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by Keela A. Herr, PhD, RN and Rita Frantz, PhD, RN, FAAN
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Pressure ulcers, also called bed sores, can cause serious problems for older adults leading to pain and disfigurement, interference with the basic activities of daily living, and admission to a hospital or long-term care setting for treatment. There are ways, however, to prevent and treat this common and challenging problem.
What is a pressure ulcer and how is it caused?
A pressure ulcer is an injury to the skin and the tissue underneath it. It is caused by unrelieved pressure, rubbing or friction to an area of the skin. Damage can range from discolored, unbroken skin to deep wounds down to muscle or bone.
Where do pressure ulcers form?
They form where skin and underlying tissue is pressed against bone by body weight or some other form of pressure. The location of the wound depends on one?s positioning and the ability to move. For example, persons confined to bed usually develop ulcers on the lower back below the waist, on skin over the hip bone, and on the heels. Those in wheelchairs may have ulcers form on the skin over the knees, ankles, shoulder blades, elbows, back of the head and spine.
Are there risk factors that increase the chances of developing pressure ulcers?
Being confined to bed or a chair without the ability to change positions is a risk factor. Other conditions can increase the chance of developing pressure ulcers as well, such as loss of bowel and bladder control, poor nutrition and lowered mental function.
How can I prevent pressure ulcers, either on myself or a family member?
You should examine the areas of your body that are exposed to pressure and watch for reddened skin. Protect skin from extreme dryness or moisture by avoiding excessive bathing, applying moisturizers to keep skin from getting too dry, using pads to absorb wetness away from skin, cleaning skin as soon as possible after soiling from urine or stool, and applying creams or ointments to protect skin from urine, stool or drainage. Other strategies to prevent ulcer development include: limiting pressure over bony parts by changing positions at least every one-to-two hours; avoiding friction by lifting instead of dragging when moving; supporting the body and preventing contact of one body part with another with pillows or wedges; using a special mattress to reduce pressure, but avoid using donut-shaped cushions when sitting; and, eating a well-balanced diet that provides adequate protein and calories. You may need to ask your health care provider about nutritional supplements if eating a normal diet is not possible.
Do pressure ulcers ever heal? What can I do to speed-up the process?
Yes, pressure ulcers can heal, but it is a challenging process that may require a team of individuals working together, including you and your caregiver. You should provide useful information to your doctor or nurse about your general health, including: conditions you have that could slow healing (such as diabetes); a list of the prescription and over-the-counter medicines you take; and who is available to help carry out the treatment plan if you are residing at home.
What does the treatment plan include?
Treatment of pressure ulcers focuses on many of the same activities done to prevent them; for example, reducing or eliminating pressure from the sore, and eating a nutritious diet that includes adequate calories, protein, vitamins and minerals in order to promote healing. Specific care for the ulcer includes cleaning the sore and removing dead tissue, and applying a dressing or bandage to protect the area while it heals. Your health care provider should be consulted for specific instructions on diet, relieving pressure and changing positions safely, and for cleaning and dressing the ulcer.
Are there specific signs I should report that indicate complications with the pressure ulcer?
Two major problems can develop with pressure ulcers, even if the ulcer is cared for properly. Pain may occur in or near the pressure ulcer. Tell your health care provider so medicines can be provided if needed, especially if the pain occurs during dressing changes. The other problem that could develop is infection. If you note any signs of infection (such as green or yellow drainage, foul odor, redness or warmth around the sore, tenderness or swelling), call your health care provider right away.
What if the ulcer does not heal?
Other treatments might be considered. For example, a special procedure called electrotherapy might be recommended. This involves applying a very small electric current to the ulcer to stimulate healing. Surgery may be needed to repair damaged tissues if the sore is large or deep. In most cases, however, if proper treatment steps are followed, healing will take place.
Where can I find out more information about pressure ulcers?
Contact the following organization:
- National Pressure Ulcer Advisory Panel
12100 Sunset Hills Road, Suite 130
Reston, Virginia 20190
Phone: (703) 464-4849
Fax: (703) 435-4390
www.npuap.org
U.S. Department of Health and Human Services
Public Health Service, Agency for HealthCare Quality and Research,
Preventing Pressure Ulcers and Treating Pressure Sores. Patient Guides.
Clinical Practice Guidelines Numbers 3 & 15. To order, call: (800) 358-9295.
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