Pressure ulcers are one of the most common injuries that can happen in a home care setup. Often called “bedsores” or “pressure sores,” these ulcers are caused by a breakdown of the skin and underlying tissue due to excessive and prolonged pressure. Pressure ulcers often develop on skin that covers bone, such as ankles, heels, hips, and tailbone.
This injury often affects people who have pre-existing health issues that prevent them from moving, especially if they are confined to lying in bed or sitting down. Those who have health conditions that affect blood flow, such as Type 2 diabetes, are prone to developing bedsores. People over 70 years of age are also vulnerable to pressure ulcers, since their skin is likely to thin as they age, and have mobility issue which can hamper their ability to reposition while seated or laying down to naturally relieve the duration of pressure.
How does a caregiver know if a patient has pressure ulcers? There are four stages that indicate the severity of the bedsore, from mild reddening of the skin to tissue damage and infection. Below are the symptoms for each stage:
- Stage 1: Ulcer is not an open wound and the skin has no breaks or tears. The sore may be painful and red, but does not lose color when you press your finger on it. The sore is warm and could feel either softer or firmer than the skin surrounding it.
- Stage 2: The sore opens or tears, making the ulcer tender and painful. The pressure sore goes deeper into the layers of skin. It often looks like a blister, a shallow crater, or an abrasion in the skin. It may appear to have clear fluid. Skin may be damaged beyond repair.
- Stage 3: The bed sore gets worse and deepens into the tissue below the skin, creating a small crater. One may see fat in the ulcer, but not tendon, bone, or muscle. There is little to no pain due to tissue damage.
- Stage 4: The pressure ulcer has gone very deep, reaching muscle, tendon, and bone. Extensive damage to tissue has occurred and serious complications may arise, such as sepsis (blood infection) and osteomyelitis (bone infection).
Some pressure ulcers do not fit into these stages. One case is when the sore is deep enough but there is no open wound to indicate damage. This is called a deep tissue injury (DTI). The only symptom is the skin may look dark red or purple or it seems like a blood-filled blister.
Some bed sores may also be deemed “unstageable” where its stage cannot be determined. This happens when the base of the ulcer is covered by a thick layer of tissue and yellow, green, brown, grey, or black pus. The doctor is unable to see the base of the ulcer, so it is not clear what stage it falls under.
Before it becomes so severe that it reaches bone and tendon, bed sores must be treated and prevented from becoming worse. Here is what you can do for your patients to aid in healing a pressure ulcer:
- Once you see bedsores forming, immediately ease pressure from the affected area. The position of the body needs to be changed frequently. If the patient is sitting on a wheelchair, shift the body weight every 15 to 30 minutes and change positions every hour. If the patient is lying down, change his position every 2 to 6 hours.
- Use specialized equipment that can prevent bed sores from accelerating, like an alternating pressure mattress, therapeutic support foam mattress, mattress and chair overlay, and wheelchair cushions. This way, you ensure that the pressure is moved away from the ulcers, allowing them heal naturally.
- If the sore has broken into a wound, make sure to keep it clean and cover it with bandages. Clean the sore with water or saline solution. The bandage keeps the wound moist, speeding up healing. It also creates a barrier against infection and keeps the skin surrounding the sore dry. If the skin is not broken, just use a gentle cleanser and pat it dry.
- Make sure the patient eats a healthy diet, since protein aids in the healing of the skin.
Prevention is better than cure when it comes to managing bed sores and pressure ulcers. Taking the time and effort to practice these bed sore prevention methods will go a long way in preserving the patient’s dignity and keeping him healthier and more comfortable.