Home Care for Patients with Bedsores
Bedsores. It’s a word you dread to hear as a caregiver. Also known as decubiti or pressure ulcers, these injuries to the skin and tissue happen after prolonged pressure on skin. Pressure ulcers develop on skin that covers bony areas of the body, such as the heels, ankles, hips and tailbone.
Elderly immobile patients are most at risk for the development of bedsores because they are unable to change positions in a bed or a chair. According to several studies of ICU patients, those who have been in the ICU for a long stay and have declining mobility are most likely to develop bedsores. Often, bedsores can cause a patient to have cellulitis or a skin or bone infection.
So, what does a caregiver do if your loved one is coming home from a long ICU stay and has a bedsore? A doctor or nurse at the hospital should examine any bedsore the patient has, and advise both the caregiver and patient about treatment at home before the patient is discharged. Follow those instructions.
Care at home
At home, the caregiver and patient must reduce the pressure and friction on the vulnerable area of the body. Turn the patient and change the patient’s position often. Ask for help from a nurse or an aide if you need to be shown how to do this. A patient who is in a bed should change positions at least every two hours. If the patient is sitting, then have the patient shift every 15 minutes and change from chair to another position every hour. If necessary, set an alarm on a watch, clock or phone to remind you to change positions. This routine can be annoying at night, but if followed, the bedsore will heal.
Cushions, pillows, and mattresses can help you in repositioning the patient and in reducing pressure. There are cushions that are filled with foam, with gel, and with air cells. Any of these can increase comfort for the patient. Do not use ring-shaped or donut-shaped cushions if the patient has a bedsore on the buttocks because cushions of this shape these could reduce blood flow to the buttocks area. There are also a variety of mattresses and mattress pads or overlays that can reduce pressure on bony areas. You might look into getting an alternating pressure mattress or an alternating pressure mattress pad. Alternating pressure mattresses inflate and deflate to change the pressure on the skin of the patient. They are particularly helpful for paralyzed patients or bariatric patients who are at high risk for pressure ulcers.
Check the patient’s clothing and bedding often to be sure that it is dry and clean.
Medications and Wound Care
Pressure ulcers can be painful, though the patient may not complain about it. It might be useful to give a gentle NSAID pain reliever to help the patient become comfortable before re-positioning. Arthritis can also make a patient stiff, and the patient may find being moved uncomfortable, so giving an arthritis medication before re-positioning may be helpful. Topical pain creams are the most common medication for bedsores. Infected wounds may be treated with topical antibiotic creams. A Stage I pressure sore should be cleaned with soapy water or saline. Consult with the doctor or pharmacist about all medications, how to administer them, and how often.
Bandaging can protect the wound. It is important to keep surrounding skin dry and the wound moist. Transparent, semi-permeable dressings can help retain moisture and help new skin grow.
When a pressure ulcer is an open sore, it has progressed to Stage II of the four stages of development. It will be red and warm, and look like a blister or a scratch. It is time to get medical attention before the sore involves muscle tissue. A physician should examine the patient and advise about treatment.
Some pressure ulcers may require surgery.
Don’t’ massage the affected area or use a heating pad or a cold pack on the area. Never use a rubber or plastic pad under the patient; the skin could stick and shear. Avoid iodine or hydrogen peroxide in cleaning the pressure ulcer. Don’t weight the patient down with heavy blankets or set a pile of “stuff” on the bed which keeps them “anchored” in place. You will only have to move all of that every time you reposition the patient. If you have an adjustable hospital bed, don’t keep the patient’s head up for hours and hours, thus causing constant pressure on the bedsores on the buttocks. Instead use the adjustable features of the bed to help you change the patient’s position frequently to avoid pressure there. Unfortunately, it is common for bedsores to develop on the buttocks/tailbone making treatment there more challenging.
The appearance of pressure ulcers on vulnerable patients is not an insult to a caregiver or to a hospital’s care, unless the bedsores go unnoticed and untreated. Get the information and treatment you need for clearing up pressure ulcers and be proactive when advocating for your loved one in a facility or at home. Do all you can to prevent and treat bedsores.