Pressure sores: Treatment, symptoms, advice and help
About pressure sores
Pressure sores or bed sores are ulcers on the body parts exposed to prolonged pressure and occur in immobilized and bedridden patients. Bed sores cause considerable morbidity and often require very prolonged care. They can be prevented with good nursing care and simple precautions in bedridden patients.
Pressure sores: Incidence, age and sex
Bedsores occur commonly and the incidence is relatively high in developed countries. They generally occur in elderly patients who are bedridden and hospitalized for a longer periods of time.
Signs and symptoms of pressure sores: Diagnosis
Bedsores are easily diagnosed on physical examination and start as areas of redness on pressure points. This is followed by formation of a blister. Subsequently the skin gets broken and an ulcer is formed. Ulcers can advance into the deeper layers of skin and can even involve ligaments and bones. The secondary infection can cause fever and other signs of sepsis.
Causes and prevention of pressure sores
Bedsores occur at the sites of pressure over bony prominences. The common sites are lower back (sacrum), hips, elbows, shoulders, knees and ankles. The pressure of bone against the surface causes tissue injury and can damage the local blood vessels. Local moisture because of incontinence or sweating, and raised skin temperature also accelerate the ulcer formation. The risk factors associated with the formation of bedsores include immobility, long-term hospitalization, malnutrition, low blood pressure, diabetes, smoking and advanced age.
Most bedsores can be prevented with good nursing care. Preventive measures include changing the position of patient frequently, use of air and water mattresses, pressure distributive mattresses, ensuring proper nutrition, treatment of fever and infection and avoiding soiling of body with secretions.
Pressure sores: Complications
Pressure sores can cause significant morbidity and may lead to sepsis, multi-organ dysfunction, reduced protein levels in the blood, anaemia and gangrene. The infection can spread to the bone and can cause what is called osteomyelitis. These complications are responsible for prolonged hospital stay and can be fatal.
Pressure sores: Treatment
The most important first step in treatment of pressure sores is relief of pressure from the affected area which may be achieved by repositioning the patient or using pressure distributive mattresses. The dead tissue needs to be removed by surgery or other means in order to accelerate healing. Treatment of infection by using antiseptic dressings is also important. In addition, treatment of associated conditions like diabetes and sepsis, and ensuring proper nutrition, either orally or by intravenous supplementation helps in timely healing of ulcers. The patient and the caregivers need proper education for control of ulcers and prevention of recurrence.