Bedsores/Pressure Ulcers, Prevention and Treatment
What are bedsores? What do they look like? How do you treat them? All good questions.
What Are They?
Bedsores, or pressure ulcers are places on the skin with insufficient blood flow to the area caused by sitting or lying in one position too long. If the skin is not oxygenated by fresh blood it is damaged and the tissue dies. It starts out as a reddened area and can quickly turn into an open sore or ulceration. Bedsores, if not treated right away can become deep and very difficult to heal. Hips, heels, shoulders, tailbone, elbows, the back of the head, anywhere there is a bony prominence that can press against the skin is an area to watch.
Frequent position changes are the best way to prevent pressure sores. A good diet, keeping the skin clean and dry and preventing friction are also important. Bedsores are an ongoing problem for those with paralysis as they can’t feel the pressure that causes you and I to change positions. Here is a detailed article on causes, prevention and treatment.
We work hard to keep my mom’s skin in good condition. She doesn’t spend the day in bed. She sits in her chair, walks or uses the wheelchair to go to the bathroom and to the kitchen for meals. We check her skin every day.
Despite all our efforts, I have seen the first few indications that pressure sores are forming. She has two areas of concern. One is behind her left shoulder. She has lost so much weight that her bones stick out (highly technical medical term). She sleeps only on her left side and once asleep, barely moves. By morning the skin in that area is red. This week, we noticed an area behind her left ear. The bones in her skull press on her fragile skin, cause friction with her ear, and she wakes up with a reddened area there that will not blanch when pressed. (Press on the red area. If it does not turn white with pressure, the skin integrity is compromised.)
Last night I made her sleep on her right side to ease the pressure there. I knew it was going to be a problem as soon as I put her in bed. She panicked immediately and began flailing her arms, trying to reach for something solid, grabbing her bed table and the bed frame and I could see she was troubled. Because she is blind, the familiar is better. She is used to sleeping on her left side so she can grab my dad in the night. On her right side, there is nothing but air.
My husband helped me pull her farther to the center of the bed but she was still uneasy. She called early this morning saying she hurt “everywhere” and she had to get up. Once she was up and sitting in her chair she felt better. The arthritis in her right hip was causing her pain. Unfortunately, the area behind her ear is better, but still red. There are ways of cushioning the area but she already uses a memory foam neck pillow in addition to her other pillow to keep that area off the bed.
What To Do?
If a person is unable to move, turning every two hours to prevent pressure ulcers is recommended. Because my mom moves, we haven’t started doing that yet, but I can see it is coming. She isn’t comfortable on her back due to an arthritic spine. Her crooked spine does not even allow her to lie flat. It’s like trying to make a banana lie flat on a table. She just doesn’t bend. That leaves her right side and her left side. She’ll need to spend time on her right side again tonight. I know she doesn’t want to. She is taking all the acetaminophen she can take now. I hate to start her on heavier pain meds until she really needs them but I don’t want her to be uncomfortable either. It’s a dilemma.
An Action Plan
If you notice reddened areas or skin problems on the person you care for, have your doctor look at them. For us, as Mom is on Hospice, we will have the hospice nurse check and give recommendations on their next visit. The methods of treatment have changed a lot since I worked in the hospital, but the prevention is still much the same. Hopefully, we can keep Mom’s from becoming worse.
Areas to watch for redness or skin breakdowns:
Have a Good Caregiving Day,
P.S. The hospice nurse came this afternoon. After a consultation with the nurse and an unidentified voice I could hear over the phone talking with her (she told me his name but I didn’t know him) they recommended a soft athletic headband between her ear and skull. I’ll let you know how it works.