What is a pressure ulcer?
A pressure ulcer is an area of skin that becomes damaged over time when the blood supply to a particular part of the body is reduced or cut off. Pressure Ulcers are often referred to as Bedsores or Pressure Sores.
What causes pressure ulcers?
Pressure ulcers are caused by three main things:
- pressure – the weight of the body pressing down on the skin
- shear – the layers of the skin are forced to slide over one another or over deeper tissues, for example when you slide down, or are pulled up, a bed or chair or when you are transferring to and from your wheelchair
- friction – rubbing the skin.
What are the signs?
The first sign that a pressure ulcer may be forming is usually discoloured skin, which may get progressively worse and eventually lead to an open wound.
Where do they occur?
The most common places for pressure ulcers to occur are over bony prominences (bones close to the skin) like the bottom, heel, hip, elbow, ankle, shoulder, back and the back of the head.
Who gets pressure ulcers?
Anyone can get a pressure ulcer, but some people are more likely to develop one than others. Most pressure ulcers occur when someone is admitted to hospital. They affect between 1 to 5 in every 100 people admitted to hospital. However, pressure ulcers can also develop in someone at home, or in a nursing or residential home.
Who is most at risk?
People most at risk of getting a pressure ulcer:
- have problems moving, immobile and unable to change position by themselves without help
- cannot feel pain over part or all of their body
- are incontinent
- have poor circulation
- are overweight
- are seriously ill or undergoing surgery
- have had pressure ulcers in the past
- have a poor diet and don’t drink enough water
- are very old or very young
- have damaged their spinal cord and can neither move nor feel their bottom and legs
- are older people who are ill or have suffered an injury, for example a broken hip.
Your healthcare professional should assess whether you are at risk of developing a pressure ulcer.
Are they easy to treat?
Pressure ulcers can be easy to treat early on, but if they are left untreated they do get worse, and can be very painful.
How quickly do they develop?
Pressure ulcers can develop very quickly in some people, sometimes within an hour. Without care, pressure ulcers can be very serious. They can damage not just the skin, but also deeper layers of tissue under the skin.
What is the best care for a patient?
The most important care for a patient with pressure ulcers is the relief of pressure. Once an ulcer is found, pressure should immediately be lifted from the area and the patient turned at least every two hours to avoid aggravating the wound.
How long do they take to heal?
Pressure ulcers can be very painful, or mean a longer stay in hospital. Severe pressure ulcers can destroy the muscle or bone underneath the skin, so they can take a very long time to heal. In extreme cases, pressure ulcers can become life threatening, as they can become infected, and sometimes cause blood poisoning or bone infections.
How can they be prevented?
One of the most important ways of preventing a pressure ulcer is to keep moving and changing position as much as possible to reduce or relieve pressure on areas of the body that are vulnerable, particularly bony areas of the body.
Your healthcare professional should advise you and your carer on how pressure is best reduced or relieved on areas of skin that are vulnerable to pressure ulcers. This advice should include:
- correct sitting and lying positions
- how to adjust your sitting and lying position
- how often you need to move or be moved
- supporting your feet
- keeping good posture
- which equipment you should use and how to use it.
How can I treat my pressure ulcer?
If you have a pressure ulcer you should change your position or be repositioned regularly to allow the ulcer to heal and avoid further damage. This applies whether you are in bed, chair or wheelchair.
What prevented measures do hospitals and nursing homes have in place?
Nursing homes and hospitals usually set programs to avoid the development of pressure ulcers in bedridden patients such as using a standing frame to reduce pressure and ensuring dry sheets by using catheters or impermeable dressings. For individuals with paralysis, pressure shifting on a regular basis and using a cushion featuring pressure relief components can help prevent pressure wounds.
What can help reduce the pressure?
There are many different types of mattress and cushion that can help reduce the pressure on bony parts of the body and help prevent pressure ulcers. Your healthcare professional should work with you to decide which types of pressure-relieving supports are best for you.
Does drinking water help?
The skin, as the largest organ in the body, must be kept will hydrated. Patients should be encouraged or assisted to drink two litres of fluid per day. Good nutrition provides essential nutrients which in turn keeps the skin healthy.
Are there any supplements I can take to reduce the risk of pressure ulcers?
Certain vitamins and supplements such as Vitamin C have been shown to reduce the risk of pressure ulcers. People with higher intakes of Vitamin C have a lower frequency of pressure ulcers in bed-ridden patients than those with lower intakes.
What are the different stages of pressure ulcers?
Pressure Ulcers are categorised into 4 stages of severity:
- Grade 1 – reddened skin which persists for more than 30 minutes after pressure has been relieved.
- Grade 2 – superficial skin damage. May present as a blister or as an abrasion.
- Grade 3 – full thickness skin loss not extending to bone or muscle. This grade is not usually painful.
- Grade 4 – full thickness skin loss with extensive tissue damage through muscle and bone
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