Bed sores

Definition: also called pressure ulcers and decubitus ulcers —

are injuries to skin and underlying tissue resulting from
prolonged pressure on the skin. Bedsores most often develop on
skin that covers bony areas of the body, such as the heels, ankles,
.hips and tailbone

Causes
 Pressure. Constant pressure on any part of your body can
lessen the blood flow to tissues. Blood flow is essential for
delivering oxygen and other nutrients to tissues. Without these
essential nutrients, skin and nearby tissues are damaged and
might eventually die.
For people with limited mobility, this kind of pressure tends to
happen in areas that aren't well padded with muscle or fat and
that lie over a bone, such as the spine, tailbone, shoulder
blades, hips, heels and elbows.

 Friction. Friction occurs when the skin rubs against clothing or

bedding. It can make fragile skin more vulnerable to injury,
especially if the skin is also moist.
 Shear. Shear occurs when two surfaces move in the opposite
direction. For example, when a bed is elevated at the head, you
can slide down in bed. As the tailbone moves down, the skin
over the bone might stay in place — essentially pulling in the
opposite direction.

:Signs and symptoms

Warning signs of bedsores or pressure ulcers are:

 Unusual changes in skin color or texture

 Swelling
 Pus-like draining
 An area of skin that feels cooler or warmer to the touch than
other areas
  Tender areas

Diagnosis and tests:

Test your skin with the blanching test: Press on the red, pink
or darkened area with your finger. The area should go white;
remove the pressure and the area should return to red, pink
or darkened color within a few seconds, indicating good blood
flow.

Treatment:
Reducing pressure
The first step in treating a bedsore is reducing the pressure and
friction that caused it. Strategies include:

 Repositioning. If you have a bedsore, turn and change your

position often. How often you reposition depends on your
condition and the quality of the surface you are on.
 Using support surfaces. Use a mattress, bed and special
cushions that help you sit or lie in a way that protects vulnerable
skin.

Putting on a bandage. A bandage speeds healing by keeping

the wound moist. It also creates a barrier against infection and
keeps skin around it dry. Bandage choices include films, gauzes,
gels, foams and treated coverings. You might need a
combination of dressings.
Surgery
A large bedsore that fails to heal might require surgery. One method
of surgical repair is to use a pad of your muscle, skin or other tissue
to cover the wound and cushion the affected bone (flap surgery).

:Nursing care

 remove the pressure from the sore by moving the patient or

using foam pads or pillows to prop up parts of the body.
 Clean the wound: Minor wounds may be gently washed with
water and a mild soap. Open sores need to be cleaned with a
saline solution each time the dressing is changed.
 Control incontinence as far as possible.
 Remove dead tissue: A wound does not heal well if dead or
infected tissue is present, so debridement is necessary.
 Apply dressings: These protect the wound and accelerate
healing. Some dressings help prevent infection by dissolving
dead tissue.
 Use oral antibiotics or antibiotic cream: These will can help
treat an infection.

References

1. Pressure ulcers. Merck Manual Professional Version.

http://www.merck.com/mmpe/sec10/ch126/ch126a.html. Accessed Dec. 16, 2016.
2. Berlowitz D. Clinical staging and management of pressure-induced injury.
http://www.uptodate.com/home. Accessed Dec. 16, 2016.
3. Office of Patient Education. How to prevent pressure injuries. Mayo Clinic; 2017.
4. AskMayoExpert. Pressure injury. Mayo Clinic; 2019.
5. Ferri FF. Pressure ulcers. In: Ferri's Clinical Advisor 2017. Philadelphia, Pa.: Elsevier;
2017. https://www.clinicalkey.com. Accessed Dec. 16, 2016.
6. Office of Patient Education. How to manage pressure injuries. Rochester, Minn.:
Mayo Foundation for Medical Education and Research; 2017.
7. Berlowitz D. Prevention of pressure ulcers. http://www.uptodate.com/home.
Accessed Dec. 16, 2016.
8. Tleyjeh I, et al. Infectious complications of pressure ulcers.
http://www.uptodate.com/home. Accessed Dec. 16, 2016.