The acronym for the best practice routine is SSKIN:
Surface - what is the person lying on or resting against? Is anything pressing on the skin? Skin Integrity - have vulnerable areas been checked for signs of breakdown? Keep Moving - encourage the person to move around as much as possible (every little helps). If s/he can't, adjust position for her/him. Incontinence - ensuring that the skin is kept clean and dry by using the correct, effective continence care products and inspecting/changing frequently. Nutrition - monitoring fluid and food intake and output.
Alternating or variable pressure air mattresses help a lot, but 2-4 hourly skin integrity checks, turning and adjusting position are needed to prevent skin breakdown in vulnerable bed bound patients. You can find charts on the internet which will help you go about checking methodically. One lists the areas to check:
Right hip Left hip Right heel Left heel Right ankle Left ankle Base of spine Right elbow Left elbow Right buttock Left buttock Other
Ears and toes are also prone, because they come into prolonged contact with surfaces. Bedclothes rest on toes. Ears are often against pillows or cushions. Seriously, that's all it takes.
Is this an existing pressure sore that you're aiming to heal, or are you more focused on preventing new ones? Prevention is massively better than cure, of course; but if there already is a pressure ulcer then you need specialist nursing care and you need to make sure the area is not in contact with any surface (except a dressing, if applied). Creative use of cushions and a compliant patient will help.
Also. maintain a good protein intake via supplements if the person doesn’t eat a lot. Protein promotes tissue healing.
It requires a lot of diligence to prevent and treat bedsores. An alternating pressure mattress is #1, imo.
There are 5 stages to bedsores. The first is a reddened area usually in a bony prominence (iliac, tailbone). You want to catch them at this phase if possible and then continue with frequent position changes, etc.
Once the skin breaks down the person should see a woundcare specialist ASAP. Frequent skin inspection is key. Good luck to you!
We're going through a first bout of pressure sores with our mom (heals and tailbone), and from my limited experience, I can safely say that prevention is WAY better than treatment. If you are beyond the initial stage (reddened area), then let a wound-care specialist take care of it. These things take forever to heal, and infection is a very real possibility, so daily care is imperative.
My mom's pressure sores went from Stage 1 to Stage 3-4 in a matter of days, so keep up the preventative measures but don't wait to see a specialist if you have any doubts/concerns!
They do take forever. Grandma got a few pressure sores from her cam boot. The worst one took 6 months for the scab to finally fall off. Even with that, it still has a way to go. I would say another few months before it's fully healed.
Thanks for the helpful answers. My wife Nicole's bedsore is just under the coccyx on the right side of the natal cleft. It has a small scabbed area surrounded by a dry red area. It is painful lying in bed & seems to be contained but slowly worsening.
I'd like to know what kinff cream works best & I've been checking out what's available to avoid pressure but everything seems to be in the form of cushion pads for use in seats & not appr0priate for use in a bed (too thick).
Is it possible to get small area mattresses for the purpose, say for the buttolck & hip area?
a thick diaper rash cream (I like the pink one) and make sure you buy one that contains Zink and Honey! For prevention rotate the body every 2 hours; I like to prop my clients with a soft pillow behind their back to help keep them on their side. As others have suggested the pressure adjusting mattresses are great, also. Also varying positions of the head and feet help if an adjustable bed is used; if not then simply prop with varying amounts of pillows to create different height will work. If tolerated changing positions by sitting in a chair is also helpful.
The thing is, you'd be using cushions to keep her from lying on the affected area, rather than for the sore area to rest on. Can she comfortably lie on her side? What sort of bed is she lying in?
There are all sorts of creams for all sorts of purposes. I don't think it would be sensible for anyone to recommend one without examining your wife. Do you have access to trained nurses with experience of wound care?
It sounds like you know quite a bit about bedsores already, but as Bluefin above wrote, bedsores can go from a little pinkish area on the skin to stage 3-4 in just a couple of days, and they can become very serious too, causing severe damage to surrounding tissue (necrosis) and then become a nightmare to heal, they can progress to Sepsis (blood poisoning) and real quickly too!
Make sure your Loved one is being treated/managed/monitored by the Wound Care Specialist. There are many different types of bandages and topicals out there, and often several types of treatment may be tried to find the one that works, sometimes the wound needs to be debried, so they know best.
Very good and thorough tips from CountryMouse too, what a great resource! The patients nutrition is very important too, especially if they are Diabetic.
You can aslo check with your Wound Dr to see if a visiting Nurse can come to your house for home treatment. Check with Medicare and secondary insurance too, as they can be a great resource for you!
I'm so sorry you are dealing with this, we did too with our bedridden Mom and it can be so frustrating for the Caregiver and so Painful to the patient. I only hope that those folks who have their parents in Nursing Home be sure to check their skin, especially in those areas (pressure points) that are prone to bedsores.
