Pressure Sores Considerations

What can be done to prevent pressure sores from developing?

Keep in mind that recent research indicates that even with the best care, some bed sores are unavoidable. Sometimes they are just an indicator that the person is very sick. Nonetheless, the following measures may help to prevent pressure sores.

• Inspect skin at least once a day.
• Bathe when needed for comfort or cleanliness.
• Prevent dry skin—use moisturisers.
• Clean skin as soon as soiled or wet from urine and pat dry.
• If moisture cannot be controlled, use absorbent pads and/or briefs with a quick drying surface. Cleanse skin as soon as possible with no-rinse cleanser and a durable barrier product. These products are readily available in your local pharmacy.
• Don’t massage bony prominences (areas where the bones protrude slightly below the skin).
• When repositioning, reduce friction by lifting rather than dragging.
• Use cornstarch on the skin to reduce friction.
• Encourage a balanced, high-protein diet or explore nutritional supplements and ensure good oral fluid intake.
• Consult a dietician about protein and calorie intake.
• Ensure clothing is not restrictive or wrinkling in pressure areas.

Are there things I should do if my loved one is dependent on a wheelchair?

Persons dependent on wheelchairs to mobilise should be repositioned every hour if they are unable to do so themselves. If they can shift their own weight, changing position every 15 minutes is recommended. Use foam, gel, or an air cushion to relieve pressure. You can consult an occupational therapist or physiotherapist to learn more about the best cushions to use, but it is strongly suggested you avoid donut-shaped cushions. Pillows or wedges can be used to keep knees or ankles from touching each other.

What if my loved one is confined to bed?

Changing position at least every two hours is very important. Keep bed linens clean, dry, and without wrinkles. Special mattresses that contain foam, air, gel, or water are recommended. It is advisable to raise the head of the bed as little as possible and for as short a time as possible
(No more than 30 degrees or it can increase the chance of bedsores). Positioning a pillow under the legs - from mid-calf to ankle - helps to keep heels off the bed
 

What do I need to know about managing pain caused by pressure sores?

The pain associated with pressure ulcers is a source of anxiety and distress and can be difficult to relieve. Pain can make it difficult to sleep or eat and can deepen depression. Aggressive interventions with a combination of pharmacologic and non-pharmacologic
measures to prevent and relieve pain are encouraged.

An effective pain management strategy takes into consideration side effects (constipation, sedation, etc.) of the measures used. Pre-medication, at least twenty to thirty minutes before dressing changes, plus scheduled analgesics, can make a significant difference in comfort. Mild to moderate pain can often be managed with non-steroidal anti-inflammatory medication

Moderate to severe pain may require opioids, which will require a prescription. At times, combinations of antidepressants and anticonvulsants can help reduce pain. Topical applications are often effective in the management of nerve pain. Consulting with a pain management team, GP, MS Nurse specialist and/or Public Health Nurse to assess and manage wound pain can help establish and maintain optimum levels of comfort for your loved one.

Would getting a special mattress help?

Selecting and positioning an appropriate support surface can be complicated for Care Givers. To be effective, support surfaces must distribute bodyweight evenly over the entire body. The degree of head elevation shifts pressure to the lower back and hips. The surface must allow prominent areas of the body to sink into the support.

For the person confined to bed, mattress overlays and mattress replacements can provide pressure relief. For pressure ulcer prevention, foam, gel and water mattress overlays that do not require electricity may be adequate. For a person with multiple pressure ulcers on the trunk or pelvis, a powered surface may be needed.

Alternating air overlays with mechanical pumps are available as mattress overlays and whole- bed systems. For the person with ulcers that have not improved with comprehensive care, sophisticated air-fluidised beds may be necessary. A wound specialist should be consulted.

When considering a support surface, look for moisture control and skin temperature (the surface should not make the person sweat). The surface should not promote bacterial growth or be flammable. The owner’s manual should describe how to clean and maintain the surface. Contact your local Occupational Therapist for best advice