Stages of Bed Sore pressure sores
- reddened or darkened skin that will not turn white when firmly pressed
- partial skin loss that may appear as an abrasion, blister or shallow crater
- full skin loss extending to underlying tissue
- full skin loss extending beyond the underlying tissue to muscle and bone
- Impaired Wheelchair Mobility
- Impaired Physical Mobility
- All the Self-Care Deficits
- Impaired Bed Mobility
- Ineffective Protection
- Risk for Trauma (if restraints are being used)
- Chronic Pain
- Risk for Impaired Skin Integrity
- Risk for Infection
- Impaired Comfort
- Keep the patient's skin moisturized
- Use of Water Filled Mattresses or Sheep Skin Pads
- Clean the pressure sore by irrigating the wound with a saline solution (available from drug stores) or other cleaning solution recommended by a health care professional.
- Remove all dead tissue and scabs. A health professional can recommend the best approach, depending on the severity of the pressure sore.
- Pat the wound dry.
- Bandage the wound with a dressing that keeps the pressure sore moist while keeping surrounding tissues dry.
- Use pillows and padded protectors to support arms, legs and vulnerable areas.
- Change the position of a bed-bound person every two hours. Handle and move carefully to avoid skin tears and scrapes.
- Change the position of a chair-bound person hourly.
- Use of foam wedges to prevent skin contact between legs or ankle bones
- Clean skin with warm water and minimal friction. Apply lotion often.
- Avoid direct pressure to bony areas such as ankles and hips.
- Discourage the bed-bound or chair-bound person from sitting with the head elevated more than 30 degrees, except for short periods of time.
- Check and change bed linens as often as necessary
- Use continence management products if necessary to reduce exposure to moisture