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Decubitus Ulcer Overview
A decubitus ulcer, also called a pressure sore or bed sore, is an open wound on your skin. Pressure sores often occur on the skin covering bony areas. The most common places for a pressure sore to appear includes your hips, back, ankles, and buttocks.
It is common among the elderly, disabled, and other people who spend long periods in bed or a wheelchair, or cannot move certain body parts without help. Decubitus ulcers are also prone to those with fragile skin. The condition is highly treatable and recovery is good with proper diagnosis.
Causes of Decubitus Ulcer
Pressure on the skin reduces blood flow to the area. Without enough blood, the skin can die. An ulcer may form.
You are more likely to get a pressure ulcer if you:
♦ Use a wheelchair or stay in bed for a long time
♦ Are an older adult
♦ Cannot move certain parts of your body without help because of a spine or brain injury or disease such as multiple sclerosis
♦ Have a disease that affects blood flow, including diabetes or vascular disease
♦ Have Alzheimer’s disease or another condition that affects your mental status
♦ Have fragile skin
♦ Have urinary incontinence or bowel incontinence
♦ Do not get enough nutrition (malnourishment)
Symptoms of Decubitus Ulcer
Symptoms of a pressure ulcer are:
♦ Red skin that gets worse over time
♦ The area forms a blister, then an open sore
Pressure sores most commonly occur on the
♦ Buttocks
♦ Elbow
♦ Hips
♦ Heels
♦ Ankles
♦ Shoulders
♦ Back
♦ Back of head
Pressure sores categorized as deep tissue injury may be purple or maroon. This may be an area of skin or blood-filled blister due to damage of soft tissue from pressure. The area around may be sore, firm, mushy, boggy, warmer, or cooler compared with tissue nearby.
Pressure sores are grouped by their severity. Stage I is the earliest stage. Stage IV is the worst.
♦ Stage I: A reddened area on the skin that, when pressed, does not turn white. This is a sign that a pressure ulcer is starting to develop.
♦ Stage II: The skin blisters or forms an open sore. The area around the sore may be red and irritated.
♦ Stage III: The skin now develops an open, sunken hole called a crater. There is damage to the tissue below the skin.
♦ Stage IV: The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes to tendons and joints.
Pressure sores are unstageable when the tissue at the base of the ulcer is covered by dead skin that is yellow, tan, green, or brown.
First Aid of Decubitus Ulcer
If you have a pressure ulcer:
♦ Relieve the pressure on that area. Use pillows, special foam cushions, and sheepskin to reduce the pressure.
♦ Treat the sore as directed by your doctor or nurse.
♦ Avoid further injury or friction to the area. Powder the sheets lightly so your skin doesn’t rub on them in bed. (There are many items made for this. Check a medical supplies store.)
♦ Eat healthy foods. Bad nutrition may affect the healing process.
♦ Clean the ulcer the way your doctor or nurse told you to. It is very important to do this properly to prevent infection.
♦ Generally, pressure ulcers are rinsed with a salt-water rinse to remove loose, dead tissue. The sore should be covered with special gauze dressing made for pressure ulcers.
♦ New medicines that promote skin healing are available and may be prescribed by your doctor.
If the pressure ulcer changes or you get a new one, tell your doctor or nurse.
DO NOT
♦ Do NOT massage the skin near or on the ulcer. It can cause more skin damage.
♦ Do NOT use a donut-shaped or ring-shaped cushions. They interfere with blood flow to that area and cause complications.
When to Contact a Medical Professional
Call your doctor or nurse if you develop blisters or an open sore.
Call immediately if there are signs of infection. Signs include:
♦ A foul odor from the ulcer
♦ Pus coming out of the ulcer
♦ Redness and tenderness around the ulcer
♦ Skin close to the ulcer is warm and swollen
♦ An infection can spread to the rest of the body and cause serious problems. Signs that the infection may have spread to the blood can include fever, weakness, and confusion.
Treating a Decubitus Ulcer
Treatment involves first properly staging your condition and then developing a wound care plan. This includes medications, therapies, and even surgery to treat pressure sores (or any type of wound).
Medications
Antibacterial drugs may be used to treat infection. Pain medication to relieve or reduce any discomfort experienced in your condition also may be prescribed.
Surgeries
Debridement, a process meant to remove dead tissue, may be used to clean your wound.
Other Therapies
Keeping the site clean and free of debris is important to promote healing. Your doctor may order frequent dressing changes of your wound.
Prevention of Decubitus Ulcer
If you are on bedrest or cannot move because of a medical condition, someone should check you for pressure sores every day.
You or your caregiver should examine your body from head to toe. Pay special attention to the areas where pressure ulcers often form. Look for reddened areas that, when pressed, do not turn white. Also look for blisters, sores, or craters.
Take the following steps to prevent pressure ulcers:
♦ Change position at least every 2 hours to relieve pressure.
♦ Use items that can help reduce pressure pillows, sheepskin, foam padding, and powders from medical supply stores.
♦ Eat well-balanced meals that contain enough calories to keep you healthy.
♦ Drink plenty of water (8 to 10 cups) every day.
♦ Exercise daily, including range-of-motion exercises.
♦ Keep the skin clean and dry.
♦ After urinating or having a bowel movement, clean the area and dry it well. A doctor can recommend creams to help protect the skin.
