WHAT IS PRESSURE ULCER?
Pressure ulcer, also called pressure sore is localized injury to the skin and/or underlying tissue as a result of pressure.
STAGES OF PRESSURE ULCER
CONTRIBUTING FACTORS OF PRESSURE ULCERS
- Lying or sitting in the same position for long periods. Bony points are particularly vulnerable.
- Friction, dragging, rubbing, sliding force, pulling of adhesives leads to skin tear.
- Excessive moisture leads to maceration of the skin.
- Poor nutrition.
- Dehydration leads to constriction of blood vessels.
SIGNS THAT A PRESSURE ULCER IS FORMING
- The affected skin is red and shiny, or dark purple (it may not be easily visible in darkly-pigmented skin).
- Localized warmness, swelling, hardness are indicators of early pressure damage to the skin.
- If the skin remains red when pressure is applied, it is considered a Stage 1 pressure sore even when skin break (ulcer) is not yet visible.
**Blanching – The pinkness/redness of the skin disappears under gentle pressure, and will return when pressure is released. This is normal.
SIGNS OF AN INFECTED PRESSURE ULCER
Drainage from the pressure ulcer
Increased heat and redness in the surrounding skin
Immediately seek medical care if you notice these signs.
HOW TO PREVENT PRESSURE ULCERS
- Skin care
- Keep the skin clean.
- Use skin moisturizer to hydrate dry skin.
- Use pH balanced skin cleanser instead of soap when bathing.
- Avoid soap or harsh chemicals that irritate and dry the skin.
- Inspect pressure areas at least once a day.
- Lying in bed
- Use a pressure-relieving device e.g. ripple mattress and heel protector.
- Help your loved one change position in bed 2 hourly to relieve or redistribute pressure e.g. left lateral -> supine -> right lateral positions.
- Lift – do not drag while repositioning.
- Avoid positioning your loved one on bony areas.
- Ensure no creases on the bedsheet, stockings etc that cause increased localized pressure on the skin.
- Ensure the heels are free of the surface of the bed using cushion under the full length of the calves.
- Sitting on a chair
- Limit the time your loved one spends seated in a chair without pressure relief.
- Provide adequate seat tilt to prevent sliding forward in the wheelchair or chair.
- Adjust footrests and armrests to maintain proper posture and pressure redistribution. Ensure that the feet are properly supported either on the floor or on footrests.
- Avoid using a ring cushion.
- Friction and shear
- Reduce friction by lifting the sheet.
- Avoid dragging your loved one.
- Consider using silk-like fabrics rather than cotton or cotton-blend fabrics to reduce friction.
- Minimize contact with moisture that causes maceration of the skin.
- Change diapers frequently or promptly cleanse the skin following episodes of incontinence.
- Use protective barrier cream.
- Nutrition and hydration
- Eat a well balanced diet.
- Drink adequate fluids regularly to avoid dehydration.
- Develop a schedule for progressive sitting or walking according to your loved one’s tolerance level.
- Increase activity as tolerated.
DR. ALAN CH'NG is a Geriatrician based in Seberang Jaya Hospital, Penang.