PRESSURE ULCERS - A guide for caregivers

DR ALAN CH'NG


WHAT IS PRESSURE ULCER?

Pressure ulcer, also called pressure sore is localized injury to the skin and/or underlying tissue as a result of pressure.

STAGES OF PRESSURE ULCER

 

CONTRIBUTING FACTORS OF PRESSURE ULCERS


SIGNS THAT A PRESSURE ULCER IS FORMING

**Blanching – The pinkness/redness of the skin disappears under gentle pressure, and will return when pressure is released. This is normal.

SIGNS OF AN INFECTED PRESSURE ULCER

  • Fever
  • Drainage from the pressure ulcer
  • Foul odour
  • Increased heat and redness in the surrounding skin
  • Immediately seek medical care if you notice these signs.

    HOW TO PREVENT PRESSURE ULCERS

    1. Skin care
      • Keep the skin clean.
      • Use skin moisturizer to hydrate dry skin.
      • Use pH balanced skin cleanser instead of soap when bathing.
      • Avoid soap or harsh chemicals that irritate and dry the skin.
      • Inspect pressure areas at least once a day. 
    2. Lying in bed
      • Use a pressure-relieving device e.g. ripple mattress and heel protector.
      • Help your loved one change position in bed 2 hourly to relieve or redistribute pressure e.g. left lateral -> supine -> right lateral positions.
      • Lift – do not drag while repositioning.
      • Avoid positioning your loved one on bony areas.
      • Ensure no creases on the bedsheet, stockings etc that cause increased localized pressure on the skin.
      • Ensure the heels are free of the surface of the bed using cushion under the full length of the calves.
    3. Sitting on a chair
      • Limit the time your loved one spends seated in a chair without pressure relief.
      • Provide adequate seat tilt to prevent sliding forward in the wheelchair or chair.
      • Adjust footrests and armrests to maintain proper posture and pressure redistribution. Ensure that the feet are properly supported either on the floor or on footrests.
      • Avoid using a ring cushion.
    4. Friction and shear
      • Reduce friction by lifting the sheet.
      • Avoid dragging your loved one.
      • Consider using silk-like fabrics rather than cotton or cotton-blend fabrics to reduce friction.
    5. Incontinence
      • Minimize contact with moisture that causes maceration of the skin.
      • Change diapers frequently or promptly cleanse the skin following episodes of incontinence.
      • Use protective barrier cream.
    6. Nutrition and hydration
      • Eat a well balanced diet.
      • Drink adequate fluids regularly to avoid dehydration.
    7. Mobilization
      • Develop a schedule for progressive sitting or walking according to your loved one’s tolerance level.
      • Increase activity as tolerated.

    DR. ALAN CH'NG is a Geriatrician based in Seberang Jaya Hospital, Penang.

     

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