Authors: Betânia Ferreira (internal medicine) and Cláudio Ferreira (nurse coordinator of LUZ 24) Pressure ulcers, pressure sores or bedsores are injuries of the skin and subcutaneous tissues due to constant or repeated pressure. They generally occur in people who spend a lot of time in the same position , for example, bedridden people, wheelchair users and those who, for whatever reason, have reduced mobility. Bedsores can also form in areas where skin suffers repeated friction , for example when using a cast, bandage, oxygen mask, or other device. Elderly people are the main risk group , due to the greater likelihood of immobilization and to the fragility of their skin. However, bedsores ulcers can occur at any age when there is prolonged immobilization. Areas where there are bony prominences are the most affected , due to greater pressure. Among these are: Nape of the neck; Nose; Back; Coccyx region; Hips; Heels; Ankles; Elbows. What does a bedsore look like? At first, when the skin is still intact, there appears to be a change in its color, which becomes reddish or bluish (similar to a bruise). Then, when the skin breaks, an ulcer (open sore) forms, which can look like a large canker sore and affects not only the skin but also the soft tissue beneath the skin. Depending on the severity, blisters and scabs may form, the muscle may become visible, and pressure sores may even become infected. How are pressure ulcers prevented? Pressure sore prevention measures can be grouped into: Care with positioning; Improve support; Skin care; Nutritional care. Given that pressure ulcers occur mainly in prolonged immobilization, the main thing for bedridden people is to change position frequently so that pressure is not always exerted on the same areas of the body. Changing a bedridden person's position at least every 2 hours is a good practice, alternating lying on their back with lying on their right side and left side whenever possible. Between positions, massage the areas of greatest pressure with a common cream. Pay attention to the reddest areas and massage them until the redness is reduced. When there is redness, the frequency of position changes must be increased to activate venous return. Anyone in a wheelchair or immobilized while sitting should, whenever possible, try to relieve the areas of support, including the buttocks, arms and back. Additionally, using specific support surfaces is important: An articulated bed promotes comfort and helps with position changes. There are mattresses ideal for those who are bedridden. These mattresses are made from materials that promote a more even distribution of weight and pressure throughout the body, improving blood circulation and thus preventing injuries. Some of those mattresses are pneumatic, meaning they have equipment that performs inflation and deflation cycles, distributing pressure and improving circulation. Ensure that bed linen and clothing are not folded or creased , as these cause pressure; It is important to use pillows, or foam blocks with specific shapes , under the heels, knees and elbows when lying on the back and between ankles and knees when lying on one side. When in a wheelchair, a specific air, gel or foam cushion can be used. Skin care should keep it as healthy as possible. Regularly monitor the skin with particular attention to areas at greatest risk. Keep in mind the look and feel; Anyone using casts, oxygen masks, or other devices should keep contact areas under surveillance and maintain skin care. Skin care: Clean with warm water and mild soap and dry by gently tapping, without rubbing; Keep skin well hydrated with a suitable cream (there are specific products for this purpose); Keep clothes clean and dry, especially underwear. Nutritional care also gains importance in this context: It is important to optimize body weight: Obesity is a risk factor; Weight loss and malnutrition aggravate the exposure to pressure on bony prominences. When weight loss is recorded, monitoring by a nutritionist should be considered to assess the need for protein supplementation. Warning signs When a bedsore is detected in an immobilized person, nursing care should be sought. Additionally, these are warning signs that should always be looked for. Fever; Loss of sensitivity in pressure areas; Changes in color, swelling, unpleasant odor. If necessary, call LUZ 24 – 217 104 424 – the clinical triage service of the Hospital da Luz, available 24 hours, 365 days, for adults and children. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
