PN Online continues its coverage on preventing and treating pressure ulcers
Pressure ulcers can be treated more easily when detected in the early stages. The earlier you notice a change in your skin, the sooner you can start treatment and reduce your risk for more serious problems. If you or someone who assists you notice a suspicious area on your skin, you should get off it immediately. If your skin does not return to normal within 24 hours, call your health-care provider.
When you seek treatment, your health-care provider should:
• Update your medical history, discuss what help you have at home, inspect your equipment and discuss what cause your ulcer
• Perform a physical examination that includes a thorough inspection of your skin
• Order laboratory and other diagnostic tests to evaluate the extent of the pressure ulcer and any other related medical problems
• Perform a thorough examination of the pressure ulcer, including measurements and descriptions of the ulcer as well as the areas surrounding it for signs of swelling or damage
• Discuss the next steps in treatment of your ulcer
There is no one-size-fits-all treatment for pressure ulcers. Treatments may range from simple to complex. Your health-care provider may:
• Tell you to get off the area until your skin returns to normal
• Use products that cleanse the area, such as normal saline or wound cleaners
• Use products or methods that remove dead tissue
• Prescribe antibiotics if you have an infection
• Change the type of wound dressing as the condition of your ulcer changes
• Consider and use other treatment technologies, such as vacuum-assisted closure and electrical stimulation
• Recommend surgery
Your health-care provider will suggest the best course of action for healing your pressure ulcer. All the options will be presented to you so you can make an informed decision regarding treatment. Factors that determine the appropriate treatment include:
(1) Your current state of health and nutrition
(2) The size and severity of your pressure ulcer
(3) Evidence of infection
(4) Other medical problems that might interfere with healing, such as diabetes or circulatory problems
(5) A prior history of pressure ulcers and surgery for them
(6) Adequate insurance coverage
If surgery is the recommended treatment, your health-care provider will discuss your post-surgery recovery plan. Always ask for written instructions on what you are supposed to do (and not do). For a speedy recovery, make sure you and everyone who helps with your care follow all the instructions and recommendations. In general, this will include:
• Prolonged bed rest to allow adequate wound healing (commonly takes four to eight weeks)
• Daily observations of the surgical site by health-care providers
• Range of motion exercises for your hips and knees
• A progressive sitting program to build up tolerance on the surgical site
• Assessment of relevant equipment for repair or replacement (wheelchair, cushions, etc.)
The recurrence of pressure ulcers is common among people with spinal-cord injury. However, the type of treatment you receive, surgical or nonsurgical, does not affect how many times you develop pressure ulcers, either at the same site as an earlier one or in another area of your body.
Adapted from “Pressure Ulcers: What You should Know,” a Consortium for Spinal Cord Medicine Consumer Guide. Go to www.scicpg.org to download a free copy.
