Decubitus ulcers, also known as pressure ulcers, are a sore that appears due to prolonged pressure and the consequent decrease in blood flow to a certain part of the skin.
This type of wound is most common in areas where bones are most in contact with the skin, such as the lower back, neck, hip or heels, because there the pressure on the skin is greater, worsening circulation.In addition, pressure ulcers are also more common in people caught, as they can spend several hours in a row in the same position, which also makes it difficult to travel to certain areas of the skin.
- Although they are sores on the skin.
- Pressure ulcers take a long time to heal and this occurs for several reasons.
- Such as weakness of the overall condition of the person.
- Alteration of the deep layers of the skin and the difficulty of completely relieving all the pressure of therefore.
- It is very important that all types of ulcers be evaluated by a doctor or nurse.
- So that treatment can be started with the most appropriate product.
- As well as the most important care to accelerate healing.
Initially, pressure ulcers appear on the skin only in the form of a red spot, but over time, this site may have a small wound that does not heal and increases in size.Depending on the time of the ulcer evolution, it is possible to identify 4 stages:
The first stage of pressure ulcers is known as “bleaching erythema” and means that at first the ulcer appears as a reddish spot that, when pressed, changes color to white or becomes paler, and maintains this coloration for a few seconds or minutes, even after removing the pressure.In the case of black or darker skin, this spot may also have a dark or violet color, rather than red.
This type of stain, in addition to being white long after being pressed, can also be harder than the rest of the skin, being warm or colder than the rest of the body.The person may also refer to the sensation of tingling or burning.There.
What to do: at this stage you can still avoid pressure ulcers and, therefore, ideally keep the skin intact and improve blood circulation, to do this try to keep the skin as dry as possible, apply a moisturizer frequently, as well as avoid positions that can put pressure on the place for more than 40 minutes in a row.In addition, it is important to have regular massages on site to facilitate circulation.
At this point, the first wound appears, which may be small, but appears as an opening of the skin in the area of the bleaching spot, in addition to the wound, the skin of the stain area appears thinner and may appear dry or even brighter than normal.
What to do: although the wound has already appeared, at this stage it is easier to stimulate healing and prevent infection, for this it is important to go to the hospital, or to a health center, so that the place is evaluated by a doctor or nurse, in order to start treatment with the most appropriate products and dressings, in addition, it must continue to relieve the pressure of the site , in order to drink plenty of water and increase the consumption of foods rich in protein and vitamins, such as eggs or fish, as they facilitate healing.
In stage 3, the ulcer continues to grow and increase in size, beginning to affect the deeper layers of the skin, including the subcutaneous layer, where the fatty deposits are located, so at this stage, within the wound, it is possible to observe a type of irregular and yellow tissue, formed by fat cells.
At this stage, the depth of the ulcer varies depending on the affected site and is therefore normal that in the nose, ears or ankles it is not possible to observe the subcutaneous layer, since it is not present.
What to do: Appropriate treatment should be maintained under the direction of a nurse or doctor, requiring a closed bandage every day, it is important to drink a lot of water during the day and bet on the most protein-rich diet.You should also continue to relieve pressure from affected areas, and even your doctor may recommend buying a mattress that will vary the pressure throughout your body, especially in people who have been bedridden for a long time.
This is the last stage of the development of pressure ulcers and is characterized by the destruction of the deeper layers, where muscles, tendons and even bones are located; in these types of ulcers, the risk of infection is high and, as a result, the person may need to be hospitalized to make more regular bandages and receive antibiotics directly into the vein.
Another very common feature is the presence of a very foul smell, due to the death of tissues and the production of secretions that can become infected.
What to do: These ulcers need to be treated in the hospital and may even need to stay in the hospital to produce antibiotics and prevent a possible infection.It may also be necessary to remove layers of dead tissue and surgery may be recommended.
One of the most important nursing cares for pressure ulcers is to make an adequate dressing, however, the nurse must also maintain a periodic assessment of the wound, as well as teach the person to avoid aggravation of the ulcer and assess the risk of new ulcers..
The dressing should always be adapted to the type of tissue present in the wound as well as to other characteristics such as: release of secretions, odor or presence of infection, in order to promote proper healing.
Thus, the dressing can include different types of materials, among the most common are:
In addition to using the appropriate dressing, the nurse should remove the debris from the previous dressing and properly clean the wound where, in addition to using a saline solution, a scalpel can be used to remove pieces of dead tissue, the so-called debridement.This debridement can also be performed directly with the compress during cleaning or with the application of enzyme ointments, such as collagenase.
Learn more about ointments for the treatment of pressure ulcers
When treating the wound, the nurse should pay attention to all the characteristics that he or she may observe or identify, so that an assessment can be made over time, in order to understand whether adequate healing is under way.It is also very important to consider this assessment to change the materials of the dressing, so that they remain suitable throughout the treatment.
Some of the most important features to evaluate during all dressings include: size, depth, edge shape, production of secretions, blood, odor and signs of infection, such as redness of the surrounding skin, swelling, heat production or pus.take pictures of the wound site or draw a picture of a piece of paper under the wound, to compare the size over time.
When assessing the characteristics of pressure ulcers, it is also recommended to pay attention to the skin around the wound, because if it is not properly hydrated, it can contribute to the increase of the ulcer.
There are several lessons that are very important to the person with scars and can help significantly improve the speed of healing as well as avoid complications.Some of these lessons include:
In addition, it may also be important to refer the person to a consultation with a nutritionist, as good nutrition is very important to promote collagen formation and wound closure.
If this is the case for a person bedridden, here’s how to put the person to bed:
People who develop pressure ulcers have an increased risk of developing new ulcers, so it’s a good idea to assess the risk of having a new ulcer, which can be done using the Braden scale.
The Braden scale evaluates 6 factors that can contribute to the onset of an ulcer and include: the person’s ability to feel pain, skin moisture, level of physical activity, ability to move, nutritional status, and the ability to rub the skin.Each of these factors is assigned a range of 1 to 4, and in the end all values must be aggregated to obtain the risk classification of developing pressure ulcers:
Depending on the risk, as well as the lower scored factors, it is possible to create a care plan that helps prevent a new ulcer, in addition to facilitating healing of the existing ulcer, some treatments may involve adequate hydration of the skin, promoting a more appropriate diet or even stimulating moderate physical activity.