Information From Your Health Care Provider

SORES, PRESSURE

(Bed Sores; Decubitus Ulcers)

Basic information

description

Pressure sores are areas of damaged skin caused by pressure. The most common places for the sores are over bony areas. These include the lower back, buttocks, elbows, knees, shoulders, heels, or ankles. They can affect all ages, but occur most often in the elderly.

FREQUENT SIGNS & SYMPTOMS

Spots of the skin that are red and shiny. Spots progress to blisters, then ulcers (deep sores), leading to a breakdown of tissue under the ulcer.

causes

Constant pressure on the skin, especially over the bony areas. Pressure reduces the blood supply, causing death in the tissue layers. Pressure sores usually develop in persons who cannot move because of chronic illness or disability that confines them to bed.

risk increases with

Elderly.
People who are frail, disabled, ill, or immobile.
Being confined to bed or a chair for long, or even short periods of time. Sores can start within 24 hours.
Poor nutrition, impaired blood circulation, or poor mental or sensory function.
Surgery, cast or splint, anemia, weak immune system, urinary or stool incontinence, and others.

PREVENTIVE MEASURES

Provide good nursing care for the disabled.
Daily skin inspection in good light. Frequent changes of position in bed or wheelchair (may need hourly).
Keep skin clean. Clean the skin of any urine or fecal matter as soon as possible. Apply moisturizers.
Maintain good nutrition (e.g., vitamins and protein).

expected outcomes

Usually curable with treatment. Sores heal in 2 to 4 weeks, or sometimes longer. Healing time varies with the site and size of the ulcer and the patient's health.

possible complications

Serious infections of bone (osteomyelitis), skin (cellulitis), or whole body (sepsis).

diagnosis & treatment

general measures

Your health care provider can diagnose a pressure sore by an exam of the affected area. The diagnosis includes a stage (1 to 4) depending on the severity.
Treatment involves relieving the pressure, treating the sores, and improving nutrition, or other conditions. Your health care provider will discuss the steps to take.
Relieve pressure by not lying on the sores. Other options include protective, soft padding, such as gel flotation pads or sheepskin, over the affected area.
A water mattress, egg-crate rubber mattress, alternating-pressure mattress, or special airbed may be recommended.
Clean the area with mild soap and warm water and pat dry. Avoid harsh soaps, tincture of benzoin, or hexachlorophene. Cover the sore with bandage or dressing.
Apply a skin product if prescribed. Apply a thin layer of the cream, ointment, or lotion 3 or 4 times daily. Rub in gently for several minutes, until it disappears.
Special dressings for pressure sores may be prescribed.
Dead skin and tissue may need to be removed. This can be done in different ways and can be painful to the patient.

medications

Antibiotics will be prescribed if infection develops.
Ointments, dressings, and drying agents may be recommended.
Drugs for pain may be needed when dead skin tissue is removed.
Vitamin and mineral supplements may be needed.

activity

Change the position of an immobilized patient every 1 to 2 hours. A wheelchair patient should change position every hour.
Passive or active exercises (if the patient is able). Instructions will be provided by your health care provider or physical therapist.
Don't smoke. Find a way to quit that works for you.

diet

Normal, well-balanced diet that includes extra protein. Good nutrition is important in prevention and healing.

notify our office if

You or a family member has symptoms of pressure sores or observe them in someone else.
The following occur during treatment:
- Skin sores become worse or don't improve.
- Signs of infection, such as pain, redness, tenderness, swelling, or increased warmth of the affected area.
- Fever.