Pressure ulcers, also called bedsores, commonly occur in bedridden or wheelchair-bound individuals, especially those who are paralyzed or comatose. Bony protuberances are the most common areas for ulcers, including the elbows, knees, heels and tailbone. Four different categories classify the severity of bedsores, according to the Merck Manual of Medical Information. Treatment for pressure ulcers depends on the extent of damage occurring to the skin and surrounding tissues. Preventing pressure ulcers is possible by frequently changing position to decease pressure on the body, and by frequently inspecting the skin.
Sustained Pressure
Pressure placed on the body without relief will cause the skin and surrounding tissues to break down. A pressure ulcer occurs because of restricted blood flow to the area of the body with the increased pressure. The lack of proper blood flow decreases the amount of oxygen and nutrients to the area, according to the Mayo Clinic. Without proper oxygen, blood and nutrients, the skin and tissue die and cause a bedsore to form. Sitting or lying on a bony portion of the body will begin the process of forming a pressure ulcer. Shifting body weight while sitting in a wheelchair and turning in bed at least every two hours are necessary to prevent the formation of a bedsore. Using proper cushions and pillows to support the body while lying in bed can help decrease the pressure.
Friction and Shear
Friction on the body from rubbing against sheets while turning may increase the risk of damaging fragile skin. Shearing occurs when the skin slides in one direction while the internal structures in the body, such as bone, move in the opposite direction. The shearing increases the possibility of pressure sores due to the stretching and tearing of blood vessels and cellular tissue, according to the Mayo Clinic. Using proper turning techniques decreases the possibility of causing a pressure ulcer. Decreasing the height of the bed protects a person from the friction and shear caused by sliding down against the sheets. Using lifting devices or extra bed linen, such as a draw sheet, may help decrease friction while turning a person in bed.
Moisture
Increased moisture--from perspiration or from incontinence--softens skin and increases the risk of developing a pressure ulcer. Moisture also increases friction and causes weakness and damage to the protective portion of the skin, according to the Merck Manual. Cleaning up immediately after incontinent accidents and using powders to decrease skin moisture help prevent bedsores.
Poor Hydration and Nutrition
Inadequate nutrition, decreased hydration and weight loss all increase the risk of developing a pressure ulcer. Proper nourishment and hydration helps maintain the integrity of the skin barrier. A diet lacking adequate amounts of calories, protein, vitamins and minerals--especially zinc and vitamin C--increases the risk of breakdown in the skin and surrounding tissues. Being underweight leads to decreased fat around the areas that commonly experience pressure ulcers.