Para, the best thing that you can do is get a rotating air mattress and cover it with a sheepskin.
This circulates the air through chambers helping with pressure and the sheepskin allows air flow, because the mattresses are plastic and not all of them have good coverings to protect your skin from the moisture created a good sheepskin will be so comfortable for her.
Go on Amazon or talk to her doctor about prescribing the mattress. You will probably have to buy the sheepskin.
Best of luck finding something that helps.
You should have a medical professional look at and treat whatever is going on with her skin.
Met a lady at my nail salon who took care of her bed ridden husband for six years. She was very proud to state her husband never got one bed sore. She told me she used Bag Balm every day on his skin daily.
My mom has a Stage 4 on her coccyx that is healing with a wound vac. I have Palos Home Health in Illinois. She gets 2 packets of Max Pro-Stat liquid protein and 2 packets of Juveen protein powder daily through Option Care. She digs a feeding tube. The protein has to be at least 30%. She also has an air mattress. Maximum Strength Desitin is great on protecting skin from moisture and heals. I use disposable liners underneath her bottom. I do not use disposable underwear anymore (caused UTI's and sores) I also use Ultimate Strenth #7 Tena pads to absorb urine. She does not get out of bed anymore. She also gets Jevity formula. I use a seat cushion that protects the coccyx for my Step Dad. He has to have a Foley catheter all the time to help urine flow. I get him out of bed daily for 4 to 6 hours. I put Desitin on his coccyx area daily. Drinking water also helps healing. Nurse is here 3 times a week for mom. And 2x a month for Step Dad.
Iwould suggest that you contact your primary care physician and request that he or she order a wound care consult. There are nurses who specialize in treating and healing wounds. There are a variety of interventions based on the location, size and stage of the wound. The nurse also instructs loved ones how to care for the wound. I think that you should request that the physician order home care along with the wound care consult. Your loved one can then be evaluated as well as treated and insurance should cover it. Nutritional status is also important in terms of healing wounds and the nurse can advise on that as well.
I have been taking care of my wife for 7 plus years and have treated her bed sores. If the area is red with skin broken and not bleeding I use Wound CLEAN to clean the area. I then apply A+D Diaper Rash Cream. Available in drug stores, supper markets and on Amazon. If the area is extreme I apply CALMOSEPTINE OINTMENT. I get mine from Amazon. If area is bloody I use SILVADENE CREAM. As a precaution, if an area looks read or looks like you could be havind a problem I use A+D PREVENTIVE OINTMENT. Again available almost any where. Once you get on top of the rash situation you will be able to control it and the recurrence will greatly decrease.
This may not work at all but try lightly massaging near the area ... NOT on the sores themselves obviously ... but near the area to try to get circulation to the area.
I actually have a vibrating foot massager which is in the form of a pillow. I place that under the bedsores and they go away. It is loud though. The massager brings circulation to the area. Also make sure your LO eats a lot of protein. I also bought a wedge pillow on amazon so in case mom wants to turn over and stay in one position the wedge pillow helps solve that.
All of these answers have great ideas. I want to put a little emphasis on general health. Something that nursing homes do is to give patients with skin breakdown, extra zinc, vitamin C, multivitamin and often times other supplements - depending on the individuals needs (though zinc and Vitamin C supplements are almost universal for skin). If you think the protein or collagen intake is low - you may want to try to supplement this, too. Despite a rigorous turning schedule - if skin is not cleaned thoroughly or allowed to dry well(yes, I have even used a hair dryer on LOW, briefly.. at a little distance) then the acids from urine or stool can continue to irritate the skin - even under the ointments you are using. Another thing to think about.... is the blood pressure running a bit low? Like a garden hose... pressure determines whether there is flow at the end of the hose. So if the blood pressure is running too low, especially if there are blood pressure medications that can be decreased in dose or even stopped, you may improve the circulation to those areas of skin for better healing. Just saying. Hope you are able to fix this painful problem.
For those who might be struggling getting in-home wound care, keep trying! Initially, my mom was bedridden (which is why she got the pressure sores) due to a reaction to a new chemo treatment, so she could not physically make it to the wound-care clinic. In-home care was approved at that point.
But after a couple of weeks, my mom was able to get up and about. At that point, in-home care was stopped, and she was supposed to go to the wound-clinic because she was no longer "home-bound." It's a 40 min drive each way, which would have been very difficult for my poor mom who has mod-sever AD and is battling mCRC. We kept calling and eventually got approved for in-home care, covered under Medicare. In the end, it came down to the doctor prescribing an antibiotic ointment that my mom's caregivers were not allowed to apply because of the Rx, and then writing an order for in-home care so a trained nurse could apply the prescription medication (and do wound care since she's already there). Our medical system is weird, but sometimes perseverance and creative thinking pay off.
