Bed sores (pressure injury)

Question 1

The decubitus ulcer is typically

Answer 1

undermined at the edges

Question 2

Prevention

Answer 2

Identifying pt at risk, e.g. Norton scale assessment

Good nursing care, inc. turning pt every 2 h (90% of pressure ulcers are preventable)

Special care of pressure areas, inc. gentle handling

Special beds, mattresses (e.g. air-filled ripple) and sheepskin to relieve pressure areas

Good nutrition and hygiene

Avoid smoking

Control of urinary and faecal incontinence

Avoid the donut cushion and soaps

Question 3

Treatment of ulcer

Answer 3

The most important is early intervention, including relief of pressure, friction and shear.

Clean base with;

• warm water or saline solution (applied gently via a syringe) or
• Intra Site Gel (most antiseptics damage cells—use 0.5–1% Betadine)

Give vitamin C, 500 mg bd

Give antibiotics for spreading cellulitis (otherwise of little use)

Healing usually satisfactory but, if not

surgical intervention with debridement of necrotic tissue and skin grafting may be necessary

Question 4

General guidelines for dressings:

Answer 4

–deep ulcers: alginates (e.g. Algisite M Tegagel, Kaltostat)

–shallow ulcers: hydrocolloids (e.g. Duoderm, Cutinova Hydro)

–dry or necrotic ulcers: hydrogels (e.g. Intra Site)

–heavy exudative ulcers: foams (e.g. Lyofoam, Lyofoam extra)

Remove dressings with care, if nec. under shower