Nursing measures for pressure sore wound

Priority should be given to relieving local oppression, accurate treatment according to wound stages, prevention and control of infection, and overall nutritional support. All measures are centered around these four points, and there is no shortcut.

I have been in the geriatrics department of 3A hospitals for almost 6 years, and I have handled more than 200 cases of pressure ulcers. I have seen too many family members step on the pit of "You don't have to turn over if you buy an expensive air cushion bed" and "It's better to disinfect with iodophor every day", dragging a shallow wound with a coin size into a severe pressure ulcer with deep bones. I have also seen many cases of stage IV pressure ulcers that can be completely healed within three months after standardized nursing. Today, I will talk about the real experience.

Don't believe in the magical "anti-pressure sore artifact" on the Internet. The first thing in all measures is always decompression. Ordinary bedridden patients turn over every 2 hours, and those who have already had pressure ulcers have to be shortened to every hour. Air cushion beds can only reduce the frequency of turning over, and they can never replace turning over. Don't really say that there are family members who don't believe in evil. Before, an old man was in bed with a femoral neck fracture. His children spent more than 2,000 yuan to buy an imported air mattress, and they felt that everything was fine. They didn't turn over for the old man for three consecutive days. When they re-examined for a week, the sacrococcygeal region was rotten to the fat layer, which was not worth the loss. Oh, by the way, don't just stare at the sacrococcygeal region. Heel, behind the ear and ilium are the prominent places that are most easily overlooked. Last time, there was a patient with cerebral infarction, and his family members were too busy decompressing his ass and forgot to pad his heel. As a result, the second-stage pressure sore on his heel was kept for more than two months. Every time he turned over, he took a small soft pillow under his calf to make his heel hang, which was more effective than any dressing. There is also a cold knowledge that many people don't know: the softer the decompression pad is, the better. The sponge pad that sinks in as soon as you sit down will make the body's stress area smaller and the pressure concentrated, which will make it easier to press out sores.

After talking about the core decompression, let's talk about the wound treatment that everyone is most concerned about. The treatment methods of pressure ulcers in different stages are very different. I have compiled a common clinical treatment comparison table and listed the controversial points in the industry, for your reference:

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When it comes to wound treatment, there is another pit that 90% of family members will step on: over-disinfection. No matter whether the wound is infected or not, many people rub it with iodophor and alcohol every day. In fact, if the wound is clean without pus or odor, just rinse it with normal saline. Irritating disinfectants will kill the new granulation tissue together, which will slow down the healing speed. Only when there are signs of infection, iodophor or silver ion dressing is needed to fight infection. There is also a debate about "whether the wound should be aired" for more than ten years. The older generation thinks that it is good to leave it dry and scab. Now the concept of wet healing advocates sealing and moisturizing. In fact, both of them have applicable scenarios: when sweating is excessive in summer, the wound is extremely shallow and there is little exudation, it is completely fine to leave it open for airing. If there is a deep wound with a lot of exudation, it is still necessary to use a dressing to keep it moist. Don't stick to a certain concept.

Don't just stare at the wound, the whole body condition is the basis for the wound to grow well. If the protein of the elderly is less than 30g/L, no matter how the dressing is changed, no new meat can grow. Every day, you must ensure that at least two eggs and a glass of milk are ingested in protein. If you can't eat it, you should drink nutritional powder. If necessary, you should give albumin according to the doctor's advice. If you are anemic, you should supplement iron in time. If your blood sugar is high, you must control your blood sugar below 10mmol/L, otherwise the risk of infection will be several times higher.

I have been used to taking a picture every time I change the dressing for patients for so many years. Compared with the changes in the previous week, if the wound has not shrunk and the exudation has not decreased for two consecutive weeks, I have to find a doctor to adjust the plan quickly and don't stare at one method. After all, every patient's physique and basic diseases are different, and measures suitable for others may not be suitable for you. Flexible adjustment is the most useful.