Pressure sores or ulcers develop when the blood supply to the skin are compressed reducing oxygen and nutrient perfusion to the area, resulting in tissue necrosis (cell death).  In patients who are not mobile (or bed-bound), pressure sores can occur after just 2-6 hours.  The key to avoid pressure sores is to identify risks and to take preventive measures early on.

Risk Factors

• Elderly patients
• Immobility (due to stroke or poor health)
• Low conscious levels
• Low body weight or poor nutritional status
• Loss of sensation in the skin or limb
• Dry or thin and fragile skin

Norton Scale for Risk Assessment for Pressure Sores

Score	Physical Condition	Mental Status	Activity	Mobility	Incontinence
4	Good	Alert	Ambulant	Full	None
3	Fair	Apathetic	Walks with help	Slightly impaired	Occasional
2	Poor	Confused	Chair-bound	Limited	Urine
1	Very bad	Stuporous	Bed- bound	Immobile	Urine & Fecal

Total Score Interpretation

• Greater than 18 (Low risk)
• 14-18 (Medium risk)
• 10-14 (High risk)
• Less than 10 (Very High risk)

Common Sites for Pressure Sores

• Sacrum (tail bone area)
• Back and shoulder areas
• Buttocks
• Heel or knee area
• Elbows
• Back of the head

Measures to Reduce the Risk for Pressure Sores

• One of the most important preventive measures is to reduce mechanical load on the pressure points in the body. The patient should shift the weight regularly or change the sitting / lying positions.  If the patient cannot turn or reposition themselves, it is important for the caregiver to help reduce the mechanical load by frequently turning and repositioning the patient every 2 hours
• Do NOT apply further friction or shearing forces to at-risk areas or areas with sores by avoiding positions which put pressure on them
• Support surfaces (such as pillows or special cushions) can be used to redistribute pressure on these pressure points 
• Apply powder on the bedsheets to reduce the amount of friction when the skin rubs on them
• It is important to consult a dietician to help plan an adequate high quality nutrition plan for the patient because undernourishment poses a higher risk for pressure sores
• Check for signs of pressure sores every day.  Contact your nurse or doctor if there are new sores developing (or if the sores are getting worse or infected)

Signs of Infection in a pressure sore

• Pus coming out of the sore
• Foul odour
• Redness or tenderness (pain) around the sore
• The surrounding skin in warm to touch
• Fever

Do consult a Nursing Care Giver or your Doctor for advice

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