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A skin or pressure sore develops when the blood supply to an
area of the body is stopped and the skin in that area dies. A person
who is bedridden or always in a wheelchair puts pressure on the same
places much of the time. This reduces the blood flow to these places,
making them more likely to develop open sores. These areas are made
worse when the patient rubs against his or her sheets, or is roughly
pulled up in the bed or chair.
What to look for
- Red areas on the skin that do not go away even after the
pressure is removed
- Cracked, blistered, scaly, broken skin
- An open sore involving skin surface or tissue under the skin
- Yellowish stains on clothing, sheets, or chair (may be
tinged with blood)
- Painful or tender "pressure points" (back of head, ears,
back of shoulders, elbows, buttocks, hips, heels, and any place a bony
part rests on the bed surface.)
What the patient can do
- Change position at least every 2 hours from left side, to
back, to right side.
- In a wheelchair, shift weight every 15 minutes. Use special
seat cushion to reduce pressure.
- Protect other "pressure points" with pillows to help
prevent new sores. If possible, use pressure-reducing mattress or 3 to
4-inch foam layer over mattress.
- Exercise as much as possible (such as taking a short walk 2
or 3 times a day). If you are not able to walk, pull up, and move your
arms and legs up and down and back and forth.
- Eat foods high in protein (for instance, tuna or other
fish, eggs, meats, milk, peanut butter).
- Increase fluids. (If you are not eating well, try
high-calorie liquids such as milkshakes.)
- Bathe each day and look at the pressure point areas.
- A lways protect the sore and the area around it
with a foam wedge or pillow.
- Rinse any open sore with water very carefully and cover
with a bandage. Do this every time the bandage gets soiled, or at least
twice a day as instructed by your doctor or nurse. If your doctor gives
you ointments or creams, use as prescribed. Report any itching or
blistering in the area.
What caregivers can do
- Remind patient to change position often, or help patient
turn over every 2 hours.
- If the patient cannot control his or her bowel and bladder,
change underwear as soon as you notice soiling and then apply an
ointment to keep area dry (such as A & D ointment®).
Sprinkle cornstarch over ointment. Avoid using plastic underwear unless
the patient is out of bed. Use underpads to prevent soiling the bed
while the patient is lying down.
- If the skin is open, talk with the doctor about special
dressings to help protect it.
- If patient is bedridden:
Keep bottom sheets pulled
tight to prevent wrinkles.
Keep head of bed flat or at a
30° angle.
Sprinkle sheets with
cornstarch to reduce friction from
rubbing against sheets.
Inspect his or her back and
sides each day to be sure that the
skin looks normal. If a reddened "pressure area" (an area that stays
red after pressure is taken off it) is noticed, keep the pressure off
it as much as possible to try to prevent further breakdown. Use pillows
and frequent position changes.
- If the patient has trouble staying on her or his sides,
find out about foam wedges to help hold positions.
- Foam pads for bed and chair may help some patients.
- If the problem continues, talk to the doctor or nurse about
home care options. Find out about special beds that reduce pressure
areas.
Call the doctor if the patient:
- has cracked, blistered, scaly, broken skin
- has a sore that is getting larger
- has a thick or bad-smelling liquid draining from the sore
- needs a referral to a home care agency for help with
pressure sore care and supplies.
Go to a list of symptoms to find
other problems in Caring for the
Patient with Cancer at Home: A Guide for Patients and Families.
Revised: 04/07/08
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