Pressure ulcers, also known as bedsores, are areas of the skin where pressure cuts off blood flow and circulation to surrounding skin tissue. The weight from lying in bed or sitting in a wheelchair over several hours without moving causes the ulcers to form. People with decreased sensation or those with an inability to shift their bodies are at high risk for developing the sores. According to the Merck Manual, pressure ulcers begin to form in as little as two hours. The sores rapidly advance and cause severe, deep infectious wounds if left untreated. Nursing interventions and precautions prevent pressure ulcers from occurring.
Turn Every Two Hours
A person’s position should change every two hours to stop ulcers from forming. Changing positions is encouraged when a person is awake and asleep. If a person is bed bound, move the person from lying on his back to the left side, then the right side, and then back to his back. The Mayo Clinic encourages people to lie at a 30 degree angle when is on their side. Bedridden people left to lie on their back commonly forms pressure ulcers on their buttocks. Encourage mobility if possible. Do not raise the head of the bed more than 30 degrees to prevent the patient from sliding down the bed. Use pillows and assistive cushioning to keep proper positioning and body alignment.
Place soft cushioning between bony prominences. Ankles, wrists and other hard bone areas are common areas where pressure ulcers form. Attach sheepskin to hard surfaces touching the skin such as the sides of a wheelchair or bedrails. Apply soft wraps or cushioning made from cotton or wool to protect bony areas. Add specialized booties and ankle wraps for additional protection to specific joints. Support the legs by always placing cushioning below the knees; never place cushioning or pillows directly under the knees. Replace mattresses with specialty bedding containing water or gel. Frequent repositioning is still required with the use of any cushioning products.
Keep the skin dry and moisture free. Dry skin is less likely to stick together and form pressure ulcers. Wash the skin daily; use a washcloth and always pat skin dry. Apply noncaking body powder to areas of the skin touching each other, suggests the Merck Manual. Change bedsheets on a daily basis.
Inspect Skin Daily
Look at all areas of the skin daily. Inspect for areas of redness and warmth, the beginning signs a pressure sore is forming. Stage two signs include formation of craters and blisters. Do not allow a person to lie or sit on the affected area until the symptoms disappear. A person may not feel a pressure sore developing; asking her if an area is painful is not always conclusive in determining if a sore is forming. Often the skin is numb, and decreased sensation to the affected area is present.
- Mayo Clinic: Bedsores
- Merck Manual: Pressure Sores
- National Pressure Ulcer Advisory Panel: Pressure Ulcer Prevention
- Gerontologic Nursing; Sue Meiner and Annette Giesler Lueckenotte; 2006.