Preventing, Recognizing and Treating Bed Sores and Pressure Ulcers
The daunting, ominous wound care topic – cue drum roll . . .
First things first, bed sores (or pressure ulcers as they’re also known) are super serious business. Google it if you don’t believe me, but be weary of the images that pop up. Left untreated, they can put someone in the hospital and worse, take their life.
Many caregivers who haven’t had experience with wound care simply don’t know what bed sores are, how to treat and prevent them, and what supplies and tools are out there to assist you. I was one of those caregivers. Mom was always tiny, but when she got sick she lost a ton of weight and balanced out at pretty much a skin-and-bones 80 lbs. She’s just under 5’ tall so it’s not insane considering her condition, but my point is, we don’t have a whole lot of fat and tissue to work with.
Bed sores are called pressure ulcers for the very reason that they’re the breakdown of skin and tissue due to pressure from a bone pressing in the same place overtime. For Mom it’s her tailbone – for others, it can be the heels of the feet, other areas of the bottom or back, elbows, ankles, and hips. We have been keeping a bed sore at bay for years and have aggregated helpful advice over the years from doctors, nurses and home health aids.
Absolutely consult your doctor regarding concerns about pressure ulcers on your loved one – they can help you with supplies, prescribe home health nurses to help teach you and help you prevent future sores.
- Know the stage: There are four stages of a pressure ulcer. At stage 1, there is pinkish or reddish coloring of the skin in a focused area on the body, and for darker skinned people, while not necessarily red, you will notice a discoloring. When you gently press the area and remove your finger, if it does not blanch (lose color briefly), this could mean there is some tissue damage. In stage 2, the skin breaks open and forms a tender and oftentimes painful ulcer. At stage 3, a crater forms where the sore is expanding into deeper layers of tissue below the skin. And at stage 4, the breakdown has made its way to layers of muscle and eventually bone, putting your loved one at serious risk for infection.
- Protect it: Protective or “wound barrier” creams are the best way to help protect sensitive skin from irritation and to prevent healed pressure ulcers from re-opening. We’ve used a variety of creams throughout our time dealing with Mom’s bed sore, but most readily prefer Corona Cream. Corona Cream is actually developed for horses but has proven to be an incredible (and totally safe) asset for wound care too. Other ointments and creams we have tried include Coloplast Critic-Aid Clean “Clear Moisture Barrier Ointment” which rocks, as well as Medihoney by DermaSciences (100% active Leptospermum Honey) and EPC (Extra Protective Cream) by Smith&Nephew, a more zinc-oxide based cream like you would use for diaper rash. Because of Mom’s incontinence, we found the clear ointments like Corona Cream to be less messy and easier to apply and wipe off, but depending on your loved one, you might try something different.Where can you get these creams? Most drugstores for sure, but we typically order them online, take them with us from a hospital stay, or ask a home health nurse to bring some. You might also ask your doctor if they have any bottles or samples they can give you too.
- Treat it: Consult your doctor right away if you are concerned there is a bed sore on your loved one that needs treating. If it is an early stage bed sore, dressing the wound is helpful in treating it and your doctor or home health nurse can do this for you/teach you how. Mepilex Border wound dressings are a self-adherent soft silicone foam dressing that come in various shapes and sizes to completely cover a pressure ulcer. These are our go-to dressing if Mom’s skin breaks down because the outer border serves as a protectant from dirty diapers. They are expensive though, so we typically ask the home health agency to bring some to dress Mom, or we order them online. Other wound treatments include hydrophilic foam dressing (HydraFoam), hydrocolloid dressing (DermaFilm HD), and alginate dressings (they contain calcium and sodium fibers derived from seaweed and can absorb fluids to promote healing on late-stage wounds). There are more treatments but these we are most familiar with.
- Toss and turn: Any medical professional can tell you the best way to prevent pressure ulcers is to change positions every couple of hours. This doesn’t mean sitting up and then lying down and then sitting up. In Mom’s case, she spends most of her time in her hospital bed. We use a gaggle of pillows (I’m not kidding, I think there are 7 or 8 on her bed right now) to prop her up, shift her hips, lift her feet, and adjust her slightly one direction or the other. This helps keep pressure off her coxic she has skin breakdown from a previous bed sore. If the person you are caring for spends a lot of time in a wheel chair, recliner or other type of chair, do the same thing – use pillows to slightly shift positions and keep from sitting the exact same way for hours at a time. Do NOT use a “donut” (circular pillow with a hold in the middle of it) if your loved one has a pressure ulcer on the bottom. This misconception is dangerous – donut pillows actually create more pressure on those sensitive parts of the bottom and can lead to tissue damage faster.
- Float the heels: Patients who spend a significant amount of time in bed, or reclining in a chair and who don’t walk, can develop “drop foot” or a gait abnormality where the forefoot drops permanently and cannot be held up. When this happens, pressure ulcers can form in the oddest of places – the heel of the foot! Prolonged pressure on this almost hidden part of the body can result in ulcers fast which is why it is so important to “float the heels.” That means, simply prop the feet up with a pillow so your loved one’s feet float in the air and their heels aren’t pressing down against anything.
Thanks for checking out these bed sore care tips from Give a Care. What would you add to the list?