Bed sores, also known as pressure ulcers, develop due to prolonged pressure on certain areas of the skin. They are typically diagnosed through visual examination and classified into four stages based on their severity. Treatment aims to reduce pressure, care for wounds, prevent infection, and maintain nutrition. This involves repositioning the patient, using support surfaces, cleaning and dressing wounds, removing damaged tissue, managing pain, and surgery for severe cases. Common areas for bed sores are bony prominences like the tailbone, heels, shoulders, and elbows.

1. Bed sore( pressure ulcers)
By: Said Elyas Sadat

2. What you need to know:
 It can develop if a person spends a long time in the same
position
 They form due to lasting pressure on specific areas of the
body
Diagnosis:
 Doctor will look closely at your skin to decide if you have
a bedsore and if so to assign a stage to the wound
 Staging helps determine what treatment is best for you

3. Treatment
Treating pressure ulcers involves:
 Reducing pressure on the affected skin
 Caring for wounds
 Controlling pain
 Preventing infection
 Maintaining good nutrition

4. Reducing pressure
The first step in treating a bedsore is reducing the pressure and friction that
caused it
Strategies include:
 Repositioning:- turn and change your position often
 How often you reposition depends on your condition and the quality of the
surface you are on

5. Using support surfaces
 Use a mattress, bed, pillow and special cushions that help
you sit or lie in a way that protects vulnerable skin

6. Cleaning and dressing wounds
 Care for pressure ulcers depends on how deep the wound is
It includes the following:
 Cleaning:- If the affected skin is not broken Wash it with gentle
cleanser and pat dry
 Clean open sores with water or a saltwater (saline) solution each time
the dressing is changed.
 Putting on a bandage. A bandage speeds healing by keeping the
wound moist. It also creates a barrier against infection and keeps skin
around it dry. Bandage choices include films, gauzes, gels, foams and
treated coverings. You might need a combination of dressings.

8. Removing damaged tissue
 To heal properly, wounds need to be free of damaged, dead or infected tissue.
The doctor or nurse may remove damaged tissue (debride) by gently flushing
the wound with water or cutting out damaged tissue.

9.  Drugs to control pain. Nonsteroidal anti-inflammatory drugs — such
as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) —
might reduce pain. These can be very helpful before or after
repositioning and wound care. Topical pain medications also can be
helpful during wound care.
 A healthy diet. Good nutrition promotes wound healing.

10. Surgery
 A large bedsore that fails to heal might require surgery. One method of surgical
repair is to use a pad of your muscle, skin or other tissue to cover the wound
and cushion the affected bone (flap surgery).

11. Signs and symptoms
1. Color changes: darken skin may become bluish, purple or shiny
 Light skin may turn pink, red or it may darken
 If dis coloration does not disappear after removing the pressure
for 10—30 minutes, this may indicate that a sore is forming

12. Continue…..
2. Texture changes: The area may feel hard or spongy and
warm
3. Broken skin : there may be a shallow open open sore
with fluid or pus in it
 The wound may extend into the deeper layers of tissu
4. Infection: Signs include a change in color or more pus
green or black tissue around the sore and a fever

13. Stages

14. Four stages:-
1. The skin feels warm to the touch. There may be a color change,
such as redness, and the area may be itchy, the skin is an broken
but inflamed.
2. A painful open sore or blister develops, with discolored skin
around it, skin is broken to epidermis or dermis
3. The lesion develops a crater-like appearance, due to tissue
damage below the skin’s surface, ulcer extends to subcutaneous
fat layer
4. There is severe damage to the skin and tissue, possibly with an
infection. The muscles, bones, and tendons may be visible, ulcer
extends to muscle or bone

16. Common locations
 Sores form in areas of pressure speacialy in bony areas. A person
who spends a lot of time sitting may develop sores on the:
 Buttocks and tailbone
 Spine
 Shoulder blades
 backs of the arms or legs
A person in bed may develop sores on the:
 ankles
 heels
 shoulders
 tailbone
 elbows
 back of the head

18. First Aids
 Relive the pressure by placing protections ( foams,pads
or pillows ….etc)
 Clean the wound: Gently wash very minor sores with
water and mild soap
 Clean open sores with saline solution with each change
of dressing
 Apply dressings: These protect wound and accelerate
healing
 Use topical creams: Antibacterial creams can help
combat an infection and barrier creams can protect
damaged skin or tissue
 Address incontinence
 Have dead tissue removed

19. Continue…..
 Take any required antibiotics
 Review bedding: use some mattresses, such as
dynamic varieties
 Keep the skin clean and dry
 Encourage to exercise for blood flow to the
infected area.
 Change positions frequently between every 15
minutes to every 2 hours depending on a person’s
need

20. References
 Hopkinsmedicin.org
 Pressure ulcers. Merck Manual Professional
Version.
 AskMayoExpert. Pressure injury. Mayo Clinic;
2019.