How to Prevent Bedsores

If you are caring for an individual who is bedridden, the chances of them developing a bed sore at some point are entirely probable, and without taking added precautions, they are relatively inevitable. While the best way to treat bed sores is to keep them from occurring in the first place, it can be difficult if you do not understand why they occur and what steps you can take as a caregiver to prevent them.

Bed sores, also known as decubitus ulcers or pressure ulcers, are caused by a number of factors. People who are confined to a bed for extended periods of time, or those who experience muscular atrophy (wasting away of the muscles) and reduction of padding between the skin that is overlying the bone are prone to their development.

Critically ill people are at greater risk for developing bed sores. The initial sign that one is about to occur, is erythema (redness of the skin). When pressure on the area involved is unrelieved, the tissue becomes deprived of oxygen to that area and then becomes destroyed or broken down. This leads to progressive destruction and death of the underlying tissue that results in what we see as a pressure sore.

There are several factors that contribute to the development of pressure sores. These include immobility, impaired sensory perception (such as with those suffering from paralysis or altered levels of consciousness), decreased blood supply to the tissues, (such as with those who have diabetes), poor nutritional status, friction and shearing forces(can occur when you pull a person up in a bed), increased moisture (such as with those who are unable to hold their bladder or bowels) and being elderly.

We will now learn some basic steps to help you prevent bed sores for the person you are caring for. If you follow these steps, you can help keep your loved one from enduring unnecessary pain and suffering that pressure sores can bestow upon them.

Difficulty: Moderate

Instructions

Things You'll Need:

• Flat Sheet
• Pillows
• Heel Protectors
• A & D Ointment
• Medical Sheepskin

1. 
    
   Using a Drawsheet

   Improving Mobility
   
   When a person does not move from a position for an extended period of time, pressure is exerted on the skin, that if continued long enough, can produce a pressure sore. This can be due to being left in one position too long in a bed, wheelchair, couch, chair, or even if on a bed pan. Susceptible areas for breakdown include the back of the head, ears, upper back, elbows, lower back above and including the tail bone, certain parts of the hip and legs, the knees and the heels.
   
   The best way to prevent bedsores that occur from immobility is to turn your patient frequently, at least every two hours. You can do this by creating a draw sheet with a flat sheet. This will save your back and make turning much easier on you and your patient.
   
   To make a draw sheet, get a flat sheet and fold it in half. Turn your patient onto their side, keeping the far leg straight and the top leg bent. Gather the sheet up about half way, leaving the other half ungathered. Place the gathered part under your patient, centering it a little above the shoulder, on down the body. Make sure the ungathered part is nice and smooth. Now, turn your patient to the opposite side of the bed using the aforementioned technique. You should be able to pull the gathered part out from under the patient and smooth it out. This should have created a draw sheet that is now totally centered under your patient. Not only can you use the draw sheet to turn, but you can also use it to pull the patient up in the bed and transfer them as well. When the patient is on their side, tuck pillows under their back and buttocks for added support, as well as under their legs to elevate heels off the bed.
   
   Turning your patient improves circulation which relieves lack of oxygen to the tissues, which is a major cause of skin breakdown. It is important to remember, however, that repositioning the patient must occur around the clock for it to be most beneficial.

2. 
    
   Your Brain and Sensory Perception

   Improving Sensory Perception
   
   When someone has altered sensory perception, they are not aware of the discomfort that is associated with prolonged pressure to a given area. It becomes the caregiver' s job to help the patient recognize this and thus compensate for the loss. This can be done in several ways, depending upon the origin of problem.
   
   For those with altered levels of consciousness, reorienting them to their environment and encouraging self-care can help stimulate their awareness. Asking the patient relevant questions, such as what their name is, what day is it, what time is it, where are they, etc, and then correcting wrong answers, will assist with the reorientation process.
   
   In spinal cord injury, patients may be completely immobile and pressure areas will need to be inspected daily for evidence of bed sore development. If a patient is suffering only partial paralysis, and has the ability to move their arms, they can be taught to use a mirror and inspect for pressure sores themselves.

3. 
    
   Patient Doing Physical Therapy

   Improving Tissue Perfusion (Circulation)
   
   When circulation is impaired, it can result in an increased risk of pressure ulcers. This can include conditions such as diabetes, obesity or those with edema (swelling) related to other disease processes.
   
   Exercise and repositioning your patient can help improve tissue perfusion by increasing blood flow to the body tissues. If the patient is unable to perform exercise on their own, then assisting them with either active or passive range of motion exercises while in bed will cultivate better circulation.
   
