How to avoid pressure sores and ulcers in patients at risk

Dear patient and family
The purpose of this leaflet is to provide you with information about pressure sores: methods of preventing them and how to treat them. Pressure sores are most likely to develop in patients who are unable to move unaided and are bedridden. Pressure sores are painful and cause much suffering to the patient, resulting in extended hospitalization and recuperation and sometimes even death, as a result of infection or other complications. It is possible to prevent and treat pressure sores. It is important for you to be aware of the risk factors and especially of ways of prevention, therefore reducing the risk of pressure sores developing.
The staff of the department is at your service to answer any queries, and for consultation and support. Please come to us for anything you need and we will be happy to assist.
Best regards
The staff of the department


What are pressure sores and how do they develop?
A pressure sore is a wound which causes damage to the skin and underlying tissue, especially in areas where the bone is close to the surface. The sore is caused by prolonged pressure on the skin against a hard surface, such as a mattress, medical equipment, armchair or wheelchair. The continuous pressure damages the small blood vessels which provide oxygen and nutrition to the surface of the skin. In the first stage the damage is superficial, affecting the outer skin tissue, which shows itself by redness in the area. If the pressure to the area continues necrosis develops, resulting in destruction of all the layers of skin down to the layers of muscle and/or bone.

Where are pressure sores likely to develop?
Pressure sores may develop in any part of the body which is subject to prolonged pressure of the weight of the body against bone or anything else hard. The location of the sore is dependent on the patient's position and ability to move. For example: a patient lying on his/her back is liable to develop pressure sores on the buttocks, shoulder blades, ankles or scalp. A patient sitting in a wheelchair is likely to develop them in the area of the shoulders, elbows, penis, hips, ankles and buttocks.


 

What are the risk factors for development of pressure sores?

  • Confinement to a bed or chair and inability to move independently.
  • Reduced feeling in part or all of the body.
  • Inability to control your bowel or bladder, resulting in continuous dampness and damage to the skin.
  • Nutritional deficiency such as protein, fats, carbohydrates, minerals and vitamins, and lack of fluids. These deficiencies cause the skin to be even more delicate and sensitive, and in addition affect the body's immune system. Symptoms which may reflect nutritional problems include rapid weight loss, lack of appetite or consumption of small amounts of food, low levels of albumen and/or hemoglobin in the blood and impaired cognition.

How to prevent the development of pressure sores

Daily skin check
Pay special attention to the areas near bone. This check allows you to discover any changes on the surface of the skin, such as local redness, chafing, blisters or rash.

Protect the skin
It is vital to keep the skin dry, aired, cleaned after urinating or bowel movements and free of sweat. Prevent dryness of the skin by using preparations which preserve moisture. Use them daily, during and after washing. Moisture prevents dry and cracked skin..

Change position
Be sure to change position at least every 2 hours. The department's nursing staff will show you how. Encourage the patient to move as much as possible.

Reduce pressure by using:

  • A special mattress to prevent pressure sores.
  • Pillows to give support in different positions.
  • Dry sheets which breathe (cotton) and are tightly stretched.
  • Clothing without any accessories which may cause pressure, such as buttons and zips.
  • Correct bandaging.

Strictness about correct positioning
When lying down it is important that the head of the bed be at no more than a 30° angle, except when eating or for another purpose (be sure not to exceed more than an hour). If the head of the bed is at more than 30° it causes the body to slide, leading to chafing and disturbance of the skin surface.
When sitting in a chair make sure that all parts of the body are supported to ensure stability, with no possibility of the body slipping and causing chafing of the skin. Find a cushion individually suited to sitting (but on no account sit on a bagel-shaped cushion). If the patient is unable to move independently, limit sitting to 2 hours. According to his/her mood, encourage the patient to move from side to side or to raise himself/herself every 30 minutes.


Nutrition & Fluids
It is important to maintain a high calorie diet rich in protein and to prevent dehydration. A clinical dietician will prescribe a suitable diet after a comprehensive nutritional evaluation

Can a pressure sore heal and how can the healing process be speeded up?
A pressure sore can heal but sometimes it requires a lengthy process with the intervention of professional staff (such as a nurse expert in treating wounds, a skin doctor, a plastic surgeon, dietician and others), and with the cooperation of the patient's family. It is important that the patient/family give the nurse and doctor all the necessary medical information about illnesses or medical problems, medications, and who can help with treatment when the patient is discharged.

What does the treatment entail?
The treatment concentrates on carrying out all the functions outlined above for preventing pressure sores, such as avoidance of pressure and keeping a strict diet. Local treatment, such as cleaning and bandaging of the area, depends on the seriousness of the sore.

What signs need to be reported to the medical staff?
Signs of a new sore developing: redness, an abrasion or blister.
Pain – If you feel any pain in the area of the sore and/or when it is being treated, it is important to report to the nurse or doctor so that they can give pain medication. Pain relief is for your benefit and helps healing.
Signs of the sore being infected: If a pressure sore is not treated as soon as it begins to develop it can become worse, causing pain, infection and/or other complications.

What if the sore does not heal?
In most cases the sore will heal with the conservative treatment outlined above. Large deep sores can be life threatening and, therefore, sometimes more complicated procedures are necessary, such as surgery to remove the gangrenous tissue.

Where to get help in preventing and treating pressure sores
The Clinic for the Treatment of Hard to Heal Wounds in Hadassah Ein Kerem:
Tuesdays 09.00-13.00 02-5842111 (appointments)
Yad Sarah branches including:
Hadassah Ein Kerem: 02-6776260
Sun 10.00-13.00 and Mon-Thurs 11.00-24.00
Hadassah Mount Scopus: 02-5844485
Sun-Thurs 10.00-13.30

Are there any Social Benefits?
A patient with 3rd degree or more pressure sores is considered as requiring skilled nursing care and hospitalization is then the financial responsibility of the health fund. The patient and family are usually required to pay some personal contribution for hospitalization in a nursing facility. To find out about all the benefits consult with the social worker of the department via the department's head nurse.

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