Care of pressure points and
prevention of decubitus ulcer
Prevention
of decubitus ulcer in their patients who are bedridden is a major
responsibility of nurses working in a hospital.
When
we walk or stand on our two feet, the weight of our body is borne by our feet.
But when an individual is confined to bed, the weight of his body has to be
borne by his back or sides. The skin of the soles of our feet is very tough and
thick and it does not break easily in spite of the entire weight of the body
being supported by it. The nature has designed the sole of the skin for weight
bearing whereas the skin over the back of the body is not. When there is
pressure on the skin of the back because of the weight of the body, the skin
breaks and an ulcer develops.
Definition of Decubitus ulcer
A decubitus ulcer is a pressure sore resulting from
prolonged confinement in bed.
Areas
which are likely to be affected.
When a patient lies in supine position, the following areas
are vulnerable to pressure sores.
Back of head Shoulder blades Elbows
Base of the spine Buttocks
Heels
When a patient is in lateral position the following areas
will be affected.
Edge of ear Shoulders Knees Ankles
All or any of the protuberant parts
of a bedridden patient may become liable to pressure sores.
Causes of decubitus ulcer
Local or external causes
Pressure : When any body prominence
presses upon the bed, the tissues lying between them, get reduced blood supply
- If this condition prolongs, the superficial tissues necrosed, skin breaks
down and formation of an ulcer takes place.
The following conditions cause
prolonged pressure
Leaving a patient in one position
for a long time.
Leaving a patient on a bedpan for a
long while.
Hard and lumpy mattress
Pressure exerted by splints and
plaster casts.
b.
Friction :
Friction from bedclothes or any
other cause irritates the skin leading to inflammation.
If you lie on a bed sheet, which has
a rough seam in the middle of it, for a while, you will notice the impression
of the seam on your back.
You will also experience burning
sensation and the part will be red in colour.
The following factors cause friction
in a patient :
Careless pulling of patient and his
linen
Giving and removing bed pan
carelessly
Leaving broad crumbs, orange seeds
and food particles on the bed
Creases in the bottom sheet
General restlessness of patient
Rubbing two skin surfaces together
c.
Moisture : Moisture makes the skin swollen, unhealthy and
easily breakable.
The following reasons result in moisture over the pressure
areas:
Incontinence of faces and urine
Severe perspiration
Leaving a patient in wet linen
Heat : Leaving a patient in one
position for a long time, the part gets heated.
Lack of cleanliness and irritating
substances on the skin. e.g. perspiration, faeces, urine and vaginal discharge.
Predisposing factor for decupitus ulcer
Unconscious, helpless or acutely ill
patients
These patients are unable to appreciate the weight of
pressure and change their positions
Paralysed patients (Paraplegic and
quadriplegic patients). They have lost motor and sensory functions.
Patients with incontinence (spinal
injuries)
Old people
Very emaciated and malnourished
people
Patients with dehydration or oedema
g. Very fat people
Patients with disease affecting
circulation e.g. heart diseases and anemia
Patients with debilitating diseases
such as cancer and tuberculosis
Patients with metabolic disorders.
eg. Diabetes
Prevention of decubitus ulcers
Prevent Pressure :
Establish a turning schedule for
bedridden patients; turn hourly.
Have a firm cot and foam mattress
for bed-ridden patients - use extra pillows, pads and air rings to reduce
pressure.
Prevent friction :
When changing position of your
patient lift him and do not drag him on to bed.
Keep sheets without wrinkles and
seams.
Keep bed clean and free from crumbs.
If patient is restless, protect
pressure points with soft pads.
Prevent moisture : a. Keep dressings
and bed dry and clean. b. Clean and dry the incontinent patients promptly.
Prevent predisposing causes: a.
Improve patient's health by means of good food, ventilation, sunlight and
exercises. b. Encourage circulation through massage. c. Have patient to
ambulate early.
Observe early signs and symptoms of
decubitus ulcers : a. Redness b. Dark discoloration. c. Bruising, d. Tenderness
of the area. e. Burning sensation.
Give good care to pressure points :
Careful cleaning and massage should be carried out 3 or 4 times a day for all
bedridden patients. For some patients, it is necessary to give care as often as
every two hours.
A. Equipment
A bowl of warm water
Sponge cloth
Soap
Towel
Dusting powder
Spirit
B. Procedure
Explain procedure to patient - Arrange articles at the
bedside.
Screen the bed
Wet the part with soapy hand massage the area in circular
movements, so that the tissues under the skin gets increased circulation Remove
soap by washing Dry the areas
Apply spirit over the area and massage well. Spirit helps to
harden the skin.
Apply lightly dusting powder to keep the part thoroughly
dry. Do this treatment to all pressure points.
If patient is incontinent, apply zinc cream instead of
spirit and powder. This protects the skin from moisture. Leave patient
comfortable after the procedure.
Treatment of decubitus ulcer
Clean ulcers with aseptic
precautions - Use antiseptics such as eusole or hydrogen peroxide.
Apply medication ordered by the
doctor. eg. Antibiotic ointment, shark liver oil, zinc oxide, or any other
topical applications.
Cover with sterile dressings and
bandage
Surgical fermentation, ultraviolet
rays or heat lamp are helpful in healing
Provide good nutrition
Prevent secondary infections.
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