PRESSURE ULCER
PRESSURE
ULCER
Bedsores also called pressure ulcers and decubitus ulcers
are injuries to skin and underlying tissue resulting from prolonged pressure on
the skin. Bedsores most often develop on skin that covers bony areas of the
body, such as the heels, ankles, hips and tailbone.
People most at risk of bed sores are those with a
medical condition that limits their ability to Change positions or those who
spend most of their time in a bed or chair.
Bed sores can develop quickly. Most sores heal with
treatment, but some never heal completely. You can take steps to help prevent
bed sores and aid healing.
SYMPTOMS
Warning signs of pressure ulcers are:
·
Unusual changes
in skin color or texture
·
Swelling
·
Pus-like draining
·
An area of skin
that feels cooler or warmer to the touch than other areas
·
Tender areas
Bedsores fall in to one of several stages based on their
depth, severity and other characteristics.
The degree of skin and tissue damage ranges from
red, unbroken skin to a deep injury involving Muscle and bone.
Common sites
of pressure sores
For people who use a wheelchair, pressure sores often
occur on skin over the following sites:
·
Tail bone or buttocks
·
Shoulder blades
and spine
·
Backs of arms
and legs where they rest against the chair
For people who are confined to a bed, common sites include
the following:
1. Back or sides of the head
2. Shoulder blades
3. Hip, lower back or tail bone
4. Heels, ankles and skin behind the knees
Causes
Bed sores are caused by pressure against the skin that
limits blood flow to the skin. Other Factors related to limited mobility can make
the skin vulnerable to damage and contribute to the Development of pressure sores.
Three primary contributing factors for bed sores are:
·
Pressure: Constant
pressure on any part of your body can lessen the blood flow to tissues. Blood flow
is essential to delivering oxygen and other nutrients to tissues.
Without these essential nutrients, skin and nearby tissues
are damaged and might eventually die. For people with limited mobility, this kind
of pressure tends to happen in areas that aren't well padded with muscle or fat
and that lie over a bone, Such as the spine, tailbone, shoulder blades, hips, heels
and elbows.
·
Friction: Friction
occurs when the skin rubs against clothing or bedding. It can make Fragile skin
more vulnerable to injury, especially if the skin is also moist.
·
Shear: Shear occurs
when two surfaces move in the opposite direction. For example, when a Bed is elevated
at the head, you can slide down in bed. As the tail bone moves down, the skin over
the bone might stay in place essentially pulling in the opposite direction.
RISK
FACTORS
People are at risk of developing pressure sores if they
have difficulty moving and are unable to easily change position while seated or
in bed. Risk factors include:
·
Immobility: This
might be due to poor health, spinal cord injury and other causes: Lack of sensory
perception, Spinal cord injuries, neurological disorders and other conditions can
result in a loss of sensation. An inability to feel pain or discomfort can result
in not being aware of warning signs and the need to change position.
·
Poor nutrition
and hydration: People need enough fluids, calories, protein, vitamins and minerals
in their daily diet to maintain healthy skin and prevent the breakdown of tissues.
·
Medical conditions affecting blood flow: Health
problems that can affect blood flow, such as diabetes and vascular disease, increase
the risk of tissue damage.
COMPLICATIONS
Complications of pressure ulcers, some life-threatening,
Include:
·
Cellulitis: Cellulitis is an infection of the skin and connected soft tissues. It
can cause warmth, redness and swelling of the affected area. People with nerve damage
often do not feel pain in the area affected by cellulitis.
·
Bone and joint infections: An infection from a pressure sore can burrow into
joints and bones. Joint infections (septic arthritis) can damage cartilage and tissue.
Bone infections (osteomyelitis) can reduce the function of joint sand limbs.
·
Cancer: Long-term, non-healing wounds (Marjolin's ulcers) can develop into a type
of Squamous cell carcinoma
·
Sepsis: Rarely, a skin ulcer leads to sepsis.
PREVENTION
Bed sores can be prevented by frequently repositioning
to avoid stress on the skin. Other strategies include taking good care of your skin,
maintaining good nutrition and fluid intake, quitting smoking, managing stress,
and exercising daily.
Tips for
repositioning
Consider the following recommendations related to repositioning
in a bed or chair:
·
Shift your weight
frequently. If you use a wheel chair, try shifting your weight about every 15 minutes.
·
Ask For help with
repositioning about once an hour.
·
Lift yourself,
if possible. If you have enough upper body strength, do wheelchair pushups raising
your body off the seat by pushing on the arms of the chair.
·
Look into a specialty
wheelchair. Some wheel chairs allow you to tilt them, which can relieve pressure.
·
Select cushions
or a mattress that relieves pressure. Use cushions or a special mattress to relieve
pressure and help ensure your body is well-positioned. Do not use doughnut cushions,
as they can focus pressure on surrounding tissue.
·
Adjust the elevation
of your bed. If your bed can be elevated at the head, raise it no more than 30 degrees.
This helps prevent shearing.
Tips for
skin care
Consider the following suggestions for skin care:
·
Keep skin clean
and dry. Wash the skin with a gentle cleanser and pat dry. Do this cleansing Routine
regularly to limit the skin's exposure to moisture, urine and stool.
·
Protect the skin.
Use plain talcum powder to protect skin at friction points.
·
Apply lotion to
dry skin. Change bedding and clothing frequently if needed. Watch for buttons on
the clothing and wrinkles in the bedding that irritate the skin.
·
Inspect the skin
daily. Look closely at your skin daily for warning signs of a pressure sore.
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