A pressure ulcer is damage to the skin and the deeper layer of tissue under the skin. This happens when pressure is applied to the same area of skin for a period of time and cuts off its blood supply. It is more likely if a person has to stay in a bed or chair for a long time. Pressure ulcers are sometimes called ‘bedsores’ or ‘pressure sores’.
There are other things that can contribute to the development of pressure ulcers:
Rubbing (shearing) – when layers of skin are forced to slide over one another such as sliding down or being pulled up in a chair or bed
Friction – when the outer layer of skin is rubbed across a surface causing the skin to become damaged
Moisture – if the skin becomes wet it makes the outer layers of skin more likely to breakdown
Anybody can develop a pressure ulcer but some people are more at risk due to various issues such as:
- Not able to move around as much as usual
- Staying in bed or a chair for long periods of time and not being able to change position
- If you have a serious illness
- If you have a poor appetite
- If you are incontinent
- If you cannot feel pain in part or all of your body eg: diabetes or spinal injury
- Poor circulation
- If you have had a pressure ulcer before
- If you are underweight or overweight
- Red areas on light skin / purple, blue areas on dark skin
- Swelling
- Blisters or broken skin
The skin may feel:
- Hard
- Warm or hot
- Swollen
- Dry
- Tender
- Moist
A moisture lesion is caused when the skin becomes soggy and sore due to excess moisture from urine, faeces or perspiration. The skin can break down and become very sore making it more vulnerable to pressure. It is extremely important to keep your skin clean, dry and protected with a barrier cream.
If you think your skin is getting sore you should inform your District Nurse or GP so that it can be treated quickly.
A continence assessment may be carried out to ensure you have the right pads or equipment to cope with any incontinence.
You need to check your skin regularly (at least daily) for early damage as this will allow action to be taken to prevent Pressure Ulcers from developing
Be aware of your skins normal colour, texture and temperature so that you will notice very quickly any changes
Get your carer to check areas that you can’t see such as back and bottom
Keep your skin clean and dry. If you are washing your skin frequently, use a soap substitute such as an emollient to prevent stripping the skin of its natural protective oils
If you have any incontinence, it is important to protect the skin with a barrier cream which is applied very sparingly after every 3rd episode of incontinence
- Regular skin checks and report to a Health Care Professional any discolouration or breaks in your skin.
- Keep skin clean and dry
- Keep moving – if you are able to, change your position frequently. If you can’t do it on your own ask your carer to assist you
- Adequate nutrition and fluids are essential to prevent pressure ulcers.
- Ensure that you do not wear tight fitting or bulky clothing that may mark your skin.
- Heels are very vulnerable to pressure damage so elevating your heels off the bed with a pillow can reduce the risk of damage.
If you are admitted to the Hospice, you will have a comprehensive skin inspection on admission and given appropriate equipment such as pressure relieving mattress and cushion and a care plan will be agreed with you to reduce your risk of developing a Pressure Ulcer or Moisture Lesion.
If you are at home you can contact your GP who will refer you to the District Nursing Service who can come and assess your needs and also provide any equipment or coordinate any care that you may need