If the alternating pressure mattress is too expensive, a cheaper option is the mattress overlay of foam that looks like an egg crate. Here a single costs about $20, and it really does make a firm mattress much softer. My BIL hired an alternating pressure mattress when he was dying and bedbound, I think through the Red Cross.
I use a prop behind my back when I am sleeping on my side, and I find that a small firm bolster cushion is much better than a pillow. It shares the weight between the hip and the back, and is easier to move around in bed than a big soft pillow.
As suggested by the hospice nurse, I used barrier cream and a pad the nurse provided. That stayed on for several days. I would also put a pillow under the side where the sore was to get her off of it for a while. *Mom’s sores never opened. I don’t know what hospice would have recommended then.
If all else fails on these great responses, a wound care physician may be in order. True story - my daughter's MIL wound was NOT healing at her Maryland doctor. She temporarily moved to her sister's in South Carolina and her wound is healing slowly at that state's specialist.
My mother has a pressure sore on her heel from where she sits in her wheelchair and uses her feet to propel herself around. It has taken ages to repair because of the continual friction. They are currently trialling an inflatable boot to keep the pressure off the heel and at last there is great improvement. Mother also gets a lot of skin tears from when she rolls out of bed or slides out of her lounge or wheelchair, her skin is just so fragile. Using the theory of an ounce of prevention is worth a pound of cure, the staff are trialling a woollen type of arm and leg protectors which cover these areas but are not attached to any garment. Also some sort of hip protector that reduces pressure. Having lost so much weight and her bones no longer have a lot of padding, she is benefiting from these protective measures even before an issue arises. And finally, some years ago I knew an RN who was in charge if a nursing home. They would not allow the traditional use of metho to toughen and dry the skin, and advocated the use of Savlon, an antiseptic ointment. This kept wounds soft, but also moist, a great breeding ground for germs. The only wounds that cleared up in a timely manner were those my friend attended to. After thoroughly cleansing the area she drew the skin together and sterri taped it. If the skin had wrinkled as in peeling back, she very delicately pulled the flap straight using forceps and laid it down on the open wound. If possible this was steri taped as well. The wound was sealed for up to 7 days, but checked regularly for leakage or smell. A strange approach I must admit, but it worked and the residents did not get an infection. I would not be game to even contemplate such a measure, let alone try the procedure, but nurses on this forum might have a go.
Surface - what is the person lying on or resting against? Is anything pressing on the skin?
Skin Integrity - have vulnerable areas been checked for signs of breakdown?
Keep Moving - encourage the person to move around as much as possible (every little helps). If s/he can't, adjust position for her/him.
Incontinence - ensuring that the skin is kept clean and dry by using the correct, effective continence care products and inspecting/changing frequently.
Nutrition - monitoring fluid and food intake and output.
Alternating or variable pressure air mattresses help a lot, but 2-4 hourly skin integrity checks, turning and adjusting position are needed to prevent skin breakdown in vulnerable bed bound patients. You can find charts on the internet which will help you go about checking methodically. One lists the areas to check:
Right hip
Left hip
Right heel
Left heel
Right ankle
Left ankle
Base of spine
Right elbow
Left elbow
Right buttock
Left buttock
Other
Ears and toes are also prone, because they come into prolonged contact with surfaces. Bedclothes rest on toes. Ears are often against pillows or cushions. Seriously, that's all it takes.
Is this an existing pressure sore that you're aiming to heal, or are you more focused on preventing new ones? Prevention is massively better than cure, of course; but if there already is a pressure ulcer then you need specialist nursing care and you need to make sure the area is not in contact with any surface (except a dressing, if applied). Creative use of cushions and a compliant patient will help.
It requires a lot of diligence to prevent and treat bedsores. An alternating pressure mattress is #1, imo.
There are 5 stages to bedsores. The first is a reddened area usually in a bony prominence (iliac, tailbone). You want to catch them at this phase if possible and then continue with frequent position changes, etc.
Once the skin breaks down the person should see a woundcare specialist ASAP. Frequent skin inspection is key.
Good luck to you!
My mom's pressure sores went from Stage 1 to Stage 3-4 in a matter of days, so keep up the preventative measures but don't wait to see a specialist if you have any doubts/concerns!
I'd like to know what kinff cream works best & I've been checking out what's available to avoid pressure but everything seems to be in the form of cushion pads for use in seats & not appr0priate for use in a bed (too thick).
Is it possible to get small area mattresses for the purpose, say for the buttolck & hip area?
Thanks again
There are all sorts of creams for all sorts of purposes. I don't think it would be sensible for anyone to recommend one without examining your wife. Do you have access to trained nurses with experience of wound care?
