Pressure Sores (Article 9) - Prevention of Pressure Sores/Ulcers

Pressure Sores - Prevention of Pressure Sores/Ulcers

As part of your treatment plan, your care team will discuss with you the best way to prevent pressure ulcers. This will be based on your individual circumstances.

However, you may find that the general advice outlined below is helpful.

Changing position

Making regular and frequent changes to your position is one of the most effective ways of preventing pressure ulcers. If a pressure ulcer has already developed, regularly changing position will help to avoid putting further pressure on it, and give the wound the best chance of healing.

As a general rule, wheelchair users will need to change their position at least once every 15 to 30 minutes. People who are confined to bed will need to change their position at least once every two hours.

Once you have developed a pressure ulcer, it's important that you minimise or avoid putting any further pressure on it to give the wound the best chance of healing.

If you are unable to change position yourself, a carer or relative will need to assist you. For more information and advice about positional changes.

Pressure Sores (Article 8) - Complications of Pressure Sores/Ulcers

Pressure Sores - Complications of Pressure Sores/Ulcers

Even with the best possible medical care, complications can arise from grade three or grade four pressure ulcers and can occasionally be life-threatening.

These complications are discussed below.

Cellulitis

Infection can spread from the site of the pressure ulcer to a deeper layer of skin. This type of infection is called cellulitis. It causes symptoms of pain and redness, plus swelling of the skin. It will need to be treated with a course of antibiotics.

Left untreated, there is a risk that the infection can spread to the blood (see below) or the underlying bone or joint. In rare cases, where pressure ulcers involve the lower back, tail bone and spine, the pressure ulcer can spread to the membranes that surround the spine and brain. This is known as menigitis.

Blood poisoning

If a person with a weak immune system has a pressure ulcer that becomes infected, there is a risk that the infection will spread into their blood and other organs. This is known as blood poisoning or septicaemia.

In the most serious cases of blood poisoning, damage to multiple organs can lead to a large drop in blood pressure, known as septic shock, which can be fatal. Symptoms include cold skin and an increased heartbeat.

Blood poisoning is a medical emergency. It requires immediate treatment in an intensive care unit (ICU), so that the functions of the body can be supported while the infection is treated with antibiotics or antiviral medication.

Bone and joint infection

Infection can also spread from a pressure ulcer into underlying joints septic arthritis and bones osteomyelitis.

Pressure Sores (Article 7) - Treatment for Pressure Sores/Ulcers

Pressure Sores - Treatment for Pressure Sores/Ulcers

Treatment for pressure ulcers can vary, depending on the grade of the ulcer.

Treatment options may include regularly changing your position, or using special mattresses and dressings to relieve pressure or protect the skin. In some cases, surgery may be needed.

Pressure ulcers are a complex health problem arising from many interrelated factors. Therefore, your care may be provided by a team comprising different types of healthcare professionals. This type of team is sometimes known as a multidisciplinary team (MDT).

Your MDT may include:

Pressure Sores (Article 6) - Diagnosing Pressure Sores/Ulcers

Diagnosing pressure ulcers 

Pressure ulcers are easily diagnosed by looking at them. However, health professionals prefer to prevent ulcers developing in the first place, so it's important to assess a person's risk of developing them. 

As part of the risk assessment process, the following will be considered:

• your general health

• your ability to move

• whether you have any problems that may affect your posture

• whether you have any symptoms that may indicate an infection

• your mental health

• whether you have had pressure ulcers in the past

• whether you have urinary incontinence or bowel incontinence 

• your diet

• how well your blood circulation system is working

• As part of the risk assessment, you may be referred for blood and urine tests.  Blood tests can be a good way of assessing your general state of health and whether your diet is providing enough nutrition.

• Urine tests can be used to check how well your kidneys are working and whether you have a UTI (urinary tract infection), which can be a cause for concern if you are incontinent or if you have had spinal damage.

Self-assessment

If you are thought to be at risk of developing pressure ulcers, but you are not staying in a hospital or care home, you may be advised to regularly check for early signs of the condition.

Look out for areas of discolouration and patches of skin that feel unusually spongy or tough to the touch. Use a mirror to check parts of your body that can be difficult to see, such as your back or buttocks. Contact your GP or your healthcare team if you notice any signs of damage.

Pressure Sores (Article 5) - Types of Pressure

Types of pressure

There are three main types of pressure that can lead to the development of pressure ulcers.

These are:

• interface pressure – the pressure of the body pressing the skin down onto a firm surface

• shear – the pressure that occurs when layers of skin are forced to slide over one another or deeper layers of tissue; shear can occur when a person slides down or is pulled up out of a bed or wheelchair

• friction – pressure caused by something rubbing against the surface of the skin, such as a mattress or clothing

Pressure Sores (Article 4) - Pressure Ulcers Causes

Pressure Sores - Pressure Ulcers Causes

Causes of pressure ulcers 

Pressure ulcers are caused by sustained pressure being placed on a particular part of the body.

This pressure interrupts the blood supply to the affected area of skin. Blood contains oxygen and other nutrients that are needed to help keep tissue healthy. Without a constant blood supply, tissue is damaged and will eventually die.

The lack of blood supply also means that the skin no longer receives infection-fighting white blood cells. Once an ulcer has developed, it can become infected by bacteria.

People with normal mobility do not develop pressure ulcers, as their body automatically makes hundreds of regular movements that prevent pressure building up on any part of their body.

For example, you may think that you are lying still when asleep, but you may shift position up to 20 times a night.

Pressure Sores (Article 3) - Symptoms of Pressure Ulcers

Pressure Sore - Symptoms of Pressure Ulcers

Symptoms of pressure ulcers 

The parts of the body most at risk of developing pressure ulcers are those that are not covered by a large amount of body fat and are in direct contact with a supporting surface, such as a bed or a wheelchair.

For example, if you are unable to get out of bed, you are at risk of developing pressure ulcers on your:

• shoulders or shoulder blades

• elbows

• back of your head

• rims of your ears

• knees, ankles, heels or toes

• spine

• tail bone (the small bone at the bottom of your spine)

If you are a wheelchair user, you are at risk of developing pressure ulcers on:

• your buttocks

• the back of your arms and legs

• the back of your hip bone

Severity of pressure ulcers

Pressure Sores (Article 2) - Treating & Preventing Pressure Ulcers/Sores

Pressure Sores - Treating & Preventing Pressure Ulcers/Sores

Treating and preventing pressure ulcers

Treatment for pressure ulcers includes the use of dressings, creams and gels designed to speed up the healing process and relieve pressure. Surgery is sometimes recommended for the most serious cases.

For some people, pressure ulcers are an inconvenience that require minor nursing care. For others, they can be serious and lead to life-threatening complications, such as blood poisoning or gangrene. 

Pressure ulcers can be unpleasant, upsetting and challenging to treat. Therefore, a range of techniques is used to prevent them developing in the first place.

These include:

Pressure Sores (Article 1) - Introduction

Pressure Sores - Introduction

Avoidable pressure ulcers are a key indicator of the quality of nursing care. Preventing them happening will improve all care for vulnerable patients.

Introduction 

Pressure ulcers are an injury that breaks down the skin and underlying tissue. They are caused when an area of skin is placed under pressure.

Quick Reference Guides skin lesion

Quick Reference Guide to Skin Lesion

A quick downloadable reference guide to skin lesion which should be beneficial to all providing care to others.