Bedsores/ Pressure Sores

jannieNovember 6, 2012

My DH is 66, has MS, seizures and Alzheimer's-like symptoms. He spends all his time in bed, unable to get up. He wears adult diapers. I change him frequently (five to six times a day, gosh Depends are expensive). Yet Sunday he said his bottom was itchy. I looked and there were red scrtches oozing blood. Put some Desitin ointment on, mixed with First Aid cream, and covered with gauze. The home aid gave him a shower Monday and said the sores didn't look too bad to her. I called his physician, who told me to go to an Emergency room and have an MD look at him. DH refuses, afraid they'll admit him to the hospital. . He threatened to hit me. So we have here a mix of physical problems and dementia. Anybody have advice? My sister is a nurse, she told me call an ambulance. What would you do?

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ogoopogo

Listen to your sister. Can you imagine how uncomfortable he must feel ? It's time to get some help..

Lots of luck!

    Bookmark   November 6, 2012 at 10:21AM
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Rusty

YES! Definitely call an ambulance!
First responders are trained on how to handle
All types of patients,
Including violent ones.

Do you have any help in caring for him?
Perhaps someone trained,
Who can help you handle the situation
After the ER visit?
Just in case he reacts with violence?

Good luck!
You are in my thoughts and prayers.

Rusty

    Bookmark   November 6, 2012 at 11:08AM
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jannie

Tuesday, I tricked him into going to the hospital. I told him we were going to vote. He made it to the car and I drove straight to the ER. Waited a long time, he was very antsy. He finally got looked at. Gave him some antibiotics and we were sent home. A visiting nurse will come every day.

    Bookmark   November 7, 2012 at 9:31AM
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jannie

We also got a "Care Manager" assigned and I can phone anytime.

    Bookmark   November 7, 2012 at 9:42AM
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Rusty

So glad it worked out for you,
And he got the treatment needed!
Glad, too, you were able to get him to the ER
Without calling an ambulance.
(That was very clever, by the way)
Probably a lot less trauma for both of you.

Don't be afraid to call your care manager
When you feel the need!
You need some help and moral support, too.

Rusty

    Bookmark   November 7, 2012 at 1:18PM
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CA Kate

Have you tried washing the sores with Hibiclense? My DH is allergic to topical antibiotics and the Hibiclense has worked.

Also, there are mattress pads that automatically inflate and deflate to help with pressure sores.

    Bookmark   November 16, 2012 at 10:19PM
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franceymargaret

Don't hesitate to ask your care manager about how to get free incontinence supplies. Or even google your state DSS site and follow the links to get more information.You may live in a state that has "Home and Community Based Service" (HCBS) special funds for the disabled and elderly for these things like gloves, chucks, disposable wash clothes and Attends or other over the counter things that don't fit your insurance or medicaid etc.No matter what, keep him off the sore area and keep it dry, after cleaning the best thing is a nice warm hair dryer, although keep it at a distance and keep it moving so not to burn. That also soothes the savage beast! There will be a scab that will fall off but keeping pressure off that area will help the most. Until it totally heals don't seal it with things like desitine or other preparations that won't allow air in. But after it heals then to avoid other moisture to break down the skin there are some great products to put a moisture barrier on the skin. Good luck

    Bookmark   November 27, 2012 at 1:21AM
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jannie

It's been 3 weeks and his bottom has remained clean and fully healed. The care aide we hired insists on him showering 3 times a week, being clean and dry helps a lot. I had contacted the VA about getting him some help, but our income is too high (sheesh!) for anything except the VA Adult Day Care Center and he refuses to go to that. The real problem is they provide transportation but it would mean sitting in his wheelchair in a van for an hour and a quarter each way. Impossible!

    Bookmark   November 27, 2012 at 8:45AM
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shambo

Jannie, good news about the sores. One less thing to worry about for the time being. Too bad, though, about the VA Adult Day Care. That's way too long a trip!

    Bookmark   November 28, 2012 at 12:25AM
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CA Kate

The first pressure sore has arrived. DH can only sit and not do any walking around, so I think it was inevitable.

I just discovered it tonight and cleaned it with Hibicleans and then put a soft, sterile pad on it to keep it clean and dry. Then I went straight to this Forum and found this and another thread that were helpful.

Is using the Duoderm or Tagaderm still the best solutions? How about the Skin Prep? Have any of you found anything better?

Also, would it help to have gel pads on all his chairs?

Any other suggestions?

    Bookmark   July 21, 2013 at 2:03AM
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emma

One of my husbands room mates had bed sores from sitting in his wheel chair all the time. They had him laying on his stomach without a sheet over him. They apologized to me and covered him. They moved my husband to a different room. I guess leaving the sores open to the air was important to healing.