Make sure your Loved one is being treated/managed/monitored by the Wound Care Specialist. There are many different types of bandages and topicals out there, and often several types of treatment may be tried to find the one that works, sometimes the wound needs to be debried, so they know best.
Very good and thorough tips from CountryMouse too, what a great resource! The patients nutrition is very important too, especially if they are Diabetic.
You can aslo check with your Wound Dr to see if a visiting Nurse can come to your house for home treatment. Check with Medicare and secondary insurance too, as they can be a great resource for you!
I'm so sorry you are dealing with this, we did too with our bedridden Mom and it can be so frustrating for the Caregiver and so Painful to the patient. I only hope that those folks who have their parents in Nursing Home be sure to check their skin, especially in those areas (pressure points) that are prone to bedsores.
This circulates the air through chambers helping with pressure and the sheepskin allows air flow, because the mattresses are plastic and not all of them have good coverings to protect your skin from the moisture created a good sheepskin will be so comfortable for her.
Go on Amazon or talk to her doctor about prescribing the mattress. You will probably have to buy the sheepskin.
Best of luck finding something that helps.
You should have a medical professional look at and treat whatever is going on with her skin.
If the area is red with skin broken and not bleeding I use Wound CLEAN to clean the area. I then apply A+D Diaper Rash Cream. Available in drug stores, supper markets and on Amazon.
If the area is extreme I apply CALMOSEPTINE OINTMENT. I get mine from Amazon.
If area is bloody I use SILVADENE CREAM.
As a precaution, if an area looks read or looks like you could be havind a problem I use A+D PREVENTIVE OINTMENT. Again available almost any where.
Once you get on top of the rash situation you will be able to control it and the recurrence will greatly decrease.
ask the doc or home health nurses to make sure.
Something that nursing homes do is to give patients with skin breakdown, extra zinc, vitamin C, multivitamin and often times other supplements - depending on the individuals needs (though zinc and Vitamin C supplements are almost universal for skin).
If you think the protein or collagen intake is low - you may want to try to supplement this, too.
Despite a rigorous turning schedule - if skin is not cleaned thoroughly or allowed to dry well(yes, I have even used a hair dryer on LOW, briefly.. at a little distance) then the acids from urine or stool can continue to irritate the skin - even under the ointments you are using.
Another thing to think about.... is the blood pressure running a bit low? Like a garden hose... pressure determines whether there is flow at the end of the hose. So if the blood pressure is running too low, especially if there are blood pressure medications that can be decreased in dose or even stopped, you may improve the circulation to those areas of skin for better healing. Just saying.
Hope you are able to fix this painful problem.
But after a couple of weeks, my mom was able to get up and about. At that point, in-home care was stopped, and she was supposed to go to the wound-clinic because she was no longer "home-bound." It's a 40 min drive each way, which would have been very difficult for my poor mom who has mod-sever AD and is battling mCRC. We kept calling and eventually got approved for in-home care, covered under Medicare. In the end, it came down to the doctor prescribing an antibiotic ointment that my mom's caregivers were not allowed to apply because of the Rx, and then writing an order for in-home care so a trained nurse could apply the prescription medication (and do wound care since she's already there). Our medical system is weird, but sometimes perseverance and creative thinking pay off.
I worked as a nurses aide some years ago and used sugar and the sores were healed.
I use a prop behind my back when I am sleeping on my side, and I find that a small firm bolster cushion is much better than a pillow. It shares the weight between the hip and the back, and is easier to move around in bed than a big soft pillow.
Mother also gets a lot of skin tears from when she rolls out of bed or slides out of her lounge or wheelchair, her skin is just so fragile. Using the theory of an ounce of prevention is worth a pound of cure, the staff are trialling a woollen type of arm and leg protectors which cover these areas but are not attached to any garment. Also some sort of hip protector that reduces pressure. Having lost so much weight and her bones no longer have a lot of padding, she is benefiting from these protective measures even before an issue arises.
And finally, some years ago I knew an RN who was in charge if a nursing home. They would not allow the traditional use of metho to toughen and dry the skin, and advocated the use of Savlon, an antiseptic ointment. This kept wounds soft, but also moist, a great breeding ground for germs. The only wounds that cleared up in a timely manner were those my friend attended to. After thoroughly cleansing the area she drew the skin together and sterri taped it. If the skin had wrinkled as in peeling back, she very delicately pulled the flap straight using forceps and laid it down on the open wound. If possible this was steri taped as well. The wound was sealed for up to 7 days, but checked regularly for leakage or smell. A strange approach I must admit, but it worked and the residents did not get an infection. I would not be game to even contemplate such a measure, let alone try the procedure, but nurses on this forum might have a go.