SORES, PRESSURE(Bed Sores; Decubitus Ulcers)
(Bed Sores; Decubitus Ulcers)
DESCRIPTIONPressure sores are skin ulcerations, usually in an area of pressure over a bony prominence. Pressure sores are not contagious or cancerous. The skin over pressure points in the lower back, buttocks, elbows, knees, shoulders, heels, ankles, and other areas with bony prominences is involved.
Appropriate health care includes:
Surgery to remove dead tissue (sometimes).
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.
Constant pressure on the child's skin, especially over bony areas. Pressure reduces the blood supply, causing death in the tissue layers. Pressure sores usually develop in children who cannot move because of chronic illness or disability that confines them to bed.
RISK FACTORSPoor circulation.
Decreased or absent sensation.
Illness or accident requiring prolonged bed confinement, especially with unsanitary living conditions and wrinkled or wet bed linen.
PREVENTING COMPLICATIONS OR RECURRENCEProvide good nursing care for the disabled child, including the following:
Frequent changes of the child's position in bed.
Protective, soft padding, such as gel flotation pads or sheepskin, over the child's bony areas.
A water mattress, egg-crate rubber mattress, or alternating-pressure mattress.
Dry, clean, smooth bed linen.
Frequent inspection of skin areas at risk.
Your own observation of symptoms.
Medical history and physical exam by a doctor.
Local or general infection.
Infection of bone (osteomyelitis) adjacent to the ulcer.
Usually curable with treatment. Sores may heal very slowly. Healing time varies with the site and size of the ulcer and the child's general health.
Provide good nursing care for the child (see PREVENTING COMPLICATIONS).
Provide warm whirlpool treatments, if a pressure sore is on the child's arm, hand, foot, or leg.
Apply lotions or ointment if prescribed for the child 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.
MEDICATIONYour 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.
See Medications section for information regarding medicines your doctor may prescribe.
Your child can resume normal activities as soon as symptoms improve.
DIET & FLUIDS
Your child should eat a normal, well-balanced diet that includes extra protein. Vitamin and mineral supplements may be necessary.
OK TO GO TO SCHOOL?When appetite returns and alertness, strength, and feeling of well-being will allow.
CALL YOUR DOCTOR IF
Your child has symptoms of pressure sores or you 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.