   Additionally, elevating a swollen limb promotes blood return to the heart. This will reduce swelling and allow for improved circulation.
   
   It is important to note, however, that massage to a reddened area is contraindicated, as this can cause further damage to already impaired tissues that can actually increase the risk of bed sores.

4. 
    
   A Balanced Diet

   Improving Nutritional Status
   
   Patients are at a greater risk of bed sores when they have poor nutritional habits. Perhaps they are being tube fed, or have a decreased appetite or just enjoy eating the wrong foods. Improving nutritional status will help reduce the risk of the development of pressure ulcers. In addition, once a pressure ulcer develops, those with a poor nutritional status will also find that the bed sore is more resistant to healing. Protein helps wounds heal quicker. Offering a high protein diet or protein supplements such as Boost or Ensure with or in between meals, will be beneficial in maintaining adequate nutrition.
   
   Supplements can also improve nutritional status. Iron will help maintain oxygen levels in the tissues. Vitamin C has been associated with tissue repair, as well as Vitamins A, B, Zinc and Sulfur.
   
   And don't forget about H2O! Hydration is also important to the repair of damaged tissues. Encourage your loved one to drink at least 8, eight ounce glasses of water daily, unless of course this is contraindicated by the doctor.

5. 
    
   Medical Sheepskin Pad

   Reducing Friction and Shearing Forces
   
   Shearing forces occur when a patient is pulled up or around in the bed, when they dig their heels or elbows into the mattress, or if they are allowed to slump down in the bed. Raising the head of the bed actually can increase the shearing force over the lower back area. If a patient is at risk, you should avoid a semi-reclining position if possible, unless of course this is contraindicated.
   
   To protect a patient from sliding down in the bed, you can use a padded footboard or place pillows under the thighs. When transferring or repositioning a patient, make sure you LIFT and don't drag them across a surface.
   
   Medical sheepskin pads and heel protectors (see below) can also help reduce shearing forces and friction. You can purchase these at any medical supply store, or online at a variety of online stores.

6. 
    
   Use Topical Barrier Ointments for Incontinent Patients

   Minimizing Moisture
   
   Moisture on the skin due to urine, stool, perspiration or drainage must be avoided by using meticulous hygienic measures. When a patient's skin becomes soiled, you must clean it immediately to reduce the risk of pressure ulcers. Use a mild soap and water and blot dry using a soft towel each time your patient's skin becomes soiled.
   
   You can use topical barrier ointments such as A&D Ointment to protect the skin from incontinence. You can also utilize incontinence pads to absorb excess moisture, but these should not be used in place of prompt cleaning of the skin.

7. 
    
   Heel Protectors

   A Word About Heel Protectors
   
   I wanted to include a picture of heel protectors and encourage their use as they will really help to relieve pressure to the heels. There are many online sites that carry these, including EBay, and they are relatively inexpensive. You can also use heel protectors on the elbows, as an added safeguard.
   
   As an additional safety measure, and to keep heels soft and supple, apply A&D daily to the entire foot. This will keep cracks from developing on the feet and acts as a wonderful aide to prevention against pressure sores in that area.

8. 
    
   Stage III Pressure Ulcer

   In Conclusion
   
   Pressure sores can start off looking quite benign, and turn into an extremely serious condition in a short period of time. Prevention is the key to avoidance and every effort should be made to employ the techniques mentioned in this article on a daily basis to ensure optimal skin integrity.

Tips & Warnings

• Regardless of how bad the bed sore is, pressure to the involved area MUST be eliminated or it will only get worse.
• Remember to not allow the patient to lie or sit on the existing pressure sore, not even for a minute.
• Use a handwritten repositioning and turning schedule and follow it precisely.
• Once a pressure sore is healed, recurrence can be anticipated unless you take preventative measures to avoid this
• Early recognition and intervention are keys to management of pressure ulcers
• Pressure ulcers can lead to secondary infections that can cause serious illness or even death.
• At no time should fluid intake be restricted to decrease the frequency of urination
• See a doctor regularly, especially when a pressure sore has developed.

[relayu]

on 7/5/2008 www.relayu.com has a product that pulls a patient up in bed without shearing, and prevent back injury to the care giver! Insurance may pay for it!!!

[kjv4thee]

on 1/25/2008 DJ , No doubt that you know what you are talking about. I did not realize that these bed sores could happen so quickly, and be so serious.