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Pressure Sores

(Pressure Ulcers; Bed Sores; Decubitus Ulcers)

Definition

A pressure sore is a lesion that develops on the skin and underlying tissues, usually over bony areas, due to unrelieved pressure.
Pressure Sore (Skin Ulceration)
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Causes

Pressure sores result from lying or sitting in one position for too long a time. The skin and tissues need enough blood supply for oxygen and nutrients. Prolonged pressure cuts off the blood supply to tissues that are compressed between a bony area and a mattress, chair, or other object. Without oxygen and nutrients, the tissue starts to become damaged and dies.
Several factors contribute to the development of pressure sores including:

Risk Factors

This condition is more common in older adults and people of African American or Hispanic descent. Other factors that may increase the chance of pressure sores include:

Symptoms

Symptoms of a pressure sore may include:

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Pressure sores are staged according to the depth and tissues that are involved.
Your bodily fluids may be tested. This can be done with:
Images may be taken of your bodily structures. This can be done with:

Treatment

Treatment aims to relieve pressure on the area, heal the wound, avoid complications, and prevent future pressure sores. In many cases, a caregiver will provide care for your pressure sores.
Treatment includes:

Positioning

  • Avoid placing any weight or pressure on the wound.
  • Change position at least every 2 hours, around the clock.
  • Maintain good body alignment.
  • Make sure bedclothes are clean and without wrinkles.
  • If needed, use a special mattress.

Hygiene

Clean soiled skin after each bowel movement and urination. Wash with mild soap and warm water. Rinse well. Pat dry. Do not rub. Apply lotion as advised.

Wound Care

You or your caregiver will be taught how to tend to the wound. Some basic instructions include:
  • Clean the sore, remove dead tissue, and apply a dressing.
  • Do not put anything else on the sore.
  • Wash hands before and after performing wound care. Wear disposable gloves.
  • Clean the wound every time the bandage is changed.
  • You may need to take pain medication a half hour or hour before dressing changes.

Nutrition

Eat a well-balanced meal. Your doctor may recommend vitamins, minerals, or supplements.

Surgery and Other Procedures

The doctor may surgically remove dead tissue. Skin grafts may be needed. In some situations, electrotherapy may be used to stimulate blood flow and promote healing.

Other Therapies

Phototherapy using ultraviolet light may have some benefits when used in combination with other treatments. In some, it has been shown to reduce healing time.

Prevention

Most pressure sores can be prevented. Suggestions include:

RESOURCES

Family Doctor—American Academy of Family Physicians http://familydoctor.org

National Pressure Ulcer Advisory Panel http://www.npuap.org

CANADIAN RESOURCES

Health Canada http://www.hc-sc.gc.ca

The College of Family Physicians of Canada http://www.cfpc.ca

References

Pressure ulcer. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 9, 2015. Accessed January 12, 2015.

Pressure ulcer category/staging illustrations. National Pressure Ulcer Advisory Panel website. Available at: http://www.npuap.org/resources/educational-and-clinical-resources/pressure-ulcer-categorystaging-illustrations. Accessed January 12, 2015.

5/27/2011 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: McInnes E, Jammali-Blasi A, Bell-Syer S, Dumville J, Cullum N. Support surfaces for pressure ulcer prevention. Cochrane Database Syst Rev. 2011;(4):CD001735.

11/25/2013 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: Moore ZE, Webster J. Dressings and topical agents for preventing pressure ulcers. Cochrane Database Syst Rev. 2013;8:CD009362.

8/11/2014 DynaMed's Systematic Literature Surveillance. http://www.ebscohost.com/dynamed: Chen C, Hou WH, Chan ES, Yeh ML, Lo HL. Phototherapy for treating pressure ulcers. Cochrane Database Syst Rev. 2014;7:CD009224.

6/22/2015 DynaMed's Systematic Literature Surveillance http://www.ebscohost.com/dynamed: Qaseem A, Mir TP, Starkey M, et al. Clinical Guidelines of the American College of Physicians. Risk assessment and prevention of pressure ulcers; a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2015;162(5):359-69.

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