Pressure Sores / Ulcers for Hospice Patients

We are often contacted for pressure sore matters. During of our home visits, Pressure Sores  is a great concern for many families. Below, we include information on pressure sore that you may find useful. Most importantly it is crucial to prevent a pressure sore from forming rather than treating a pressure sore. We sourced the information from www.cancerresearchuk.org. Hope you will find it useful.

 

What are pressure sores/ulcers?

Pressure sores are sores or ulcers on your skin.

 

Causes

Pressure sores occur when there is prolong pressure on the skin for too long. Like sitting or sleeping in one position for long period of time, thus reduced blood flow to the area. Without enough blood,   a sore /ulcer may form.

 

Who will likely get a pressure sore

• Use a wheelchair or stay in bed for a long time
• Cannot move certain parts of your body without help
• Have a disease that affects blood flow, including diabetes or vascular disease
• Have fragile skin
• Cannot control your bladder or bowels

 

Symptoms and Care and Treatment

• Relieve the pressure on the area;
• Use special pillows, foam cushions, booties, or mattress pads to reduce the pressure.
• Change positions often. If you are in a wheelchair, try to change your position every 15 minutes . If you are in bed, change your position every 2 hours.

 

• Stage I:
  • Symptoms

A reddened, painful area on the skin that does not turn white when pressed. This is a sign that a pressure ulcer is forming. The skin may be warm or cool, firm or soft.

• Care and treatment

sore, you can wash the area gently with mild soap and water. If needed, use a moisture barrier to protect the area from bodily fluids. Ask your provider what type of barrier moisturizer to use.

 

• Stage II:
  • Symptoms

The skin blisters or forms an open sore. The area around the sore may be red and irritated.

• Care and treatment

pressure sores should be cleaned with a salt water (saline) rinse to remove loose, dead tissue.., apply antiseptic cream

 

• Stage III:
  • Symptoms

The skin now develops an open, sunken hole called a crater. The tissue below the skin is damaged. You may be able to see body fat in the sore .

• Care and treatment

Talk with your care provider about what type of dressing to use. Depending on the size and stage of the sore, you may use a film, gauze, gel, foam, or other type of dressing.

 

• Stage IV:
  • Symptoms

The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes to tendons and joints.

• Care and treatment

Talk with your care provider, may need admission to hospital.

 

Pressure sores tend to form where skin covers bony areas, such as ;

 

 

Tips to prevent pressure sores

“Prevention Is Better than Cure” is very true for bedsores

Relieving direct pressure

• change position and keep moving as much as possible
• stand up to relieve pressure if you can
• ask your carer to re-position you regularly if you can't move
• change position at least every 2 hours
• use special pressure relieving mattresses and cushions
• don't drag your heels or elbows when moving in your bed or chair
• place soft pillow between knees or ankles to prevent pressure

 

Skincare

• Inspect your skin daily for early sign of sore, such as redness
• keep your skin clean and dry
• avoid scented soaps as they can be more drying
• moisturise your skin thoroughly after washing
• avoid using talcum powder as this dries the skins natural oils
• keep your skin well moisturised

 

General tips

• make sure the bed sheets are smooth and not wrinkled when you are lying in bed
• sheets should be cotton or silk like fabric
• eat a well balanced diet as tolerated
• encourage more fluids as tolerated
• tell your doctor or nurse if you notice any skin changes or discomfort as soon as possible

 

References

• Oxford textbook of palliative medicine (3rd Edition)
  D Doyle and others
  Oxford University Press
  ISBN 0 19 856698 0
• Support surfaces for pressure ulcer prevention
  E McInnes and others.
  Cochrane Database for Systematic Reviews (2011) Issue 4, Art. No.: CD001735. DOI: 10.1002/14651858.CD001735.pub4
• Pressure ulcers
  National Institute for Health and Care Excellence (NICE), 2015
• Prevention and management of pressure ulcers. Best Practice Statement
  Healthcare Improvement Scotland, 2009
• Pressure ulcers prevention and treatment
  European Pressure Ulcer Advisory Panel (EPUAP), 2014
• https://familydoctor.org/condition/pressure-sores/
• https://www.nhs.uk/conditions/pressure-sores/treatment/