Managing Pressure Sores
When a patient has a pressure sore, the healthcare team's goal is to prevent them from worsening and to help those that started to heal. For people who have a good prognosis, meaning they are not expected to die soon, surgery may be recommended for severe pressure sores. However, in palliative care, that is rarely an option.
Stage 1 Pressure Sore
A stage 1 pressure sore is an area that is reddened but the skin hasn't yet broken.
If you are a caregiver and you have found what you believe to be the beginning of a pressure sore, it's important that you mention this to the palliative care nurse or other healthcare team member. It's a good idea to relate the size to something that is familiar to everyone, rather than saying "large" or "small." You can note that the red spot is the size of a quarter, perhaps, or a dime. That gives people a point of reference.
You can help care for a stage 1 pressure sore by relieving the pressure to the area. This could mean keeping your loved one from lying on the side with the sore or by using pillows to move the pressure from one area to another. While avoiding pressure on the area that is reddened, be careful that you don't put too much pressure on the rest of the limb or area of the body.
The area needs to be kept clean and dry. Don't apply creams or bandages unless told to by a healthcare professional. Just clean gently and dry well.
Stage 2 Pressure Sore
A stage 2 pressure sore has broken skin or blisters. At this point, the care is much the same as with Stage 1 but you must watch the sore closely as it can progress to stage 3 very quickly. Keeping the area dry and clean is important to prevent infection. Your palliative care team can show you how to do this.
Some palliative care teams use special dressings that are meant to act like second skins. They are applied and can stay on for days, allowing air to flow through, but not allowing moisture through.
Stage 3 Pressure Sore
Stage 3 pressure sores can be very painful. As well as having gone deeper into the tissue, they may be infected. If there is an infection, the doctor will likely prescribe antibiotics. As with stage 1 and 2, pressure must be kept off the area. The doctor may prescribe a dressing to be placed over the wound after it has been cleaned and packed with a special solution.
If there is dead tissue inside or around the wound, this may be removed as well.
Stage 4 Pressure Sores
A sore that has become a stage 4 pressure sore is deep into the body tissue. You may be able to see the muscles, tendons, or bone. Patients who have stage 4 pressure sores will have pain and will need to be given medications for the pain, particularly before any treatment is done to the sore. Because of the palliative care status of the patient, neither stage 3 or stage 4 sores will likely ever heal.
References:
EMedicine.com | 
