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Preventing Pressure Ulcers

ulcersA pressure ulcer, sometimes called a "bed sore" is an injury usually caused by unrelieved pressure to the skin or being dragged across a bed sheet-movements that result in what is called “shearing and friction”. This happens when a boney area presses against the skin or an area with less fat to cushion cutting off the blood supply to that area. A decrease in the blood supply causes damage to the skin and underlying tissue. This causes the formation of a pressure ulcer.
Pressure ulcers can range in severity and are measured in stages. Mild ones are minor skin reddening that doesn't go away when the pressure is relieved from the skin, to severe ones that can be deep craters down to the layers of muscle or bone.

Following stroke an individual may be at risk of developing a pressure ulcer. As a caregiver of an individual with stroke there are some actions you can take to decrease the risk of a pressure ulcer:

Inspect the skin daily for areas of redness. If redness is found avoid any pressure or eliminate moisture to the area until the redness is no longer present. If a skin sore is found, report it to your health care provider.

Prevent dry, cracked skin by applying a cream moisturizer immediately after a bath or shower at least daily and avoiding cold or dry air. If you are uncertain what type of cream moisturizer is best, ask your health care provider.

Avoid rubbing the skin, especially skin over bony parts of the body. Rubbing or massaging the skin can cause damage to the tissue under the skin and increase the risk of a pressure ulcer developing.

For individuals with stroke who spend long periods of time in bed, remind or assist them to change positions at least every 2 hours. Ask your health care provider to recommend a special mattress for the bed that helps to reduce pressure on the skin.

For individuals with stroke who spend long periods of time in a chair or wheelchair, remind or assist them to stand or change positions every 15 minutes. Do not use donut-shape cushions on the chair or wheelchair. Ask your health care provider to recommend a special seat cushion to reduce pressure on the skin.

In bed, use pillows between knees and ankles to prevent them from touching each other. When lying on the back, place a pillow under the legs from mid-calf to ankle in order to keep the heels off the bed.

For frequent perspiration, change clothing and linens as soon as they become damp. Eliminating sources of moisture reduces the risk of skin irritation and breakdown.

Encourage the individual with stroke to be as active as able. This helps to promote the blood supply to the skin. Ask your health care provider about an exercise program that is safe.

Clean skin with a gentle cleanser as soon as it becomes soiled with urine or stool as it contains enzymes that can damage the skin. Use absorbent briefs and pads that pull moisture away from the skin. Pat the skin dry, do not rub. Ask your health care provider about skin barrier creams and ointments that may help to prevent moisture irritation.

 

Additional Information:

The following are some web sites to provide you with more information on pressure ulcers:

Wound Healing Patient Guide

Bedsore; Decubitus Ulcer

Pressure Sores


References:

AHCPR. (2011). Preventing pressure ulcers: A patient's guide (AHCPR 92-0048) and Treating pressure sores: Consumer guide (AHCPR 95-0654). Retrieved from http://www.focusonals.com/pressure_ulcers.htm

Bryant, R., & Nix, D. (2007). Acute and chronic wounds. Missouri: Mosby.

Derstine, J., & Hargrove, S. (2001). Comprehensive rehabilitation nursing. Philadelphia: Saunders.

Fenstermacher, K., & Hudson, B. (2000). Practice guidelines for family nurse practitioners. Philadelphia: Saunders.

Medline Plus. (2011). Pressure ulcer. Retrieved from http://www.nlm.nih.gov/medlineplus/ency/article/007071.htm

Phipps, W. (1999). Medical-surgical nursing: Concepts and clinical practice (6th ed.). St. Louis: Mosby.

Pressure sores – Treatment overview. (2011). Retrieved from http://www.webmd.com/skin-problems-and-treatments/tc/pressure-sores-treatment-overview

Pressure ulcers. (1995-2009). Retrieved from http://my.clevelandclinic.org

Uphold, C., & Graham, M. (1998). Clinical guidelines in family practice (3rd ed.). Gainesville, FL: Barmarrae Books.

Developed in 2001 by Gerri Rupp, MSN, RN, CNP, the University of Toledo for Caring~Web©.

Revised 2010, 2012

Last Updated: 6/17/14