Pressure ulcers in nursing home patients.

Pressure, moisture, shear forces and friction lead to skin ulcer formation. Nursing home and home-bound patients with restricted mobility, poor nutrition, incontinence and chronic conditions such as anemia, diabetes and dementia are at risk for ulcer formation. Bedridden patients should be turned from side to side at 30-degree angles at least every two hours. Mattress and chair cushions, splints and cradle boots may reduce pressure. Good hygiene and barrier ointments, condom catheters, absorptive products and scheduled toileting for incontinence may control moisture. Calorie and protein supplements, feeding assistance and serial weight measurements are essential in the management of malnourished patients. Treatment should be based on the stage of the ulcer and the presence of conditions such as necrotic debris, infection and drainage. Saline wet-to-dry dressings and enzymatic and surgical debridement are necessary to remove necrotic tissue. Saline-soaked gauze, hydrogel preparations and occlusive dressings provide the physiologic environment for fibroblasts to grow and form granulation tissue. Patients with sepsis may require hospital admission for both further evaluation and systemic antibiotic therapy.