| Joan Carter 2005-08-19, 10:53 pm |
| Pressure Ulcers or bedsores as some call them have several contributing causes.
The main culprit is lack of movement, e.g. those who are bedridden or sit in a
wheelchair for much of the day. An ulcer can be caused by severe pressure for a
short time or less pressure over a prolonged period of time. Often the first
sign is a red area on a pressure point. Underlying damage may be more severe
than indicated on the surface.
Pressure ulcers are staged from 1 to 4. The time to catch one is when it is
stage 1, a red area of skin that does not blanch, or turn white, when pressed.
This is when measures must be instituted to halt the progress.
The most common areas are, first and foremost, the hip area, next is the sacrum,
or tail bone. Other areas are the heel and the ankle. Elbows are a potential
area, in fact any area when a bony prominence is in contact with a hard surface.
They can even appear on the knee, chin or back of the head. I have seen the
latter in babies in NICU.
Prevention is of vital importance. People in wheelchairs should change position
at least every 20 minutes. Bed patients should turn or be turned every 1 to 2
hours. Bony prominences should be protected. Skin should be kept dry. Nutrition
is important. A malnourished person is more apt to develop pressure ulcers. If
you cannot move yourself make sure your caregiver does not drag you when moving
you. This cause friction and shear. Avoid sliding down in bed or in a chair. A
person with impaired sensory perception is at risk because he or she may not
feel pain in an area that is under pressure. Age is also a factor. Other things
such as depression, low blood pressure and smoking can be associated with
pressure ulcers. As one ages the skin becomes thinner and more fragile. A
severely depressed person may not be motivated to move or to eat enough. Smoking
can lead to poorer oxygenation of the blood.
There are many aids available now to reduce or relieve pressure. Pressure
reduction cushions and mattresses help to decrease the amount of pressure. These
are foam or gel cushions or mattresses. However, some people need more than
this, and this is when a pressure relief cushion or mattress is needed. These
are cushions like RoHo which are air-filled cells that can be individually set
for each person. Mattresses that have an air flow are an example of this. These
items are very expensive, but vital if one is severely limited in movement or
already has pressure ulcers. Sometimes a mattress overlay can be used instead of
purchasing an entire mattress.
If a special cushion or mattress is needed it is essential to consult a
professional. This could be an occupational therapist, a physiotherapist or a
wound care specialist. People who work in mobility care retail outlets can be
helpful, but you should have a consultation with an expert.
Items and practices that do NOT help, but have endured are:
Frequent rubbing of red areas. This causes more pressure and friction.
"Toughening" the skin with things like Tincture or Benzoine, or Friar's Balsam.
Egg crate mattresses or cushions. These may afford a false sense of security by
offering some comfort, but do not reduce pressure. Foam cushions or mattresses
need to have at least 4-6 inches of foam to reduce pressure, and several types
of foam are needed to distribute weight on pressure points. Again, these can
reduce, but not relieve pressure.
Sheepskins, same as egg crates. Sheepskin can hold moisture against the skin,
making things worse.
Foam or rubber rings or donuts are a definite no-no. They concentrate pressure
on the surrounding tissue.
In summary, there are many factors that contribute to formation of pressure
ulcers. There are also many items available that can help. The selection is
mind-boggling. There are new devices on the market all the time. One needs an
evaluation by a professional to see what is needed, to save money, and get the
best choice.
I hope this helps. If you have specific questions please feel free to e-mail me
at jcarter at ripnet dot com. I was an ET nurse (enterostomal therapy nurse) for
the last years of my profession, working most with colostomies and wound care.
Prevention is of utmost importance.
I can give you names of wound care nurses if you are in Canada, if you are in
the US, you need to ask for referral to one of the professionals I mentioned
above. The Wound, Ostomy and Continence Nurses are a great source. I have been
to conferences where some of these people have spoken and they are awesome. Our
main textbooks for the ET course I took were written by members of WOCN.
Joan Carter, BN ET
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Joan
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