Treatment
Once a pressure ulcer has developed, immediate treatment is required. In choosing a treatment strategy, consideration should be given to the stage of the wound and the purpose of the treatment (i.e., protection, moisture, or removal of necrotic tissue).
The treatment strategy that is used is highly individualized for each person based off of his or her health status, diagnoses, size and site of pressure ulcer, and the stage of the pressure ulcer. 1
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The treatment strategy that is used is highly individualized for each person based off of his or her health status, diagnoses, size and site of pressure ulcer, and the stage of the pressure ulcer. 1
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REDUCE THE PRESSURE
· REPOSITIONING If you have a pressure ulcer, you need to be repositioned regularly placed in correct positions. If you use a wheel chair, try shifting your weight about every 15 minutes or so. Ask for help with repositioning every hour. If you are confined to a bed, change positions every two hours. If you have enough upper body strength, try repositioning yourself using a device such as a trapeze bar or the railings alongside your bed. Caregivers can also use bed linens to help lift and reposition you. This will help to reduce friction and shearing.
· USING SUPPORT SURFACES Use a mattress, bed and special cushions that help you lie in an appropriate position, relieve pressure on any sores and protect vulnerable skin. If you are in a wheelchair, use a cushion. Different styles include foam, or air and water filled. Talk with the health care provider to select one that suits the condition, body type, and mobility. 1
· USING SUPPORT SURFACES Use a mattress, bed and special cushions that help you lie in an appropriate position, relieve pressure on any sores and protect vulnerable skin. If you are in a wheelchair, use a cushion. Different styles include foam, or air and water filled. Talk with the health care provider to select one that suits the condition, body type, and mobility. 1
CLEANING & DRESSING WOUNDS
· CLEANING It is essential to keep wounds clean to help prevent infection. If the affected skin is not broken (a stage 1 pressure ulcer), gently wash the area with water and mild soap and pat dry. Clean open wounds with a saltwater (saline) solution each time the dressing is changed.
· APPLYING DRESSINGS A dressing promotes healing by keeping a wound moist, creating a barrier against infection and keeping the surrounding skin dry. Dressing choices include films, gauzes, gels, foams and treated coverings. A combination of dressings may be used. The doctor will select a dressing based on a number of factors, such as the size and severity of the wound, the amount of discharge, and the ease of placing and removing the dressing. 1
· APPLYING DRESSINGS A dressing promotes healing by keeping a wound moist, creating a barrier against infection and keeping the surrounding skin dry. Dressing choices include films, gauzes, gels, foams and treated coverings. A combination of dressings may be used. The doctor will select a dressing based on a number of factors, such as the size and severity of the wound, the amount of discharge, and the ease of placing and removing the dressing. 1
REMOVING THE DAMAGED TISSUE
In order for wounds to heal properly, they need to be free of damaged, dead, or infected tissue. Removing this tissue (debridement) is accomplished with a number of methods, depending on the severity of the wound, your overall condition and the treatment goals.
· SURGICAL DEBRIDEMENT involves cutting away dead tissue.
· MECHANICAL DEBRIDEMENT loosens and removes wound debris. This may be done with a pressurized irrigation device, low-frequency mist ultrasound or specialized dressings.
· AUTOLYTIC DEBRIDEMENT enhances the body’s natural process of using enzymes to break down dead tissue. This method may be used on smaller, uninfected wounds and involves special dressings to keep the wound moist and clean.
· ENZYMATIC DEBRIDEMENT involves applying chemical enzymes and appropriate dressings to break down dead tissue. 1
· SURGICAL DEBRIDEMENT involves cutting away dead tissue.
· MECHANICAL DEBRIDEMENT loosens and removes wound debris. This may be done with a pressurized irrigation device, low-frequency mist ultrasound or specialized dressings.
