Dakota Travel Nurse Home Care

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How to Prevent and Care for Bedsores

Elderly womanBedsores, or more accurately “pressure sores,” are easier to prevent than to treat, but when a person is confined to bed or a wheelchair and can’t move about easily, prevention can take constant vigilance. Both prevention and care can be very time-consuming and difficult, and they may require more assistance than the immobile person or family care givers can give. The entire care team needs to be aware of the risk of bedsores. 

This blog should not be considered medical advice, only a summary of the possible causes, symptoms, treatment and risk factors involved in this common source of discomfort, infection and even a life-threatening condition. If you suspect that you, a loved one or a patient has a pressure sore, you should contact a physician. Before doing so, you can be armed with the excellent information from professionals and the illustrations contained in these two articles:

Taking Care of Pressure Sores, from the University of Washington Medical School website
Bedsores (pressure sores), from the Mayo Clinic website

Definition

Bedsores—also called pressure sores or pressure ulcers—are injuries to the skin and underlying tissue most commonly resulting from prolonged pressure on the skin. Other causes include friction or shear (when two surfaces move in opposite directions.) They most often develop on skin that covers bony areas of the body, such as the heels, ankles, hips and tailbone, but they can also develop on the backs of the arms or legs, the ear or other parts of the head. Probably the first sign is discomfort and any redness or break in the skin that can’t be explained otherwise. Constant pressure prevents blood from getting to the skin so the skin dies. Damage to the spinal cord may keep pain messages from reaching the brain, increasing the risk and decreasing the chance of detection.

Other factors that increase the risk of bedsores

  • Age: The skin of older adults is generally more fragile, thinner, less elastic and drier than the skin of younger adults. Also, older adults usually produce new skin cells more slowly.
  • Weight loss.Weight loss is common during prolonged illnesses. The loss of fat and muscle results in less cushioning between bones and a bed or a wheelchair.
  • Poor nutrition and hydration.People need enough fluids, calories, protein, vitamins and minerals in their daily diet to maintain healthy skin and prevent the breakdown of tissues.
  • Excess moisture or dryness.Skin that is moist from sweat or lack of bladder control is more likely to be injured. Very dry skin also increases risk from friction.
  • Bowel incontinence.Bacteria from fecal matter can cause serious local infections and lead to life-threatening infections affecting the whole body.
  • Reduced blood flow.Health problems such as diabetes and vascular disease, increase the risk of tissue damage.
  • Smoking: Smoking reduces blood flow and limits the amount of oxygen in the blood. Smokers tend to develop more-severe wounds, and their wounds heal more slowly.

Four Stages

Bedsores are usually described as being in one of four stages, based on their severity. In Stage 1, the skin is not broken, appears red and doesn’t briefly lighten when touched. The site may be tender, even painful, and be a different temperature than the surrounding skin. See the recommended articles for a detailed description of each stage, but if you notice early signs or symptoms of a pressure sore that doesn’t improve in 24-48 hours after a change in position, contact a physician. Don’t wait until the area looks like a blister or becomes an open sore that drains or smells bad.

Preventing Additional Damage while in Stage One

  1. Keep pressure off the sore area.
  2. Maintain good hygiene. Wash with mild soap and water, rinse well, pat dry carefully (but gently). Do not rub vigorously directly overthe wound.
  3. Evaluate the patient’s diet – enough protein, calories, vitamins A and C, zinc and iron are necessary for healthy skin.
  4. Examine the mattress, wheelchair cushion, transfer methods, pressure points, and turning techniques for possible cause of the problem. 

Complications caused by advanced-stage pressure sores

Pressure sores should not be ignored, as they can cause possibly life-threatening complications:

  • Infection that spreads to the blood, heart, bone
  • The need for prolonged bed rest
  • Amputations
  • Autonomic dysreflexia (an over-active Autonomic Nervous System, which causes an abrupt onset of excessively high blood pressure)

Reapplying pressure

Only when a bedsore is completely healed can pressure be reapplied to the area. ­Complete healing means that the outer layer of skin is unbroken and normal coloring has returned to the area. The first time pressure is applied to a newly healed area, it must be for a very short time (15 minutes at most). Then remove pressure from the area and inspect it for redness that doesn’t fade in 15 minutes or less. Wait at least one hour and repeat pressure application. After three successful 15-minute trials, increase to 30 minutes and repeat the above process using the guideline of a 15-minute or less fading time as a successful trial. After three successful 30-minute trials, you may increase the time by 30 minutes each day. If at any length of time a trial is not successful, continue at that level until three successful trials are observed. In this way, skin pressure tolerance will be gradually rebuilt.

Call Dakota Travel Nurse Home Care for Help

Bedsores may still develop in those who can’t move about freely, even with consistent, appropriate preventive care. A doctor and other members of your care team can help develop a good strategy, whether it’s personal care with at-home assistance or professional care in-home or in a hospital. DTN Home Care can provide many services that my make hospitalization unnecessary. Call us today at 701.663.5373 for a free consultation.

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