Pressure ulcers

They get them from not being repositioned enough, sitting in urine and feces...it does not take long for a pressure ulcer to start and once it does it takes a lot of care and time to heal if it ever heals.

Also people that cannot afford full-time home care or those who take care of themselves are prone to ulcers. My mom who is 52 has very fragile skin. She is constantly getting skin tears. I recently called her to give her some information on how to care for them and I asked her how some of them are looking. She said one is over 3 weeks old and won't heal. I told her she needed to get it looked at because it could be infected and she said "oh I'm guessing it already is". So even though this isn't a pressure ulcer it informs one that lots of people don't seek care for skin problems. This summer when I visited her I was shocked at how many skin tears she has and she has yet to see a skin care specialist. Our instructor said as bad as they look, people tend to loose the sensation in the area that is infected, so people tend to just ignore them,especially when they are home bound.

Good freakin grief! Please tell me how people end up getting ulcers as bad as the ones in our textbooks! Is there no care where these patients are?! They must be people bed ridden at home.

I did a Yahoo image search on these and saw sores where I thought the person MUST be dead but apparently not.

Not on my watch!

Certainly no nurse wants to see pressure ulcers on their watch but they do happen. Not only frequent turning, urine, feces but take into consideration the person's nutrition, mental status, sensory, plus in the elderly they have very thin skin so even the best of care can't necessarily prevent these from occurring.

certainly no nurse wants to see pressure ulcers on their watch but they do happen. not only frequent turning, urine, feces but take into consideration the person's nutrition, mental status, sensory, plus in the elderly they have very thin skin so even the best of care can't necessarily prevent these from occurring.

this is sooo true! what's this person's albumin level (or better yet, in the elderly prealbumin level)? do they have decreased colloid pressure thus contributing to extravasation of fluid and destruction to the tissues? do they posses enough protein to aid in healing and the ability to maintain tissue health?

also, you have to take into consideration what their circulation is like. are they getting good tissue perfusion? do they have any co-existing problems, i.e. htn, increased svr, pad, dm, anemia, etc. that would contribute to decreased tissue perfusion? too, you have to take into account with dm, (for lack of a better way to put it) an existing medium which encourages bacterial growth and tissue destruction with excess circulating glucose, you know?

lots of times, these ulcers are, in fact, not due to poor personal care but rather a secondary result of an existing poor health status. does that make sense?

i mean, look, they'll tell you, oh you gotta turn these people @ least q2hr or they'll get bed sores. so, the general perception is, if a pt gets skin breakdown, it's b/c they didn't get turned or cleaned. this may be true and i'm certainly not advocating giving less than adequate personal care (turning, keeping dry, etc.) but you have to think...we take car trips in excess of 2 hours all the time and don't wind up with pressure ulcers, why is that? it's because we don't have a compromised health status, meaning we have (as suzy253 indicated its importance) a good nutritional, mental and sensory status.

again, pressure ulcers and other forms of skin breakdown are not always due to a lack of delivery of care...jmo

fwiw when i was on the sci unit they taught us that repositioning needed to be done q20 minutes!

wow!!!!!!!

When I was a student nurse we had a lady on the medical care of the elderly ward who had cancer, I can't remember where. She would only sit up in bed virtually with her legs crossed because she said lying on her side was too painful. We had her on the most state of the art pressure relieveing bed at the time but despite everything her sacrum broke down. we tried soooooooooooooo hard to try and get her to change positions but she just wouldn't. she ended up with a pressure sore so deep that to clean it you literally had to reach right up inside with your hand beyond your wrist!!

I was really distressed to see this but at the same time it wasn't the nurses fault. In those days we had plenty of staff & things were done as they should be. It was just she wouldn't move! It was awful & 17 odd years later I still remember it vividly!

Lots of times, these ulcers are, in fact, not due to poor personal care but rather a secondary result of an existing poor health status. Does that make sense?

I mean, look, they'll tell you, oh you gotta turn these people @ least q2hr or they'll get bed sores. So, the general perception is, if a pt gets skin breakdown, it's b/c they didn't get turned or cleaned. This may be true and I'm certainly not advocating giving less than adequate personal care (turning, keeping dry, etc.) but you have to think...we take car trips in excess of 2 hours all the time and don't wind up with pressure ulcers, why is that? It's because we don't have a compromised health status, meaning we have (as suzy253 indicated its importance) a good nutritional, mental and sensory status.

Again, pressure ulcers and other forms of skin breakdown are not always due to a lack of delivery of care...JMO

:yeahthat: Sad but true ... alert & oriented individuals who are grossly overweight plus have vascular issues & diabetes (and it's rare when those 3 don't go together) will, sooner or later, have skin breakdown. You do what you can.

We've had pts. on the med-surg floors that had to be turned q15min or q30 min, they were that prone to skin breakdown.

It's so sad isn't it? I have had my fair share of cleaning out stage 3/4's in just 2 semesters. The majority come in from the local nursing homes...where yup they arent being kept dry/moved enough/health problems/etc.

We can sit in a car for 2 hours and not get pressure ulcers, but we are able to reposition our weight q 15 minutes....or however short/long of time our body tells us too. (I know every nursing student would be in trouble as much as we are studying!!)

Those who are immobile, comatose, etc can't move at all even if they feel their pressure points starting to hurt. It is a very sad thing, yet so common, I'm afraid!!

I saw pressure ulcers in two different patients on my very first clinical day!! One pt had them on both ankles/feet but were healing very well. The other pt had deep pressure ulcers covering the buttocks area and had tunneling present as well.