    Bookmark   July 21, 2013 at 9:37AM
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CA Kate

It's interesting that everything I've read here advises to keep bedsores dry, but the doctor/ clinical websites say to keep the sore clean, moist, and covered with a light bandage.

Tomorrow I will be able to call the doctor to see what he has to say.

    Bookmark   July 21, 2013 at 7:40PM
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sunnyca_gw

Yes, Westelle it's amazing how long bedsores have been around & how much opposite information on how to treat them. My dad had small sore where he rubbed the sheet at night. He slept on his left side & only twice did he ever change & was on right side in morning. He never changed as couldn't breathe out of 1 side of nose. So side of right foot rubbed every night. Caregiver said use antibiotic cream on it, it got worse. RN told me keep it clean & dry. I showered him at least twice a week & covered it with loose cotton & small piece of tape. Still didn't heal up didn't get worse but then I took 1 ft square of that bed topper foam rubber & put the bumpy side up. It healed up fairly quickly & I made sure his feet were on it each night. Dad passed away but now mom is "getting sore" as she sits & sleeps in her recliner, sleeping there at night as she can't lay down or heart acts up. RN suggested a pad of that bumpy foam for both her wheelchair & her recliner. So hoping that works. I worked for a dr. & so many of creams for dry skin have alcohol in them, he gave me bunch of samples & then asked me how I liked them, I said I didn't & he said he didn't like them either. I think over counter products are sometimes better. I think with a wound drs recommend keeping moist & clean but bedsores on folks with poor circulation calls for different treatment & I think drs. sometimes "1 size fits all" & forget that old folks skin is not like a 20 yr old's. Dad was hit by another wheelchair in nursing home & got a scratch on bone half way between knee & ankle about 2 in. long. They treated itt with creams & dad came home 2 weeks later, no improvement, I left it uncovered & kept clean & it gradually healed up in about 3 mos. Dad was 95, no arthritis but circulation wasn't the best on his legs. His face he could scratch & would heal up within couple of weeks but below knees it seemed to take forever! Even when he walked with walker some each day it was still so slow.

    Bookmark   July 23, 2013 at 6:05PM
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CA Kate

Our doctor put in an order for a visiting nurse to come take care of the sore. She cleans it with sterile saline, then covers it with a Tagaderm product. The sore is healing nicely.

Also the nurse recommended we get a Gel Overlay to top the mattress, and gel pads for his chairs. I wll remember about the bumpy foam tho'.

Since he has to be turned at least once every two hours I added a caretaker for overnight so I can sleep.

    Bookmark   July 26, 2013 at 12:48AM
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sunnyca_gw

Mom has a nice 3 in. thick gel pad for recliner- it's in the corner now with all the other things we tried. I think you just have to keep trying things. I lost a lot of muscle so I've tried a lot of different pads, cushion etc. I do best with 2 -3 different ones for different chairs. Sitting a lot on 1 type is irritating.

    Bookmark   July 26, 2013 at 6:46PM
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jannie

I bought a triangular shaped bed pillow for DH. It's helped a lot-elevates his head for eating,TV watching. One side is flat foam, the other has egg-crate shaped depressions, keeps him from sweating a lot. Right nowe he has no bedsores at all, mostly because I change his adult diaper frequently and care aide gets him out of bed and showered three times a week.

    Bookmark   July 28, 2013 at 2:34PM
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CA Kate

I am soooo angry and sad right now. DH's sore was healing nicely, and now, thanks to poor care by a lazy sub-nurse and inattentive care by his night caretaker, the sore is twice as big, raw, and infected.

A RN came this afternoon and added an extra pad to his dressing that contains calcium and silver to help stop the infection. I hope it works. Our assigned RN will be back from holiday tomorrow. It will be interesting to hear what she will have to say.

    Bookmark   July 28, 2013 at 10:40PM
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raee_gw

There are different sores that immobile people get and the management is different.
Warm flowing air is one thing that seems to help any type.
Soaps and detergents are increasing thought to be harmful to elderly skin. Cleansers need to be pH balanced to skin and not drying.

Skin breakdown from urine, feces, and other moisture needs to be kept clean and exposed to air regularly to heal. Desitin works well to protect from repeated exposure, but the area needs to be exposed to air and warmth too, for 20 minutes at least 3 or so times a day. It doesn't matter if you put the desitin on first, if it dries to a coating that will not hurt the skin (good in fact, if really moist and weepy), just don't think that you have to scrub every bit of it off every time you clean. A hair dryer on low, or a sunny window, or a warm lamp (NOT a heating pad or lamp!) are examples that work. Generally for excoriated or macerated skin, antibiotic creams are not needed and will upset the normal balance of bacteria on the skin.

