What are pressure ulcers? Pressure ulcers are developed when unrelieved pressure damages the skin and underlying tissue. The unrelieved pressure squeezes the blood vessels, cutting off oxygen and nutrients to the area of skin. When the area of skin goes without oxygen and nutrients for too long, it begins to die and a pressure ulcer forms.

Most pressure ulcers form over the bony areas such as the buttocks, tailbone, shoulder blades, behind the knee or ankle, and heel of the foot. Pressure ulcers are referred to by many names, including decubitis ulcers, bedsores, pressure sores, and dermal ulcers.

Pressure ulcers are serious and can be life-threatening if left untreated or if they become infected. They lead to pain, a stay in the hospital, and slower recovery from other health problems.

Fortunately, pressure ulcers can be treated but they are much easier to prevent than cure. We must keep in mind that pressure ulcers are difficult to treat. As few as 13% of pressure ulcers heal within two weeks in an acute hospital. Only 33% of Stage 4 pressure ulcers heal after six months of therapy.

There are many reasons why people develop pressure ulcers. Some residents may even develop pressure ulcers in one health care facility and then be transferred to another facility.

Many elderly patients because of serious medical problems, decreased appetite, and decreased mobility, are at risk for developing pressure ulcers. The best way of caring for skin is preventing problems from ever occurring.

In an effort to reduce the number of residents with pressure ulcer problems, the Facility Care Team will assess each resident on admission for their risk of developing pressure ulcers. If they come to our facility with a pressure ulcer, we treat the ulcer aggressively. You will be notified if your family member is found to have a pressure ulcer and the steps we are taking to treat it.

If you notice that you/your family member have/has any symptoms of a pressure ulcer, please inform the nursing staff immediately.

Risk Factors

Risk Factors for developing pressure ulcers include the following:

• Reduced mobility (e.g. osteoarthritis, strokes)
• Immobility (unable to get out of bed because of illness)
• Acute illness (e.g. pneumonia)
• Incontinence (accidental loss of urine or bowels)
• Poor nutrition
• Persons over 70 years old
• Unrelieved pressure on an area of skin
• Indirect pressure (e.g. friction)
• Decreased mental awareness (e.g. after an operation; delirium) – certain medications
• Diminished sensation (e.g. diabetes, strokes)

How to Recognize a Pressure Ulcer

One of the earliest signs of a pressure ulcer is the development of a reddened area of skin that remains after you have changed positions and the pressure is relieved. If you press the reddened area lightly with your finger and the area remains red, this could be the start of a pressure ulcer. Normal undamaged skin should turn white after a few seconds following finger pressure.

Pressure Ulcer Stages

Pressure ulcers are staged according to standard clinical definitions.

• Continuous warm, pink, or red area of unbroken skin. The area will usually be over a bony area.
• A sore has formed that looks like a blister, small break in the skin, or shallow crater. The area surrounding the sore may be red.
• The sore goes through the layer of fat under the skin. The sore may be white or black in color, have a foul smell, or be draining.
• The sore extends into the muscle or bone. The sore may be white or black in color. The area surrounding the wound may be warm to the touch or red. Foul smelling drainage may be present. Such a sore can pose a life-threatening situation due to infection or blood poisoning.

How to Prevent Pressure Ulcers

Most pressure ulcers can be prevented by following a few simple guidelines:

• Identify persons at risk of developing a pressure ulcer
• Assess the skin for early signs of skin problems
• Change the person's position frequently
• Ensure sheets are wrinkle and crumb free
• Maintain nutrition
• Have the person sit or lie on surfaces which support and reduce pressure on vulnerable areas
• Do not rub or massage the skin
• Keep the skin clean and dry. Do not use too much soap or powder
• Do not use creams or ointments without consulting a nurse or doctor
• Protect elbows and heels by using special devices
• Protect skin from friction

Treatment of Pressure Ulcers

If your family member is suspected of having a pressure ulcer, a doctor or nurse will assess the situation immediately, offer advice on how to prevent further tissue damage and treat the area.

• We will try to relieve the pressure and treat any pain.
• We will keep the area clean and treat infection when present.
• We will remove any dead tissue

We will do our best to use different accepted treatments to try to heal the pressure ulcer. Many of the treatments include the use of medications (or medicine). The area will be covered with a suitable dressing.

The dressing should:

• Encourage healing
• Keep the wound warm and moist
• Prevent infection
• Be removed and put on easily
• Clean easily if soiled

There are many different types of dressing used to help protect pressure ulcers and speed the healing of affected tissues. Usually the longer the dressing stays in place, the faster the wound will heal (as long as there is no infection).

Prevention is the best defense against pressure ulcers. It is the responsibility of health care professionals, bedside caregivers, residents, and family members to help prevent and treat pressure ulcers. Unfortunately, even with the best of care some residents may develop pressure ulcers that will not heal. Working with you, our goal will be to prevent and treat any pressure ulcers your family member may have or develop. When we work as partners, we can improve the quality of life of the resident(s) we care for and love.