About Pressure Sores

Published: May 2, 2005  |  Source: spinalcord.org
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A Pressure Sore (or bed sore) is an injury to the skin and tissue under it. Sitting or lying in the same position will begin to cut off the flow of blood to that area, blocking oxygen and vital nutrients from maintaining healthy tissue. When the tissue becomes starved to too long a period of time it begin to die and an pressure sore starts to form.

Pressure sores will also be referred to as pressure ulcers or decubitus ulcers. Damage from a pressure sore will range from slight discoloration of the skin (stage 1) to open sores that go all the way to the bone (severe). The affected area may feel warmer than the surrounding tissue. In light-skinned people, the discoloration may appear as dark purple or red. In darker-skinned people, the discoloration will appear darker than the surrounding tissue.

A pressure sore is serious! It must not be ignored. With proper treatment, most pressure sores will heal. Healing depends on many things:

  • Your general health
  • Diet
  • Relieving pressure on the sore
  • Careful cleaning and dressing of the sore

The information on this page will help you to better work with the health care professionals by providing basic information about treating and preventing pressure sores.

The following information provides essential help on:

  • Learn how to prevent and treat pressure sores
  • Ask questions if you do not understand.
  • Explain your needs and concerns.
  • Know what is best for you.
  • Be active in your care.

Healing a Pressure Sore is a team effort. This team may be made up of many members that include doctors, nurses, dietitians, social workers, pharmacists and occupational/physical therapists. The most important members of the team will be yourself and your caregiver.

Your Role
You and your caregiver need to:

  • Know your roles in the treatment program.
  • Learn how to perform the care.
  • Know what to report to the doctor or nurse.
  • Know how to tell if the treatment works.
  • Help change the treatment plan when needed.
  • Know what questions you want to ask.
  • Get answers you understand.

To develop a treatment plan that meets your needs, your team members will need to know information about:

  • Your general health.
  • Illnesses that might slow healing (such as diabetes or hardening of the arteries).
  • Prescription or over-the-counter medicines you take.
  • The emotional support and physical assistance available from family, friends, and others.

Your caregiver, doctor or nurse will perform a physical exam and check the condition of your Pressure Sore to decide how to care for it. If you have had a pressure sore before, tell the team members what helped it heal and what didn’t help.

Your emotional health is also important. Be sure to share information about stresses in your life as well as health beliefs and practices. This will help your care team design a treatment plan that meets your personal needs.

The treatment plan will be based on the results of your physical exam, health history, personal circumstances, and the condition of the sore (how it looks).

This plan will include specific instructions for:

  • Taking pressure off the sore.
  • Caring for the pressure sore by cleaning the wound, removing dead tissue and debris, and dressing or bandaging the area.
  • Aiding healing by making sure you get enough calories, protein, vitamins, and minerals.

Note to Caregivers
Although patients should be as active in their care as possible, you may need to provide much or all of their care. As a result, you may find you have questions or problems. If so, ask for help. Talk to the other member of the team.

Remember that patients who must be in a bed or chair for long periods don’t have to get pressure sores. Pressure sores can be prevented and sores that have formed can be healed.

There are three basic principles to the process of helping a Pressure Sore heal.

  • Pressure Relief
  • Care of the Sore
  • Good Nutrition

Pressure Relief
Pressure sores form when there is constant pressure on certain parts of the body. Long periods of unrelieved pressure cause or worsen pressure sores and slow healing once a sore has formed. Taking pressure off the sore is the first step toward healing.

Pressure sores usually form on parts of the body over bony prominences (such as hips and heels) that bear weight when you sit or lie down for a long time.

You can relieve or reduce pressure by

  • Using special surfaces to support your body.
  • Putting your body in certain positions.
  • Changing positions often.

Support surfaces
Support surfaces are special beds, mattresses, mattress overlays, or seat cushions that support your body in bed or in a chair. These surfaces reduce or relieve pressure. By relieving pressure, you can help pressure sores heal and prevent new ones from forming.

You can get different kinds of support surfaces. The best kind depends on your general health, if you are able to change positions, your body build, and the condition of your sore. You and your team members can choose the surface best for you.

Hand Check
One way to see if a support surface reduces pressure enough is to do a “hand check”. The caregiver places his or her hand under the support surface, beneath the pressure point, with the palm up and fingers flat. If there is less than 1 inch of support surface between the pressure point of the body and the caregiver’s hand, the surface does not give enough support.

Your position is important to relieving pressure on the sore and preventing new ones. You need to switch positions whether you are in a bed or a chair.

While In Bed

  • Do not lie on the Pressure Sore. The use of pads or pillows to position the body will help relieve the pressure on specific areas.
  • Change positions at lease every 2 hours.
  • Avoid lying directly on the hip bone. A 30-degree position is best.
  • When lying on your back, keep your lower legs up by placing a thin foam pad or pillow under the lower part of the legs (midcalf to ankle).
  • Do not place the pad or pillow directly under the knee as this will reduce the flow of blood to the lower leg areas.
  • Do not use donut shapped cushions as they will reduce the flow of blood.
  • Use pillows or small pads to keep the knees and ankles from touching
  • Raise the head of the bed as little as possible (30 degrees or less)
  • Feed meals in an upright position to prevent choking.