Since pressure is the main cause of the development of pressure ulcers, the relief of endangered body parts has top priority, for example through: mobilization, storage and change of position. Other measures such as skincare or blood circulation may supplement but not replace pressure relief measures. At the same time, as far as possible, other risks are eliminated, such as incontinence or sweating.
The bedridden should be mobilized as soon as possible. To mobilize a patient is not only getting up, but any movement exercises (even in bed). Early passive exercise exercises can be started, which can be increased to active exercises through assistive exercises (leading and supporting the caregiver). If these exercises are integrated into other care procedures (whole-body washing, rearrangement), they require little time compared to the benefits.
The aim of the bearings for decubitus prophylaxis is the enlargement of the support surface. As a result, the weight of the patient is distributed over a larger area, the contact pressure on individual body parts is thus reduced. A distinction is made between soft and super soft storage: In soft storage (for example with anti-decubitus mattresses, waterbed, gel cushion, fur), the contact pressure should not exceed a certain pressure. With the help of special mattresses, the patient can be stored super-soft, which should ensure unrestricted oxygenation of all skin areas. Soft and super-soft storage, however, lead to reduced mobility and inhibit spontaneous movements of the person concerned. For this reason, patients who still move minimally, not too soft stored.
If soft and super-soft storage are not sufficient for decubitus prophylaxis, the patient must be relocated at fixed intervals. Regular repositioning ensures an interim complete pressure relief of endangered skin areas. Patients should be rearranged at least every two hours, and more frequently for risk factors. As a rule, you can alternate between left and right side position and supine position, only a few patients accept the prone position. For example, if a patient can not be turned over to the right side due to his or her illness (for example due to an artificial hip joint), it is changed every two hours between left lateral position and supine position. However, this reduces the recovery time of the endangered skin areas to half!
Protects the skin from harmful influences. For example, skin care protects the skin of incontinent patients from stool or urine. A "nutrition" of the skin from the outside is not possible, so that creams and ointments do not replace acts that ensure the skin circulation (ie the nutrition from the inside), for example, storage and change of position. It is important to know that moist skin can develop into a decubitus ulcer. Therefore, it is important to keep the skin dry.
To promote the blood circulation of the skin, if the patient's condition allows it, warm full baths with added carbon dioxide can be carried out or the skin can be gently massaged during body care and then rubbed off. The skin of vulnerable patients should be checked for redness on a regular basis (at least once or twice daily). Well suited to the body care and the beds. A reddening of the skin, which does not disappear within 20 minutes when pressure is relieved, is the first sign of an incipient decubitus ulcer. It makes little sense to wait for any remarks by the patient, because above all those patients are at risk who feel nothing due to sensory disturbances and then do not turn themselves (for example, diabetics with polyneuropathy).
Beware of old braids in the care of decubitus patients!
Unfortunately, in some places still traditional, but demonstrably rather harmful "prophylaxis" is common. Ointments help little. For skin care do not use greasy ointments, milking fat etc. They clog the skin pores and prevent the heat balance. Iron and blow dryer is megaout. Do not iron and blow the skin! This measure is not only ineffective, it even leads to increase the germ burden, because with the hair dryer germs are blown to the skin. Improper use may cause cold damage and burns. Do not rub the skin with rubbing alcohol or other alcohols as alcohol will degrease the skin. This leads to small cracks in the skin, through which germs can easily penetrate. The addition of essential oils (pine needle oil) can not sustainably increase the circulation of the skin. Mercurochrome used to be almost "literary" in the past, today tons of red stuff are being used. It contains poisonous mercury, which is absorbed through the skin and makes it difficult to observe the color of the skin due to its rich red color. In addition, the stains of clothing never go out. Do not use skin disinfectant prophylactically. Skin germs are physiological. By prophylactic use of skin disinfectants, this natural skin flora is destroyed along with the pathogenic germs. Avoid rubber and plastic. They prevent the skin from determining the optimal moisture content itself. It can not be ruled out that some incontinence aids increase the risk of decubitus due to the incorporated plastic foil. A regular review of whether the planned and implemented measures are sufficient, ensures the success of decubitus prophylaxis.
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