Pressure sores, also called bedsores and decubitus ulcers, occur when there is unrelenting pressure on the skin. This pressure interferes with blood flow, thus causing the skin to break down and form an ulcer. Any diseases or problems that lead to immobility can result in pressure sores. It is a common secondary problem in elderly patients.
Pressure points naturally occur over bony prominences or in areas where the bone is just beneath the skin, uncushioned by surrounding muscles and fat. Skin is also more susceptible to breakdown if it becomes wet and macerated. Friction caused by clothes against skin, skin against skin, or tugging and pulling on skin is a shearing force and also may cause the skin to break down.
The first indication of a bedsore is an area that is red but that pales (blanches) on touch. Common sites are over the pelvic area, the back, the outside of the hips, the heels, the bones on each side of the ankle, the elbows, and the back of the head. At the reddening stage, these changes are reversible.
All subsequent changes involve skin breakdown and the development of ulceration. If not attended to, the problem becomes one of successively deeper penetration of the ulcer. Secondary infections are common, spreading the damage and slowing the healing process.
Important Points in Treatment
Prevention of bedsores is the primary focus of attention. Passive movements are necessary for patients who cannot move themselves. It is best to set a 2-hour limit on resting without a position change. Even small bodily movements can help. A patient with only limited mobility may still make small adjustments in position that permit redistribution of the pressure placed on the skin, and this goes a long way toward the prevention of bedsores. Bony prominences need particular protection. Egg crate-like foam mattresses are a help in adjusting the distribution of pressure. Cushions made of similar material should be used when the patient is sitting for prolonged periods. These should replace pillows, which lack the ability to shift the focus of pressure. Rubber rings are not safe; they cut off circulation to the area inside the ring and can worsen bedsores. Sheepskin protectors (with the fleece on) for heels and elbows can be effective.
A variety of mattresses and beds designed to prevent bedsores are available. These can be expensive. Discuss any planned purchase with the patient’s physician to be sure that the mattress selected is appropriate for the patient’s problem and setting.
Good nutrition and scrupulous personal hygiene can help in keeping the skin clean and dry. This reduces the risk of ulceration. Patients with incontinence should have this problem addressed directly because the maceration caused may advance the problem of bedsores.
Should ulcers occur, their management requires careful nursing care. A formal management program that fits the patient’s setting and problem should be set up with the help of the patient’s physician and the participation of health care services.
Notify Our Office If ...
- The patient has any skin breakdown, particularly in areas over bony prominences.