Are You Caring for Someone at Risk?

If you are looking after someone who may be at risk for developing a pressure ulcer, there are a number of things you can do to assist in prevention. First, it’s important to understand the level of risk of the person in your care. If the person is in a health-care setting or is being visited regularly by a health-care provider, you can ask for a formal pressure ulcer risk assessment to be done. The risk assessment will give you and the health-care provider the first tool in your pressure ulcer prevention toolbox.

If the person you are looking after is not under the care of a health professional, you can answer the questions below to find out if he/she is at risk.

First a bit of background information: A pressure ulcer is a change or break in the skin caused by constant pressure, especially over a bony area such as the ankle, tailbone, hip or elbow. Heels, ears and the back of the head are other areas that are prone to pressure ulcers. A pressure ulcer can appear as a red area on the skin or a blister or an open sore. To prevent an increase in tissue damage, it is important for you to notice changes in the skin’s appearance and take steps to correct the cause of the pressure.

Pressure ulcers develop when a person stays for too long in one position without moving. Blood flow to a body part is reduced so that the tissue is starved for nutrients. Over a short or long period, depending on how high the pressure on the body part is, the tissue may be damaged enough to cause an ulcer. To reduce the chances of getting a pressure ulcer, a person needs to sense the discomfort that begins when the tissue is first starved of nutrients and then make sure the person’s position is shifted to relieve the pressure to that spot.

It is important to know that pressure ulcers can also develop when the body is rubbed, dragged or slid against a surface such as bed sheets. The result of this sliding action is referred to as friction or shear, depending on the type of damage it causes.

The beginning of a pressure ulcer is often a red area on the skin, or in darker skin, an area that iss darker than usual. At the first sign of a pressure ulcer, you should seek help from a health-care provider. DO NOT rub the skin to get the blood flowing to the area. This is a common mistake that can actually cause more damage.

Pressure ulcers are also known as pressure sores, bedsores, decubitus ulcers.

Questions to Ask

Now that you know how pressure ulcers develop, you can ask the following questions to find out how high the risk of getting one might be for the person under your care. If you answer “yes” to all of the questions, the person you are caring for is not at high risk. If you answer “no” to any of the questions, you should seek help from a health-care expert to develop a plan for reducing risk.

Q Does the person have sensation in all parts of the body?
A This question is asking if the person can sense discomfort or pain when pressure has cut off the blood flow to a body part. If he/she can’t sense that something is wrong, it is hard for him/her to do anything about it. If the person doesn’t have sensation to every part, you will need to remind him/her to shift position every few minutes.

Q Is the person capable of moving all the parts of the body?
A If a person can’t move on his/her own, the risk for developing a pressure ulcer is high because he/she will be unable to take the pressure off a body part that is against a surface, such as a bed or chair. In that case, the person under your care may need your assistance to move. In some cases, a whole range of devices such as trapeze bars and special mattresses that move the person constantly can be employed. If you are giving assistance to someone, you need to know how to move him/her properly so he/she isn’t dragged across a surface, which might lead to damage from friction or shear. You should also learn good moving techniques from a trained professional so you do not injure yourself.

Q Is the person’s skin moist, but not too moist?
A Too much moisture on skin, especially from urine and perspiration, can cause it to break down easily. Skin with normal moisture levels feels dry to the touch. There are many devices, such as continence control pads and barrier creams, that can be used to keep excessive moisture away from a person’s skin.

Q Is the person physically active?
A If the person is able to walk regularly throughout the day, he/she is at much lower risk than someone who is confined to bed or chair.

Q Is the person adequately nourished?
A A surprising fact about pressure ulcer prevention is how important eating well is. A person who does not get enough nutrients like protein, vitamins, minerals and fluids is at higher risk for developing a pressure ulcer than someone who gets enough of the right kinds of foods. If the person under your care rarely eats a full meal, or cannot tolerate a wide range of foods, you should call in a dietary specialist to help you with meal and snack planning.

Preventing Pressure Ulcers Based on Level of Risk

Once you know what the person’s risk level is, you can begin to take steps to prevent the development of a pressure ulcer.

If the person is at low risk: Make sure they keep active, eat well and drink plenty of fluids.

If the person is at moderate risk: Identify areas that you can change, such as selecting healthy foods and preparing them in a way that will help them eat if they have swallowing or digesting problems. Try to encourage them to get more activity. It can often help if you do the activity too. Get assistance in the areas where you need it; if you can’t you aren’t capable of shifting the person yourself, get help from a health professional to plan for personal assistance or the use of devices.

If the person is at high risk: Work with a care provider to develop a pressure ulcer prevention plan. It is very difficult to develop an adequate plan without the assistance of an expert.

Top Tips for Preventing Pressure Ulcers

Inspect skin daily. Make note of any changes in colour. Reddened areas are signs of potential pressure ulcer development.
Do not rub reddened areas of skin. This will cause more damage.
Keep skin clean and dry. Moisturize as necessary.
Make sure the person does not spend long periods of time resting in any one position.
To avoid friction and shear, use lifting or transferring devices such as a transfer board or a trapeze bar.
Protect skin from incontinence (loss of bowel and bladder function) using a skin barrier and incontinence pad.
Prepare a well-balanced diet with lots of variety and plenty of fluids to keep skin healthy and hydrated.
Seek help from a health-care professional!

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