· AUTOLYTIC DEBRIDEMENT enhances the body’s natural process of using enzymes to break down dead tissue. This method may be used on smaller, uninfected wounds and involves special dressings to keep the wound moist and clean.
· ENZYMATIC DEBRIDEMENT involves applying chemical enzymes and appropriate dressings to break down dead tissue. 1
OTHER INTERVENTIONS
· PAIN MANAGEMENT Pressure ulcers can be painful depending on the size, depth, location, and other factors. Nonsteroidal anti-inflammatory drugs-such as ibuprofen, Aleve, and others, may reduce pain. These may be very helpful before or after repositioning, debridement procedures and dressing changes. Topical pain medications may also be used during debridement and dressing changes.
· ANTIBIOTICS Pressure ulcers that are infected and aren’t responding to other interventions may need to be treated with oral or topical antibiotics.
· HEALTHY DIET To promote wound healing, the doctor or dietician may recommend an increase in calories and fluids, a high-protein diet, and an increase in foods rich in vitamins and minerals. You may also be advised to take dietary supplements such as Vitamin C and Zinc.
· MANAGEMENT OF INCONTINENCE Urinary or bowel incontinence may cause excess moisture and bacteria on the skin, increasing the risk of infection. Managing incontinence may also help improve healing. Strategies include frequently scheduled help with urinating, frequent depend changes, protective lotions on health skin, and urinary catheters or tubes.
· MUSCLE SPASM RELIEF Spasm-related friction or shearing can cause or worsen bedsores. Muscle relaxants such as Diazepam, Tizanidine, Dantrolene, and Baclofen, may inhibit muscle spasms and help sores heal.
· NEGATIVE PRESSURE THERAPY (VACUUM-ASSISTED CLOSURE, OR VAC) This therapy uses a device that applies suction to a clean wound.
· SURGERY A pressure ulcer that fails to heal may require surgery. The goals of surgery include improving hygiene and the appearance of the sore, preventing or treating infection, reducing fluid loss through the wound, and lowering the risk of cancer. If surgery is needed, the type of procedure will depend mainly on the location of the wound. In general, most pressure ulcers are repaired using a pad of your muscle, skin, or other tissue to cover the wound and cushion the affected bone. 1
· ANTIBIOTICS Pressure ulcers that are infected and aren’t responding to other interventions may need to be treated with oral or topical antibiotics.
· HEALTHY DIET To promote wound healing, the doctor or dietician may recommend an increase in calories and fluids, a high-protein diet, and an increase in foods rich in vitamins and minerals. You may also be advised to take dietary supplements such as Vitamin C and Zinc.
· MANAGEMENT OF INCONTINENCE Urinary or bowel incontinence may cause excess moisture and bacteria on the skin, increasing the risk of infection. Managing incontinence may also help improve healing. Strategies include frequently scheduled help with urinating, frequent depend changes, protective lotions on health skin, and urinary catheters or tubes.
· MUSCLE SPASM RELIEF Spasm-related friction or shearing can cause or worsen bedsores. Muscle relaxants such as Diazepam, Tizanidine, Dantrolene, and Baclofen, may inhibit muscle spasms and help sores heal.
· NEGATIVE PRESSURE THERAPY (VACUUM-ASSISTED CLOSURE, OR VAC) This therapy uses a device that applies suction to a clean wound.
· SURGERY A pressure ulcer that fails to heal may require surgery. The goals of surgery include improving hygiene and the appearance of the sore, preventing or treating infection, reducing fluid loss through the wound, and lowering the risk of cancer. If surgery is needed, the type of procedure will depend mainly on the location of the wound. In general, most pressure ulcers are repaired using a pad of your muscle, skin, or other tissue to cover the wound and cushion the affected bone. 1
1 Staff, M. (2014, January 1). Bedsores (pressure sores). Retrieved October 25, 2014, from http://www.mayoclinic.org/diseases-conditions/bedsores/basics/treatment/con-20030848
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*All references listed in the "About" tab