Elderly people who are bed-ridden or wheelchair-bound for long periods of time may have complications due to reduced limb movement, such as pneumonia, or localized skin ulcers and necrosis due to pressure, known as pressure sores (aka bedsores); or even muscle atrophy. The occurrence of these complications has much to do with the correct posture of the elderly. If caregivers can strengthen their knowledge of nursing skills and regularly change the posture of the elderly, they can not only help the elderly maintain normal muscle function and help promote blood circulation in their limbs, but also prevent such complications from occurring.
I. Relationship between posture and pressure sores.
Pressure sores are skin ulcers that occur in areas where bones protrude. When these locations are under prolonged pressure and blood circulation to the microvasculature is blocked, the pressurized areas do not receive adequate nutrition, resulting in local skin tissue damage, or pressure sores.
People who are prone to pressure sores include: people who are immobile, frail or bedridden for long periods of time; people who are incontinent; and people who are too thin or too fat.
Common locations of pressure sores.
Preventing pressure sores Preventing pressure sores means preventing them from occurring by reducing the amount of pressure between the patient and the surface of the object they are touching and by shortening the time that pressure is applied to local tissues.
(1) Ways to reduce pressure on the skin
Maintain proper posture and try to avoid pressure on bony projections.
Although various cushions, mattresses and supports have been continuously improved, and the application of various turning beds, air beds or sand beds has yielded better results, the most basic, simple and effective methods to prevent pressure ulcers are to reduce pressure on the skin. However, the most basic, simple and effective preventive measure is for nursing staff or family members to turn the patient or for the patient to change position regularly. At least once every two hours.
Avoid friction and collision between the patient’s body and the bed when carrying or transferring the patient.
Choose a suitable chair. If the elderly person has strong upper extremities, encourage them to sit with their hands for 10 seconds every 30 minutes to reduce the chance of pressure sores on the sit bones.
Consider using various types of pressure-reducing aids
(2) Other ways to reduce skin pressure
Keep clothing and bed linens clean, neat and dry.
Avoid putting heavy objects such as heavy bedding or warm water bags on the limb.
Avoid tight wound dressing.
Avoid keeping long nails or wearing ornaments to avoid hurting the skin of the elderly.
(3) Reduce the pressure on the bone protrusion: use soft pillows, foam, sponges and other items to drive the empty bone protrusion area.
(4) Skin care
Keep the skin of the elderly clean and hygienic; change diapers for the incontinent elderly regularly to reduce the chance of skin infection.
Carefully observe the skin health of the elderly and treat any early signs of pressure sores as soon as possible.
(5) Eat a balanced diet of nutritious, high-protein foods such as meat, eggs, dairy and beans to maintain healthy skin.
(6) Observe the skin: Check the skin of the whole body at least once a day, especially the areas where pressure sores are likely to occur, which can be done by doctors, nurses and family members in the acute stage. Patients in the chronic stage can examine themselves with a hand mirror. When abnormalities are found in the skin, immediate mitigation measures should be taken to prevent the development of the disease.
(7) Support training: For patients who live on wheelchairs for a long time, in order to reduce the pressure on the hips, they should practice lifting their hips by supporting the bed surface and the armrest of the chair with both hands. If your hands are weak, you can first tilt your upper body to one side so that the opposite hip leaves the chair surface, and then tilt to the other side.
(8) Avoid trauma. Even a very minor skin injury when there is a lack of innervation or malnutrition can become infected and evolve into a trauma similar to a pressure sore, so special attention should be paid to removing foreign objects from the bed and chair. Trauma should also be prevented during training.
(9) Strengthening nutrition Malnourished patients are prone to pressure sores and have difficulty healing because of the reduced tolerance of the skin to pressure injuries. Therefore, attention should be paid to increasing protein and a high-calorie diet to prevent patients from developing anemia and hypoproteinemia.
II. Treatment of pressure sores
We should pay attention to a comprehensive treatment that combines local treatment of the trauma surface and the patient’s general condition.
First, the pressure sore area should be relieved from compression, otherwise any treatment will not be helpful.
Second, the systemic factors that affect the healing of pressure sores should be controlled, such as improving nutrition, correcting anemia and hypoproteinemia, treating edema, and controlling diabetes mellitus. On the basis of comprehensive treatment, pressure sore treatment can be divided into conservative therapy and surgical therapy.
(1) Conservative therapy hospital: Conservative therapy is used in principle for I and II degree trauma. It mainly includes three aspects: release of pressure, trauma treatment, and systemic management. For trauma, in addition to treatment with conventional aseptic surgery for clean wound replacement, physical therapy, such as ultraviolet and infrared irradiation, should be fully utilized to promote wound healing.
(2) Surgical treatment: For those who do not heal by long-term conservative treatment, aging trauma granulation, scar tissue formation at the trauma edge, combined with osteoarticular infection or deep sinus tract formation, surgical treatment should be considered. Adequate preparations should be made before surgery, including improving the general nutritional status, correcting anemia, controlling infection and flushing the trauma two weeks before surgery. Intraoperatively, the pressure sore is completely excised. Then, different flaps are designed according to the trauma site and size. After suturing, attention is paid to maintaining effective negative pressure drainage to prevent local blood leakage, oozing, incisional infection and flap necrosis.