About Your Diagnosis

A pressure ulcer is a sore that results from the death of the skin and its underlying tissue over areas of the body that receive pressure when the patient is sitting or lying still for long periods. A pressure ulcer develops because the weight of the body or body part causes a slowing of the circulation in the skin over that pressure point. With decreased circulation and nutrition, the skin and eventually its underlying tissues such as fat and muscle will die, and an ulcer or sore will develop. Other factors that contribute to the development of an ulcer are poor patient nutrition, wetness from urine and stool, and shear or friction from moving the patient over clothes and bedding. Who gets pressure ulcers?
• Stroke patients.
• Patients with spinal cord injury.
• Anyone who spends long periods in bed or in a wheelchair.
• Individuals who cannot control their bowels or bladder.
• Individuals with illnesses that prevent them from changing position easily.
• Individuals who cannot tell a caregiver whether they are sore or need turning.
• Individuals with any of the above conditions and poor nutrition.
If a patient who has been immobile for some time is moved and turned, he may have an area of red skin (stage 1 ulcer) discovered. A deeper ulcer (stage 2 or 3 ) may be discovered if that part of the skin hasn’t been inspected in a while, or if pressure continues on a stage 1 ulcer.

Living With Your Diagnosis
Pressure ulcers can be treated with a combination of good nursing care and the use of pressurerelieving devices. Special types of dressings that your physician may prescribe and sometimes surgery may be needed. Once the ulcer is resolved, it is imperative that prolonged pressure on that area be relieved.

Treatment
The treatment plan will depend on the stage of the ulcer.
Stage 1: redness with no break in the skin.
Stage 2: the outer layer of the skin is broken with blistering and drainage.
Stage 3: the sore extends into underlying tissue. It may have a white or lack base. It can be painful around the edges and have foul-smelling drainage.
Stage 4: the sore reaches through to muscle or bone. It can be white or black at the base. It can have an bone infection and foul-smelling drainage. All ulcers must be kept clean. This is best accomplished with sterile saline and an irrigation device such as a syringe or a “Water Pik” under the lowest pressure. The use of hydrogen peroxide, povidoneiodine solution (Betadine and others), liquid detergents, and bleach solutions all delay wound healing. Cleaning of hard scabs and dead tissue is done by several methods. Sharp debridement is done with a scalpel or scissors by the doctor. Mechanical debridement is done by using wet-to-dry dressings, which pull off the scab when they are changed. Enzymatic debridement is done with solutions that contain enzymes that digest dead tissue. Autolytic debridement is done by using moist wound dressings that are changed every several days. Control of any infection is very important. The doctor may prescribe an antibiotic cream to be applied to the ulcer, an oral antibiotic to be taken by mouth, and in some cases, an injectable antibiotic is given.

The DOs
• PREVENTION IS BY FAR THE BEST TREATMENT!
• Know the pressure points that are likely to have areas of skin breakdown. These are areas that usually don’t have much fat to pad them.
• Use pressure relief devices such as pillows, gel or foam cushions or mattresses, and foam or gel heel protectors.
• Move the patient or encourage the patient to move at least every 2 hours, and inspect the pressure points regularly. Write down a turning schedule.
• Keep the skin clean and lubricated but not moist.
• Manage stool and urine by a regular voiding or stooling schedule, or use incontinent devices.
• Use draw sheets or boards to keep down friction when the patient is moved.
• If the patient is bed bound, keep the head of the bed no higher than 30 degrees because this pre-vents sliding and friction to the lower back and buttocks.
• Promote good nutrition. Liquid protein supplements and vitamin supplements may be necessary. Ask the patient’s physician.

The DONT’S
• Do not use donut-type cushions or devices.

When to Call Your Doctor
• The area of reddness around the ulcer increases.
• Drainage from the ulcer increases.
• Drainage from the ulcer is foul-smelling and looks like pus.
• Pain in the area of the ulcer increases.
• Fever and/or chills develop.
• Mental confusion, weakness, or rapid heartbeat develops.