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Pressure Ulcers: Tips to Prevent Them from Developing

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Updated February 26, 2009

Try to Maintain Nutrition

There is a strong correlation between nutrition deficits and pressure ulcer risk. If your loved one has an appetite, try to maintain adequate nutrition with nutrient rich foods (think lean proteins, whole grains, fruits, and vegetables). If his appetite is waning, offer supplements such as Ensure or Boost to help bolster nutrition.

See “7 Ways to Whet an Appetite” for tips on helping your loved one maintain nutrition.

Nutrition is often a problem in palliative care patients and it’s important to note here that you should never try to “force” your loved one to eat. For more information about loss of appetite and weight loss in palliative care patients, see “Where Did Your Appetite Go?”

Manage the Moisture

Moisture from sweat, urine, or feces can be damaging to skin. It’s important to maintain the skin’s integrity by managing the moisture. If a patient accumulates a lot of moisture from sweat, he will need his clothing and possibly his sheets changed frequently. You can make this easy on yourself by using hospital gowns or other clothing that slips on and off easily. Using several layers of sheets can also make this task easy. One family I cared for started the day by layering the bed with three cotton sheets and simply removed one when it became damp.

If your loved one is incontinent of urine, he will need frequent changing of his adult diapers or pull-ups. Checking his diaper at least every two hours and changing it as soon as it is soiled is important. Using skin barrier creams can help prevent damage from urine. It’s the same principle as preventing diaper rash in babies. Use Desitin, A&D Ointment, or another similar product to protect the skin from moisture and acidity from the urine.

If a pressure ulcer already exists or if there is a high risk of developing one, it may be beneficial to place an indwelling foley catheter. This can only be done by a nurse with a physician’s order. A foley catheter is a small tube that is inserted in the urethra and into the bladder where it remains with the help of an inflated balloon. Once placed, urine drains out of the tube and into a collection bag, keeping the skin free from urine.

If he's also incontinent of stool, he's at an increased risk of skin breakdown from the bacteria and digestive enzymes found in bowel movements. He will need to be cleaned and changed as soon as possible after every bowel movement. This can be quite a challenge if your patient suffers from diarrhea or has frequent bowel movement. But it will be well worth the hard work if it prevents painful skin breakdown.

See “How to Change a Diaper or Bed Sheet” for tips on changing your loved one in bed.

Hard Work Pays Off

Preventing pressure ulcers can be hard work. It’s physically exhausting to lift, turn, position, clean, and change another person every couple of hours. Like most things that require hard work, the payoff is huge. Keeping your loved one free of painful pressure sores will make all the physical labor seem well worth it. If you find you’re having difficulty maintaining the job yourself, you may need to seek additional support. For more information, see:

Is it Time to Hire Help?

Types of Hired Caregivers

Acts of Love: Caring for a Dying Loved One

Finding Palliative or Hospice Care

Sources:

Ferrell BR, Coyle N. Textbook of Palliative Nursing, 2nd Edition. Oxford Press, 2006.

Kinzbrunner BM, Weinreb NJ, Policzer JS. 20 Common Problems: End of Life Care. McGraw-Hill, 2002.

Kayser-Jones J, et al. Pressure ulcers among terminally ill nursing home residents. Research in Gerontological Nursing 2008;1(1):14-24.

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