What is a pressure ulcer?

Submitted by Emma Hamilton on Wed, 17/09/2008 - 4:08pm

A pressure ulcer is a lesion caused by unrelieved pressure, friction or force on the skin. Pressure ulcers are commonly referred to as pressure sores, bedsores or decubitus ulcers.

In this article:

What do pressure ulcers look like?
Pressure ulcers risk factors
Pressure ulcers and the importance of changing position
Pressure ulcers and incontinence
Tips for prevention of pressure ulcers

What do pressure ulcers look like?

Pressure ulcers first appear as small, reddened areas on the skin. Damage can extend from the skin to underlying tissue and bone. They can be slow to heal and difficult to treat.

Ageing people are at increased risk of pressure ulcers especially if they are immobile, recovering from serious illness and infection or have diabetes.

Pressure ulcers commonly occur on the:

Sacrum
Heels
Spine
Elbows
Ears

Pressure ulcers risk factors

Immobility: Spending long periods sitting or lying in the same position increase the risk of pressure ulcers. Prolonged pressure on a pressure point can cut off the blood supply and delivery of oxygen and nutrients to the skin causing the skin to break down.

Skin Integrity: Excessive exposure to moisture through urine or perspiration can lead to skin breaking down particularly in areas such as the sacrum. Skin that becomes too dry can crack and tear.

Friction: Fragile delicate skin can tear easily with friction. Pulling clothes over bony prominences such as elbows can cause friction. Moving a person in bed or a chair by dragging on the skin can easily cause skin to tear and break down. Repeated irritation from poorly fitted shoes can also cause pressure areas.

Poor Nutrition: To repair itself the skin needs nutrients. Inadequate nutrition can slow healing. Ageing people who are ill often have poor appetite and are at risk of malnutrition.

Pressure ulcers and the importance of changing position

If you are caring for someone who is immobile or has limited movement you need to provide regular pressure area relief. This means relieving pressure on at risk areas by turning, repositioning or shifting weight regularly.

Pay attention to bony areas. You can use special pillows and foams to reduce contact between the skin and a support surface. Everybody is different but as a general rule changing position and taking pressure off prominent areas every two hours reduces the risk of pressure areas.

If a person is not on a good support surface or special equipment they will need to reposition themselves every 20 minutes. A good indication that a person needs repositioning is when the skin starts to redden. Even encouraging someone to shift his or her weight slightly in a chair can help.

Turning someone regularly can be difficult for a carer. Some people are totally dependent and can't change position or others can't alert a carer when they are uncomfortable. When you transfer someone you need to avoid causing friction or shearing thus causing further damage. Cloth slide sheets are useful tools for moving someone in bed. Ask a nurse to show you how you can safely transfer someone using a slide sheet.

Preventing pressure ulcers is easier than healing them. Look over the skin daily whilst showering or toileting. Inspect the skin for reddened areas or signs of discolouration. Notify a nurse or doctor if you notice any reddened areas of the skin or wounds that are not healing. Seek help early if the skin shows any signs of breakdown.

Pressure ulcers and incontinence

If someone you care for is incontinent of urine or faeces they are at risk of skin breakdown. Remember to wash and dry skin after incontinence episodes. Use a cleanser with a pH of 5.5 (check with your pharmacist). Apply a zinc based barrier cream to protect from skin irritants. Specialised commercial skin products with zinc are better than plain zinc based creams.

Incontinence pads can also help keep skin dry. For someone with a pressure ulcer on the sacrum place a Kylie (special incontinence bed covers) under the sacrum to keep excess moisture from the area.

Tips for prevention of pressure ulcers

Keep skin clean and dry
Ensure the person gets out of bed and doesn't sit for prolonged periods in the same position
Ask the person to rock from side to side occasionally
Use special pressure cushions or an underlay to relieve skin of pressure
Do not use donut devices
Do not drag a person when changing position or sitting up
Ensure bedding is smooth and wrinkle free
If the person is bed ridden, use pressure area relieving devices such as air-mattresses, booties, and medical sheepskin products
Do not massage or rub reddened areas
Wash and dry skin after incontinence episodes
Encourage a balanced diet and hydration
Do not elevate the bed more than 30 degrees if sitting a person up in bed for long periods. They can slip down and extra force is applied on the buttocks
Prevent excessive sweating and moisture by dressing in natural fibres