BedSores... Persistent Attention is Key to Healing ©

By: Clare Absher RN, BSN

DO NOT FEEL GUILTY or incompetent should your loved one develop a bedsore as this can happen in spite of your best efforts. Other complicating factors contribute that are often well beyond your control such as advanced age, incontinence, poor nutritional status including dehydration and certain medical conditions such as neuromuscular disorders, diabetes and cardiovasular disease.

Here Are Some Practical Tips on Caring for Bedsores

Keep in mind that pressure sores can be serious, depending on how much of the skin and tissues have been damaged. You should call your doctor if you suspect a sore is forming.

Prevent buildup of skin moisture where pressure exists in attempt to prevent further skin breakdown of early Stage I ulcers.

Initiate an aggressive turning and pressure relief schedule doing everything possible to relieve the pressure that caused the sore. Avoiding further trauma or friction. Powdering the sheets lightly can help decrease friction in bed. (Refer to our article about bed sore prevention for more pressure relief ideas)

Institute all possible measures to improve nutrition, hydration and other conditions to help the sore heal.

In general, do not use strong antiseptic agents for cleaning wounds, such as a Betadine, Dakins Solution, Hydrogen Peroxide, Acetic Acid, and others. Older patients may heal slowly, and these agents slow the healing process even further.

Use skin barriers (Skin Prep) and other barrier ointments/lotions (Cavilon Durable Barrier Cream) around the ulcer to help maintain it intact and prevent further breakdown as well as a barrier to irritating adhesive created by some dressing applications.

Clean the sore and keep free of dead tissue by rinsing the area with a salt-water solution (Wound Wash Saline) or a special prescribed solution with every dressing change. The solution removes extra fluid and loose material. Your doctor or nurse can show you how to properly clean the pressure sore.

Sometimes your doctor may suggest a method to remove dead tissue such as applying wet gauze bandages on the sore and allowing them to dry with frequent changes. The dead tissue sticks to the gauze and is removed when the gauze is pulled off. Other times he may order special dressings that are left in place for days to assist with debridement or surgical debridement may be necessary.

Maintaining a moist environment is critical at Stage II and more advanced stages. After cleansing, if moderate to heavy draining wound an alginate, hydrocolloid (Duoderm) foams (Lyofoam) or hydrofibers may be prescribed with waterproof dressing cover (Tegaderm) or cover with gauze.

If the wound is dry, hydrating the wound bed with a hydrogel (Tegagel) or (Saf-Gel) may be ordered with a secondary dressing to cover and keep the gel in wound bed. Frequency of dressing changes will depend on type of dressing prescribed and amount of drainage.

Since removing dead tissue and cleaning the sore can be painful, ask your doctor to suggest a pain reliever for you to take 30 to 60 minutes before dressing changes.

Deep sores can go down into the muscle or even to the bone and if not treated properly can become infected. An infection in a pressure sore can be serious and spread to rest of the body requiring immediate medical attention. Consult with your doctor about appropriate treatment after his evaluation.

Treatment for an infected sore depends on how extensive the infection is. If only the sore is infected, an antibiotic ointment may be prescribed to apply to the sore. When bone or deeper tissue is infected, IV antibiotics are often required.

Controlling infection is crucial. Report signs related to ulcer of:

Thick yellow or green pus
Foul smell from the sore
Redness and swelling around the sore
Tenderness and warmth around the sore

Report signs that the infection may have spread (systemic infection) including:

Fever or chills
Mental confusion
Rapid heartbeat
Weakness

As a pressure sore heals, it slowly gets smaller and has less drainage. New, healthy tissue starts growing initially at the bottom or base of the sore. This new tissue is light red or pink and looks lumpy and shiny.

Remember persistence pays off when it comes to healing pressure sores. It may take 2 to 4 weeks of treatment or longer before you see these signs of healing. Do not get discouraged and take one day at a time rejoicing even the slightest progress.

About Stage I Stage II Stage III Stage IV
General Appearance of Ulcer Reddened area of skin that is still intact (unbroken). Nonblanchable (nonwhitening when press and release) with discoloration of skin and inflamed. The skin blisters or forms an open sore. The sore is superficial with a shallow craterlike formation or blister at and/or adjacent to ulcer.The skin breakdown looks like a crater where there is damage to the tissue below the skin. The necrotic tissue (dead tissue) may be yellow or black in color. The skin breakdown looks like a crater where there is damage to the tissue below the skin. The necrotic tissue (dead tissue) may be yellow or black in color. The pressure ulcer has become so deep that there is damage to the underlying tissue. The necrotic tissue (dead tissue) may be yellow or black in color with extensive eschar. (sloughing tissue)
Additional Characteristics Intact surrounding skin. May be painful and warm to the touch. This indicates that a pressure ulcer is starting to develop. Broken skin area is red and painful and the area around the sore may be red and irritated. May be draining and is at risk to become infected. Destruction usually involves tissue loss down to the bones and joints and will be extensive and is painful. At great risk for infection.
Understanding Anatomy/Physiology Skin intact. Partial thickness breakdown in the skin involving partial loss of the 1st and 2nd layer of skin known as the epidermis and the dermis. Full thickness skin loss involving damage or necrosis (tissue death) of the underlying tissues may extend down to but not through the fascia (muscle sheath). Full thickness skin loss with extensive lower layer tissue destruction of fascia (muscle sheath), muscle, bone, ligaments and tendons.