Treating Pressure Sores

by National Institute of Health

What Is a Pressure Sore?

A pressure sore (or bed sore) is an injury to the skin and tissue under it. Pressure sores are usually caused by unrelieved pressure. If you sit or lie in the same position for a long time, the pressure on a small area of the body can squeeze shut tiny blood vessels that normally supply tissue with oxygen and nutrients. If tissue is starved of these "fuels" for too long, it begins to die, and a pressure sore starts to form.

Pressure sores are called pressure ulcers and decubitus ulcers as well as bed sores. How serious they are depends on the amount of damage to skin and tissue. Damage can range from a change in the color of unbroken skin (Stage I) to severe, deep wounds down to muscle or bone (Stage IV) (see Figure 1). In light-skinned people, a Stage I sore may change skin color to a dark purple or red area that does not become pale under fingertip pressure. In dark-skinned people, this area may become darker than normal. The affected area may feel warmer than surrounding tissue.

Purpose of This Booklet

A pressure sore is serious. It must not be ignored. With proper treatment, most pressure sores will heal. Healing depends on many things: your general health, diet, relieving pressure on the sore, and careful cleaning and dressing of the sore. Share this booklet with your family members and caregivers. By working with health care professionals and following these guidelines, you and your caregiver can better treat pressure sores and prevent new ones.

This booklet will help you and your caregiver care for pressure sores. It also gives basic information about preventing new sores.

This booklet gives the steps essential to helping a pressure sore heal. Although not all steps apply to everyone, it is important that you:

• Learn how to prevent and treat pressure sores.
• Ask questions if you do not understand.
• Explain your needs and concerns.
• Know what is best for you.
• Be active in your care.

Treatment

Healing a pressure sore is a team effort. A team of health care professionals will work with you to prepare a treatment plan. Your team may include doctors, nurses, dietitians, social workers, pharmacists, and occupational and physical therapists. However, you and your caregiver are the most important team members. Feel free to ask questions or share concerns with other team members.

Your Role

You and your caregiver need to:

• Know your roles in the treatment program.
• Learn how to perform the care.
• Know what to report to the doctor or nurse.
• Know how to tell if the treatment works.
• Help change the treatment plan when needed.
• Know what questions you want to ask.
• Get answers you understand.

Treatment Plan

To develop a treatment plan that meets your needs, the doctor or nurse must know about:

• Your general health.
• Illnesses that might slow healing (such as diabetes or hardening of the arteries).
• Prescription or over-the-counter medicines you take.
• The emotional support and physical assistance available from family, friends, and others.

Your doctor or nurse will perform a physical exam and check the condition of your pressure sore to decide how to care for it. If you have had a pressure sore before, tell the doctor or nurse what helped it heal and what didn't help.

Your emotional health is also important. Be sure to share information about stresses in your life as well as health beliefs and practices. This will help your care team design a treatment plan that meets your personal needs.

The treatment plan will be based on the results of your physical exam, health history, personal circumstances, and the condition of the sore (how it looks). This plan will include specific instructions for:

• Taking pressure off the sore.
• Caring for the pressure sore by cleaning the wound, removing dead tissue and debris, and dressing or bandaging the area to protect it while it heals.
• Aiding healing by making sure you get enough calories, protein, vitamins, and minerals.

Note to Caregivers

Although patients should be as active in their care as possible, you may need to provide much or all of their care. As a result, you may find you have questions or problems. If so, ask for help. Call doctors, nurses, and other professionals for answers and other support.

Remember that patients who must be in a bed or chair for long periods don't have to get pressure sores. Pressure sores can be prevented. And sores that have formed can be healed.

Helping Pressure Sores Heal

Healing pressure sores depends on three principles: pressure relief, care of the sore, and good nutrition.

Pressure Relief

Pressure sores form when there is constant pressure on certain parts of the body. Long periods of unrelieved pressure cause or worsen pressure sores and slow healing once a sore has formed. Taking pressure off the sore is the first step toward healing.

Pressure sores usually form on parts of the body over bony prominences (such as hips and heels) that bear weight when you sit or lie down for a long time. Figure 2 shows "pressure points" where sores often form.

You can relieve or reduce pressure by:

• Using special surfaces to support your body.
• Putting your body in certain positions.
• Changing positions often.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.