Pressure Care
An approach to symptom management to guide decision-making in the management of patients with life-threatening illness
- Pressure sores (decubitus ulcers) are ulcers of the skin which can extend into the subcutaneous tissue caused by ischaemia secondary to extrinsic pressure and shearing forces.
- Tissue ischaemia is caused by external pressure that is greater than capillary pressure (25mm Hg). Pressure for periods of 1-2hrs can cause cell death and ulceration.
- When sitting, pressure over ischial tuberosity is about 300mm Hg; when lying, pressure on heels is about 160mm Hg on foam mattress. (Twycross, 1997)
- There are a number of risk factors that increase the likelihood of a patient developing pressure sores in the bed-bound patient including general debility, malnutrition, cachexia, dehydration, anaemia, incontinence, neurological deficit, reduced mobility, restlessness, coma, infection, poor hygiene.
It is essential that professional and non-professional health care workers are aware of the causes and risk of pressure sores and the imperative to prevent pressure sores where possible.
The following measures will assist in the prevention of pressure sores:
- Vigilance of nursing staff
- Inspect the skin every time the patient is moved
- Care of the skin and pressure areas
- The skin should be washed and dried regularly, including bed bath for bed bound patient
- Maintain suppleness of skin by regular massage with skin lotion
- Avoid trauma – no restraints, lift patients do not drag them to move them in the bed
- Regular positional change, if patient is not able to lift and shift their weight 3-4 times an hour, family or hospice/hospital carers should assist in changing the patients position every 2-4 hours depending on patient’s risk factors
- Special mattress to distribute body weight more evenly
- Keep the bed linen dry and free from creases
- Keep the patient well nourished and well hydrated
The most vulnerable areas are elbows, shoulder blades, spine, buttocks and heels. If the patient is more comfortable lying on his/her side, then special attention should be given to ears, shoulders, hips and knees.
Periods of contact with the patient are valuable to the HCW. Regular position changes also serve to keep joints supple and add to patient’s comfort. Using cushions to support joints helps the patient relax and prevent ligaments from being overstretched.