Skin (pressure) sores

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 the 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, or broken skin
• An open sore involving skin surface or tissue under the skin
• Yellowish stains on clothing, sheets, or chairs (may be tinged with blood)
• Painful or tender "pressure points" (such as on the back of the head, ears, back of shoulders, elbows, buttocks, hips, heels, or any place a bony part rests on the bed surface)

What the patient can do

• Change position at least every 2 hours from your left side, to your back, to your right side.
• In a wheelchair, shift your 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 your mattress.
• Exercise as much as possible. For example, take 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 (such as fish, eggs, meats, milk, or 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.
• Always 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 them as prescribed. Report any itching or blistering in the area.

What caregivers can do

• Remind the patient to change position often, or help the patient turn every 2 hours.
• If the patient cannot control their bowels and bladder, change their underwear as soon as you notice soiling, and then apply an ointment (such as A & D ointment) to keep the area dry. Sprinkle cornstarch over the ointment. Avoid using plastic underwear unless the patient is out of bed. Use underpads to keep the patient from soiling the bed while lying down.
• If the skin is open, talk with the doctor about special dressings to help protect it.
• If the patient is bedridden:
• Keep the bottom sheets pulled tight to prevent wrinkles.
• Keep the head of bed flat or at a 30° angle.
• Sprinkle sheets with cornstarch to reduce friction from rubbing against them.
• Inspect the patient's 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 have the patient change position frequently.
• If the patient has trouble staying on their side, find out about foam wedges to help hold positions.
• Foam pads for the bed and chairs 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, or 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