Hey guys and welcome back to our weekly blog. We have recently concluded the “All About Wounds” series where we took an in-depth look at wounds concerning identifying them so that you can follow up treatment with a doctor as soon as possible. The purpose was to ensure persons do not delay with getting medical intervention for wounds that may need immediate attention – sometimes we do not know how serious something is and the longer we delay treatment, the worst it gets.
Staying in the same area, today we will have a look at Pressure Ulcers, sometimes called Bed Sores, with the main purpose of knowing how to prevent them. Please take some time out to read up on the blogs in the previous series to get a better understanding of what we discuss in this blog.
So… what is a Pressure Ulcer? A pressure ulcer is an injury to the skin and underlying tissues that occurs when there is prolonged pressure to a pressure area. A pressure area is a bony area that is more likely to get forces applied over it while a person is sitting or lying. Common pressure areas are: back of the head, ears, shoulders, elbows, back, buttocks, hips, inner knees, heels, and toes. Because of this pressure exerted by a person’s own body weight, it damages tissue and blood vessels in the area. If blood vessels are damaged to a point where they begin to die, the tissue will not have adequate nourishment and will die as well. This is the beginning of a pressure ulcer and these ulcers can occur with terrible pain, death of the flesh, and extremely foul odours.
Pressure ulcers commonly occur in bedridden or wheelchair-bound persons because of their inability to move and/or shift their weight from constant exertion over a pressure area. Pressure ulcers are a sign that they are not getting the right care that they deserve. The person’s nurse or caregiver is responsible for ensuring they do not develop pressure ulcers. It is preventable and there is no reason why someone should develop them once they have someone taking care of them. Let us look at the ways to prevent them, shall we?
It is important to assess the skin for abnormalities. Wrinkles are a normal occurrence with the elderly, as well as aging spots, but there are certain marks that are unusual or make you go “Hmmmmm”. If you encounter such a mark, consult your doctor. Nothing is wrong with not being sure but everything is wrong with not giving an opportunity to prove your feeling wrong.
How to assess the skin.
Always inform your loved ones of your actions before you do it. Let them know what you are going to do and that it is for their benefit.
- Look – for red areas, bruises, cuts, depressions, blood, discolouration or if the area is saturated (with a fluid)
- Feel – for increased warmth, extreme dryness or moisture.
- Test for dehydration. Grasp the skin at the back of the palm (hands) and pull away from the body (firmly but not rough/ harsh). How long it takes to return to its natural state will say how dehydrated the client is.
- Make a note of any strange observations. Write the date, time and location of it on the body. If it is a red spot, you can measure its size with a ruler if possible.
It is best to do this assessment during your loved one’s bath. Doing so allows you to see more of their skin and it avoids them feeling awkward because… won’t you feel awkward if you had to expose your body just like that? During a bath, they have to remove their clothes anyway. Make it a habit to always assess the skin and document any noteworthy marks, redness, if the bed was wet and their skin was drenched, signs of dehydration as described above, or anything else you may think relevant.
Do this assessment in the most non-intrusive way possible. Do not make it too uncomfortable. Let them know you are checking their skin for marks just to be sure. Do not keep them exposed for extended periods because they may feel cold very easily. Do not probe, poke, or make comments that may make them worried or feel insecure. Just think of what would make you feel uncomfortable and then don’t do that thing. Always be mindful.
So now, you have done your assessment and written down your findings, it is important to know that there are specific conditions that make the skin susceptible to bedsores. If a person is bedridden or wheelchair-bound, you cannot change that. However, the following conditions below can be avoided to ensure your loved one has a better chance at not developing bedsores.
Fluids will make the skin soggy and allow important minerals to come out of the skin, which otherwise would have made it strong. Be careful to avoid moisture especially in the genital area. Persons who wear diapers should be changed regularly, and ensure the diaper is properly secured during the night to avoid leakage on the bed. Pro-tip- for heavy urination flow at night, pad up the diaper with cotton to soak up the extra urine.
Wrinkles in the sheets cause an uneven surface that can dig into your loved one’s skin. This may seem insignificant but when considering their body weight in that same area for days, and then it becomes very relevant. Ensure their sheets are straight, neatly placed on the bed, and free from wrinkles.
Items on the bed
Anything that can leave an impression on your loved one’s skin can be a culprit. Even crumbs can cause dents on their skin and cause havoc. Ensure the sheet is clean, free from moisture, and free from any items: crumbs, food, ANYTHING. Make a thorough check to ensure they are not lying on their phone or any item that may be on the bed.
The skin needs to be healthy from the inside for optimal health. The elderly skin is already susceptible, so ensure they get enough water. The body is made up of 70% water. Water is essential.
Dry skin is easy to break/crack and if that occurs, bacteria can get into the skin, make it weak and make it easier for the ulcer to form. Use moisturizers to keep the skin supple. Do not apply too much but just enough to keep the skin moisturized.
If your loved one is not getting the nourishment they need, they will not be strong enough to fight off disease. This nourishment may vary from person to person depending on their health status. Consult your doctor for a referral to a nutritionist or dietitian to get the best diet for your loved one based on their unique needs
So now you know what to avoid to prevent susceptibility to pressure ulcers, what are some other ways you can prevent their development? Glad you asked…here are a few.
A bedridden person cannot move on their own, so you have to do it for them. Turn them every 2 – 4 hours to remove the pressure of their body weight being continuously exerted on one area. Remember the pressure ulcer occurs with continued pressure exerted on a pressure area so it is CRITICAL to shift their weight. In wheelchair-bound individuals, if they can, tell them to shift the weight from one buttock to the next periodically. If they can’t, designate times to get them out of the wheelchair and lay them down on their side, to remove the constant weight on their buttocks.
Use of Devices
Continued pressure exerted on a pressure area is the real culprit for pressure ulcers. So avoiding this from occurring will help prevent pressure ulcer development. Using special devices to do this is very helpful. Please note you should not get complacent with these devices. You still HAVE to turn a bedridden person every 2 – 4 hours to ensure they do not develop bedsores.
Air Rings – placed under specific areas such as the heel, buttocks, elbows, etc to keep the pressure from being directly exerted on the pressure area
Air Ripple Mattress – air circulates within an undulating surface, constantly altering the pressure under the bedridden person. This ensures that the surface they are lying on is not firm, as a firm surface will enhance the effects of your loved one’s weight bearing down on the pressure area.
You can also use pillows to reduce the firmness below your loved one and cushion the pressure areas, in both bedridden and wheelchair-bound persons.
However, understand this. TO PREVENT PRESSURE ULCERS YOU MUST TURN THE BEDRIDDEN PERSON EVERY 2 TO 4 HOURS!!!
Thank you for taking the time out to read our blogs. Please share it with someone who needs this information. We will do it again next week!