Pressure sores are another animal. They also need to be kept clean, but relieving the pressure is the only true treatment. Prevention is the best treatment! All the other dressings etc are just add-ons to try to provide the best environment for healing.

There are many types of cushions available; gel is generally considered the best for a chair or small area, there are also some very good air seat (Sundance Medical makes a nice one that I got for my mother) and bed cushions plus the air mattresses that can inflate with a special machine do work. Eggcrate foam is another option more budget friendly. None of these will 100% (or even 80%) prevent a pressure sore if the person stays in one position for hours.

The Calcium alginate and silver dressings are quite effective, westelle, I can tell you that. But it takes time. As someone stated above, elderly skin and tissue just don't heal quickly sometimes. Ulcers that are due to nerve damage or poor circulation can be nigh impossible to heal completely.

I don't like duoderm that much for pressure wounds, I think that there are better products like Mepilex (very gentle on the skin) and Tegasorb, but it is a good protecter/preventor for areas that tend to get banged up like ankle and elbows.

Tegaderm (and similar products) is good for skin areas that are prone to tearing or abrasion--like arms and shins. It is like adding a layer of tough skin, but mind, once it is on, it stays on until it comes loose on its own or you risk tearing the skin further.

A product like skin- prep or cavilon no-sting barrier needs to be applied to the skin before any kind of adhesive (tape or dressing). These also can work quite well as incontinence barriers.

The other key to preventing sores is to prevent shearing -- like when the person tends to slide down & out of the chair. Find a chair that doesn't encourage this.

Hope all that helps someone!

(PS I am a critical care RN and on my unit's skin team)

    Bookmark   August 4, 2013 at 3:42PM
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CA Kate

Rae: thank you for all this information. I am going to copy it and keep for future reference. Our nurse likes the Mepilex too and has been putting it on DH. The combination of the calcium/silver patch and the mepilex has the sore totally healed. Now to just prevent more sores, and your info will help.

    Bookmark   August 4, 2013 at 10:51PM
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CA Kate

Rae: thank you for all this information. I am going to copy it and keep for future reference. Our nurse likes the Mepilex too and has been putting it on DH. The combination of the calcium/silver patch and the mepilex has the sore totally healed. Now to just prevent more sores, and your info will help.

    Bookmark   August 4, 2013 at 10:52PM
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sunnyca_gw

Raee, thanks for the info. I copied it down also. Visited friend in nursing home yesterday & she was sitting on a gel pad about 3-4 in. thick, looked like it was full of air until I felt it, it's very heavy so makes it difficult for relatives to remove from wheelchair so wheelchair can be loaded in vehicle. So they don't take her out very often. She claimed it weighs 25 lbs but doubt that. Gel pad we have is heavy but not more than 10 lb bag of sugar. We need all the help we can get so appreciate all the advice & ideas. Caring for elderly is not a 1 size fits all !!

.

    Bookmark   August 6, 2013 at 1:52PM
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raee_gw

You are both welcome! It was one thing to know all this for work, and another thing entirely when I had to put it into practice for my own mom at her nursing home (and especially to get the NH staff to follow through consistently -- OY!!!)

They had provided a "gel" seat for her geri chair that seem hard as clay to me and not effective. She had lost much weight and sitting was painful. That is why I obtained the air cushion finally, it did make sitting much more comfortable; plus the pressure sore that was threatening never progressed. Once hospice got involved with her care, they brought in an air mattress for the bed. When she passed away, 3 years after her first stroke, she weighed only 74 pounds and was contractured but had no skin sores.

    Bookmark   August 12, 2013 at 2:55PM
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CA Kate

The gel overlay was delivered the other day. It was 4" thick and was suppose to go on top of a 7" mattress. The bed is already high, and the added 4" would have looked like " The Princess and the Pea", and we wouldn't have been able to get him out of or into the bed anymore.

The turning him from side to side is helping. I guess I will need to look online for a more reasonably sized overlay.

    Bookmark   August 12, 2013 at 11:04PM
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sunnyca_gw

Westelle, They have a metal thing that goes under mattress & helps in turning or getting him out of bed, you really have to look for items. I went to medical supply but they weren't much help. I don't think the air mattresses were too thick. Also if you get 1 be sure it can't slid off the bed, might have to run straps over top & bottom of it to hold it & so if he attempts to get up or even throws leg off bed he won't go with it. I visited friend in hospital & she never regained consciousness but constantly threw her leg off the bed, if mattress pad not secured person might go flying off also & then broken bones or such to deal with. I would try the warm air from hair dryer, just warm, not hot on your DH. See if that sore won't heal faster.

    Bookmark   August 13, 2013 at 4:31PM
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CA Kate

The nurses don't want it to dry out. They say that new skin will develop better in protected. moisture. So far it has been healing.

    Bookmark   August 13, 2013 at 11:34PM
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