The healthcare provider will examine the ulcer and develop a treatment plan based on stage of the ulcer. A pressure ulcer care plan includes the following:
When treating a pressure ulcer, it is very important to relieve pressure on the area near the ulcer. Do not allow the person to lie or sit on a pressure ulcer. Move and reposition the person regularly. Use bed-positioning devices (e.g., pillows, special foam cushions, and medically approved sheepskin) and support surfaces to take pressure off the sore. Do not use donut-shaped devices.
Many types of dressings are used for pressure ulcers to absorb drainage and promote healing. The doctor or nurse will select the proper dressing to be used based on characteristics of the pressure ulcer. As the pressure ulcer heals, the type of dressing used may be changed. It is important that the dressing be changed on the schedule set by the doctor or nurse. Many dressings must be changed at least once a day; other dressings are designed to stay on for several days at a time.
Patients with pressure ulcers commonly have pain to some degree. Pain can be caused by several factors including the pressure ulcer itself (e.g., inflammation, damage to nerve endings, and infection), pressure ulcer treatments (e.g., repositioning, wound cleansing, debridement, or dressing changes), and other health conditions (e.g., immobility, cancer, arthritis).
Report the patient’s pain to the doctor or nurse. Once the pain has been properly assessed, the doctor or nurse will develop a treatment plan to control the pain (e.g., change the type of wound dressing, adjust support surfaces). Some patients may need pain medications.
Pruritus can be caused by dry skin, allergies, and side effects of medications and treatments. Bathing the patient in cool water may help. Baking soda can be added to the bath water. A cool, moist cloth applied to the skin may also be helpful. Bed linens should be washed with a mild laundry detergent; harsh laundry detergents should be avoided. The doctor may prescribe medication that can be applied to the skin to reduce pruritus.
Odor from pressure ulcers can be caused by dead tissue, infection, and/or other problems. It can be very distressing for patients, their families, and caregivers.
Make sure pressure ulcers are carefully cleansed to remove pus and debrided to remove as much dead or infected tissue as possible. A warm shower or spray may be useful for cleansing wounds. If the pressure ulcer appears to be infected, contact the doctor or nurse immediately. A topical medicine might be prescribed to target bacteria causing the odor.
Essential oils in diffusers may be helpful for eliminating odor. They are longer-acting and stronger than regular air freshener sprays. These should never be put on patient’s skin because they cause a burning sensation. Make sure the patient’s room is well ventilated by opening windows or running a fan on low speed. A tray of kitty litter or activated charcoal placed under the patient’s bed might reduce odor.
The fluid that is secreted by the wound can be substantial in pressure ulcers. Excessive drainage (also called exudate) can cause psychological and emotional stress for the patient.
Highly absorptive dressings are usually used for pressure ulcers with a lot of drainage. These dressings may lead to maceration of the surrounding skin; therefore skin creams, ointments, or sprays should be used to protect the skin around the wounds. Dressings should be changed when the fluid begins to leak through to the outside of the dressing. If the dressing does not seem to contain the exudate, the doctor may consider using a drainage stoma.
Good nutrition is necessary for the patient with a pressure ulcer because the body requires proper nutrition to heal. The dietitian is an important part of the pressure ulcer healthcare team and should be involved in managing the pressure ulcer. The dietitian will obtain a nutrition assessment, which may include a food- and nutrition-related history, height, weight, biochemical data, medical tests and procedures, nutrition-related physical examination findings, and the patient’s medical history.
The goals for nutrition, which the dietitian will help with, are to make sure the patient is receiving enough fluids; make sure that any reasons for poor intake are identified and treated; monitor the weight of the patient so that any unexpected weight loss does not occur; and suggest nutrition interventions that will help the patient’s nutritional status to improve.
The dietitian can give specific advice about a healthful diet. Protein and calorie supplements may be helpful for patients who are malnourished. Vitamin supplements and zinc might also help pressure ulcers to heal more rapidly. Report any weight loss or gain to the nurse or healthcare provider.
Cleansing the pressure ulcer and applying a topical antibacterial product may be all that is needed for a superficial infection that does not have much redness around it. An antibiotic (given by mouth or injection) may be necessary if the infection is more severe or if it is delaying the pressure ulcer healing. If you believe a pressure ulcer is becoming infected (pain, redness of surrounding skin, foul odor, increased drainage that looks like pus, fever, weakness or confusion), call the nurse or healthcare provider immediately.