SORES, PRESSURE

General Information

DEFINITION--Skin ulcerations, usually in an area of pressure over a bony prominence. Pressure sores are not contagious or cancerous.

BODY PARTS INVOLVED--Skin over pressure points in the lower back, buttocks, elbows, knees, shoulders, heels, ankles and other areas with bony prominences.

SEX OR AGE MOST AFFECTED--All ages, but most likely in the elderly.

SIGNS & SYMPTOMS--Spots of skin that are red and shiny. Spots progress to blisters, then ulcers, leading to a breakdown of tissue under the ulcer. Ulcers are usually painless.

CAUSES--Constant pressure on the skin, especially over bony areas. Pressure reduces the blood supply, causing death in the tissue layers. Pressure sores usually develop in persons who cannot move because of chronic illness or disability that confines them to bed.

RISK INCREASES WITH

• Adults over 60.
• Poor circulation.
• Decreased or absent sensation.
• Malnutrition.
• Obesity.
• Illness or accident requiring prolonged bed confinement, especially with unsanitary living conditions and wrinkled or wet bed linen.

HOW TO PREVENT--

Provide good nursing care for the disabled, including the following:

• Daily skin inspection in good light.
• Frequent changes of position in bed (hourly may be necessary).
• Control of fecal or urinary incontinence.
• Protective, soft padding, such as gel flotation pads or sheepskin, over bony areas.
• A water mattress, egg-crate rubber mattress or alternating-pressure mattress.
• Specialized air bed.
• Dry, clean, smooth bed linen.
• Frequent inspection of skin areas at risk.

What To Expect

DIAGNOSTIC MEASURES--

• Your own observation of symptoms.
• Medical history and physical exam by a doctor.

APPROPRIATE HEALTH CARE

• Home care.
• Doctor's treatment.
• Surgery to remove dead tissue (sometimes).

POSSIBLE COMPLICATIONS

• Local or general infection.
• Infection of bone (osteomyelitis) adjacent to the ulcer.

PROBABLE OUTCOME--Usually curable with treatment. Sores may heal very slowly. Healing time varies with the site and size of the ulcer and the patient's general health.

How To Treat

GENERAL MEASURES--

• Provide good nursing care for the patient (see How to Prevent).
• Provide warm whirlpool treatments, if a pressure sore is on an arm, hand, foot or leg.
• Apply lotions or ointment if prescribed by your doctor. Apply a thin layer of the cream, ointment or lotion 3 or 4 times daily. A heavy layer wastes medicine and is no more beneficial than a thin layer. Rub in gently for several minutes until it disappears.
• Use saline or peroxide on gauze pad to clean the sore and pat dry. Avoid harsh soaps, tincture of benzoin or hexachlorophene.
• Special dressings for sores may be prescribed.

MEDICATION--

• Your doctor may prescribe: Antibiotics to fight infection. Ointments, dressings and drying agents, such as zinc oxide, granulated sugar, povidone-iodine packs or 3% hydrogen peroxide.
• Avoid harsh soaps, tincture of benzoin or hexachlorophene.

ACTIVITY--

• Change the position of an immobilized patient every 1-2 hours. A wheelchair patient should change position every 10-15 minutes.
• Passive or active exercises (if the patient is able).

DIET--Normal, well-balanced diet that includes extra protein. Vitamin and mineral supplements may be necessary.

Call Your Doctor If

• You have symptoms of pressure sores or observe them in someone else.
• The following occurs during treatment: Skin inflammation or breakdown. Signs of infection, such as: pain, redness, tenderness, swelling or increased warmth of the affected area. Fever.