PRESSURE SORES, PRESSURE ULCERS = PAIN

After reading chapter 37 in your textbook, write a half page summary on what measures nursing assistants can do to help prevent pressure sores in their patients. Include devices that can be used to relieve pressure sores.
Pressure ulcers are a common problem in palliative care patients. Pressure Sores are measured easily through these four stages of soreness:
Stage 1 - The skin is not broken but the color of the skin changes. The redness of a Stage 1 pressure sore is non-blanch able, which means that the skin does not turn pale when you press on it. You skin feels firmer, warmer, or cooler than the skin around it. You will feel pain, or itching in the area. Protect the area from further pressure, meaning the pressure sore do not go away easily.
Stage 2 - The top layer of the skin, including the skin just below it are damaged. Broken; Scrapes, blisters, caved-in.
Stage 3 - The damage to the tissue has gone all the way into the fatty layer; Looks like a deep crater under the skin, that is wider than the hole you see at the top of the skin.
Stage 4 - The pressure sore is a very deep wound that goes all of the way down into muscle, or the bone.
To prevent a pressure sore before it starts, protect the skin from friction, shearing, any stress. “Do not massage (rubbing-like) the skin over bony areas.
Check the skin several times a day. Look for redness over bony areas, areas that support a lot of body weight. Include a thorough check on the elbows, Achilles heel, butt, ankles, and hips, even breasts.
Keep your skin dry. Moisture from sweating, wound drainage, or urine can increase the risk of skin damage. Use clinical padding, bedclothes, sheets, or briefs that are made of materials that soak up moisture. Rotate changes to this to avoid irritation (A requirement from the CDC will come inspect this randomly). Moisture barrier products can help protect areas of skin that are exposed to moisture; If someone had Excessive ‘MALABSORPTION problems’ = (CELIAC DISEASE) (Uh, Diarrhea, come on were adults, why is this so hard to say in public), OAB = (Overactive Bladder), Bladder Infection (Cystitis = bacteria entering the bladder through the urethra with inflammation of your bladder), Urinary tract infections (UTIs = are infections of the bladder, urethra, and sometimes the kidney) (For this by the way my fellow classmates take some Cranberry NS 500 mg 180 caps (CRA13)) , may need moisture barrier to the buttocks, and groin area. Use soap, and warm (not hot) water to gently clean your skin. Do not rub, and avoid harsh soaps and products with alcohol. This will dry out your skin. Use lotion or a moisturizer on the skin often. Use a towel to gently pat (DO NOT RUB) the skin. Keep skin clean.
Change the patient’s positions frequently. When in bed, change the position of their entire body at least every one to two hours. Use a clock timer- thing; this may help remind you when it is time to turn the patient. Write a ‘Turning’ (HINT) schedule to help you remember to turn the patient. When helping a patient move in, and out of bed, to prevent putting stress on the skin, lifts the patient, do not slide the patient. Use cornstarch on the sheets to help keep the skin from dragging on the sheets during movement. To prevent damage to the skin from sliding down in bed, move the patients head rose as little as possible, for as short a time as possible. Report to Nurses or Managers about any vital sign changes, or Breathing problems the patient may have. We want to make our patients feel as comfortable as possible, they are our ‘GUESTS’, we must be nice and polite at all times, right. Unlike my wife, anyway moving on.
Do not rest the patients hipbone directly, lying on their side. Have the patient lean back into a pillow (foam wedge), behind their back when lying on their side. This will decrease the pressure put directly on the patient’s hipbone. Use pillows (anything soft-like, really) to keep bony areas from touching one another: Use a pillow between the patient’s knees to keep them from pressing on one another. Keep their heels from touching the bed when lying on their back. Do this by putting a foam pad or a pillow under their legs from mid-calf to ankle. The pillow should raise the heels enough for proper circulation. ‘Never’ (*HINT) put a pillow under your knees.
The use of a ‘turn sheet’ or a mattress pad under the patients buttocks, and upper body help others move the up in bed. An overhead trapeze can help them to change positions in bed. Special mattresses and overlays will help decrease the risk of ‘Pressure Sores’.
Keep the bottom sheet of the bed free of wrinkles. Make sure there are no hard items in the bed, such as crumbs or hairpins. Avoid clothing that has buttons, zippers, or thick seams that could put pressure on your skin. Exercises you can be done in bed (Exercising helps the blood flow to your skin) (I know I’m always talking about exercise, but honestly ‘Sexercise’ is even better). If the patient is at high-risk of getting pressure sores, do not have the patient sit in a chair for longer than two hours at a time. Lift, or sling to move the patient in bed, remove the sling and equipment from underneath, right after the patient is moved *We do not want anyone tripping, or clumsy enough to crash into this and hurt the patient even more because someone lost their balance) (This can be avoided).
Have the patient sit up straight in a chair or wheelchair. Change their position every hour; shift their weight from one side to the other every 15 minutes. Make sure their feet are supported, and not hanging freely. Use seat pads that are specially made to decrease pressure on your buttocks and hips. Again be respectful of the patient (Even though, they may be really hot, and you can’t help yourself but glare at his/her/its buttocks, legs, face, because he/she/it is chemistry igniting with yours, like he/she/it is the love of your life) (AHEM!, okay just be careful). Moving on.
Below is the disclosure you’ll either hear, or see while in the hospital;

Risks: Preventing pressure sores is very important. Pressure sores can be hard to heal once they start. They can cause pain, and discomfort. If a pressure sore gets bad, you may need to stay in the hospital. You may get a bad infection (in-FECK-shun) because of your pressure sore. A pressure sore can take weeks to months to heal, or may not heal at all. A pressure sore can be very serious, even life threatening.

PATIENT’S CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.