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Definition A pressure ulcer is an area of
skin and tissue that becomes injured or broken down. Generally, pressure ulcers
occur when a person is in a sitting or lying position for too long without
shifting his or her weight. The constant pressure against the skin causes a
decreased blood supply to that area. Without a blood supply, the area cannot
survive and the affected tissue dies.
The most common places for
pressure ulcers are over bony prominences (bones close to the skin), such as the
elbow, heels, hips, ankles, shoulders, back, and the back of the head.
Considerations
While it
is more common for people to get pressure ulcers if they spend most of their
time in bed or use a wheelchair, people who can walk can also get pressure
ulcers when they are bedridden as a result of an acute illness or injury.
Causes
Factors
which increase risk for pressure ulcers include:
- Age -- elderly people are at
higher risk
- Inability to move certain
parts of the body without assistance, such as with spinal or brain injury
patients, and patients with neuromuscular diseases
- Malnourishment
- Being bedridden or in a
wheelchair
- Having a chronic condition,
such as diabetes or artery disease, that prevents areas of the body from
receiving proper blood flow and nutrition
- Urinary incontinence or bowel
incontinence (moisture next to the skin for long periods of time can cause
skin irritation that may lead to skin breakdown)
- Fragile skin
- Mental disability from
conditions, such as Alzheimer's (some patients may not be capable of taking
the proper steps toward prevention and may not seek appropriate treatment when
an ulcer has formed)
Symptoms
The
National Pressure Ulcer Advisory Panel (NPUAP) created a process for evaluating
pressure sores based on a staging system from Stage I (earliest signs) to Stage
IV (worst):
- Stage I:
A reddened area on the skin that, when pressed, is "non-blanchable" (does not
turn white). This indicates that a pressure ulcer is starting to develop.
- Stage II:
The skin blisters or forms an open sore. The area around the sore may be red
and irritated.
- Stage III:
The skin breakdown now looks like a crater where there is damage to the tissue
below the skin.
- Stage IV:
The pressure ulcer has become so deep that there is damage to the muscle and
bone, and sometimes tendons and joints.
First Aid
Once a
pressure ulcer is identified, certain basic steps must be taken immediately.
These include:
- Relieving the pressure to that
area. Use pillows, special foam cushions, and sheepskin to help reduce the
pressure.
- Treating the sore. Treatment
will be based on the stage of the ulcer. Your health care provider will give
you specific treatment and care instructions.
- Avoiding further trauma or
friction. Powdering the sheets lightly can help decrease friction in bed.
(There are many items made specifically for this purpose -- check a medical
supplies store.)
- Focusing on improving
nutrition and other underlying problems that may affect the healing process.
- If the pressure ulcer is at
Stage II or worse, your health care provider will give you specific
instructions on how to clean and care for open ulcers, as it is very important
to do this properly to prevent infection.
- Keep the area clean and free
of dead tissue. Your health care provider will give you specific care
directions. Generally, pressure ulcers are rinsed with a salt-water rinse that
removes the loose, dead tissue. The sore should be covered with special gauze
dressing made for pressure ulcers.
Do Not
- Do NOT massage the area of the
ulcer because massage can cause tissue damage under the skin.
- Donut-shaped or ring-shaped
cushions are NOT recommended because they can interfere with the blood flow to
that area and cause complications.
Call immediately for emergency medical assistance if
The
patient's health care provider should be contacted immediately if there are any
signs that the pressure ulcer is getting infected. An infection can lead to
serious problems because the infection can spread to the rest of the body. Some
of the signs of an infected pressure ulcer include:
- A foul odor from the ulcer
- Redness and tenderness around
the area of the ulcer
- The skin close to the ulcer is
warm and swollen
If the patient starts running a
fever or have other symptoms, such as weakness or confusion, he or she may be
developing a systemic infection that can be very serious.
Prevention
Education
of at-risk patients and their families is the most productive way to prevent
pressure ulcers. Steps toward prevention include:
- Identifying individuals at
high risk for pressure ulcers.
- Ensuring that immobile
patients change their position at least every two hours to relieve pressure.
- Using items that can help
reduce pressure caused by bed sheets and wheelchairs (e.g., low air-loss
mattress system, pillows, cushions, foam padding ).
- Making sure patients eat
healthy, well-balanced meals.
- Encouraging daily exercise,
including range-of-motion exercises for immobile patients.
- Following good skin care,
including inspecting the skin every day and keeping skin clean and dry.
Incontinent people need to take extra steps to limit areas of moisture.
Children who are destined
to spend years in a chair should be taught at an early age to do push-ups
while in the chair and shift their weight often. |
