What increases my risk for a pressure ulcer?

  • Incontinence: Incontinence occurs when you cannot control when you urinate or have bowel movements. You may be at risk for pressure ulcers if you sit or lie in urine or bowel movement.

  • 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 tissue and fat over bony areas of your body. Less padding may increase the pressure over a bony area.

  • Lack of movement: Pressure will build on body areas if you stay in a chair or bed most of the time. The risk that an ulcer will form increases the longer you leave pressure on a bony area. Medical conditions that may lead to a lack of movement include spinal cord injury, stroke, and hip fracture.

  • Numbness: Your skin may become damaged without your knowing it. Medical conditions that may cause numbness include multiple sclerosis and 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.

What are the stages of a pressure ulcer?

Caregivers use stages to describe how severe 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. Your skin may feel warm, spongy, or tight when you touch it.

  • Stage 1: 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 2: 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 3: 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 4: 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.

What can I do to help prevent a pressure ulcer?

  • 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 2 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. They reduce blood flow to your tissues and increase your risk for a pressure ulcer. Ask your caregiver 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 if they get wet.

  • 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 caregiver tells you not to. Healthy liquids include water, milk, and juice. Ask your caregiver for more information about the right foods for you.

When should I contact my caregiver?

Contact 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.

  • 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. 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.

© 2014 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.

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