Cancer patients suffer a number of uncomfortable side effects from their treatments, whether surgery, chemotherapy, radiation or a combination. One of the most challenging to treat is a decubitus ulcer, also known as a pressure sore, bed sore or butt sore. Because of the patient's weakened condition, difficulty in moving and shifting weight, decreased nutritional status and weight loss, pressure ulcers occur frequently in this population. Treating pressure sores calls for a consistent, conscientious approach and adherence to basic principles of positioning.
Step 1
Determine the exact location of pressure areas for the patient. Ask him basic questions: Do you prefer to sleep on your back or your side? Do you sleep with your head and back slightly elevated? How often do you turn over? How often do you stand up or change chairs? The patient who does not stand and who lies on his back has an increased risk of pressure ulcers on his tailbone or butt bones. Visually inspect the patient's skin, paying attention to the skin around bony areas including the hip bones, spine, elbows and heels. Skin that appears red or feels hot to the touch signals imminent pressure issues.
Step 2
Review the type of materials on which the patient sits or sleeps. She should always sit on a pressure-relieving, padded surface. Change the toilet seat to a padded commode seat. Put a gel pad or memory foam pad on patient's chair. Make sure the bath chair has a padded seat, or attach a sealed gel pad to it. You will find them at pharmacies and medical-supply companies. Put a memory mattress overlay on the bed. Use soft cotton sheets on the patient's bed..
Step 3
Monitor what the patient wears. Light, soft cotton clothing with few seams reduces the chance of pressure from fabrics against delicate skin. Avoid heavy fabrics including denim, leather and those that do not easily breathe such as dense synthetics.
Step 4
Help the patient to shift his weight or move to a different position every two hours. Set a timer to help you remember. If the patient is sleeping on his back, help him to turn on his side or stand for at least five minutes. Weight shifting increases blood flow in bony areas where sores occur.
Step 5
Learn proper techniques to assist the patient with transferring from bed to chair, wheelchair to vehicle and the like. One of the causes of sores in addition to pressure is skin shearing as it is rubbed against fabric or upholstery when the caregiver transfers the patient. Use a transfer, or gait, belt to stand the patient, or use a padded transfer board to slide the patient from place to place.
Tips and Warnings
- Monitor the patient's skin condition on a daily basis, reporting increased redness on bony areas to her physician or nursing staff immediately. Prevent sitting or lying down without shifting weight or moving for more than two hours at a time. Use two people to help transfer a very weak or heavy client for your safety as well as the patient's. Ask a physical therapist for recommendations on methods of transfer to allow you to help the patient shift weight regularly without causing problems for you. Keep the patient as cool as possible. Increased heat exacerbates pressure problems. Keep the patient's bottom as dry as possible. Increased moisture contributes to pressure issues. Keep bedding as dry and clean as possible.
- Consult a physician immediately if a pressure area that was reddened opens up, begins to bleed or changes color. Maintain good hygiene to decrease risk of infection. Wash your hands before and after patient contact. Wear gloves if the patient has open sores. Do not stack pillows and foam in excess under the patient. This causes instability as well as increased pressure against bony areas. Do not put any additional padding on top of a gel cushion. Padding interferes with the effectiveness of the pressure-relieving properties of the gel.
Things You'll Need
- Padded transfer bench
- Padded commode seat
- Padded shower chair or bench
- Gel padded seat cushion or air cushion
- Cotton clothing
- Mattress overlay
- Transfer belt
- Timer
