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Identifying patient at risk, e.g. Norton scale assessment
Good nursing care, incl. turning patient every 2 h (90% of pressure ulcers are preventable)
Special care of pressure areas, incl. gentle handling
Special beds, mattresses (e.g. air-filled ripple) and sheepskin to relieve pressure areas
Good nutrition and hygiene
Avoid smoking
Control of urinary and faecal incontinence
Avoid the donut cushion and soaps
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Treatment of ulcer The most important principle is early intervention, including relief of pressure, friction and shear.
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Use above measures, plus:
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Clean base with warm water or saline solution (applied gently via a syringe) or IntraSite Gel (most antiseptics damage cells—use 0.5–1% Betadine)
General guidelines for dressings:
– deep ulcers: alginates (e.g. Algisite M, Kaltostat)
– shallow ulcers: hydrocolloids (e.g. DuoDERM, CGF)
– dry or necrotic ulcers: hydrogels (e.g. IntraSite)
– heavy exudative ulcers: foams (e.g. Lyofoam Max, Lyofoam Extra)
Give vitamin C, 500 mg bd
Give antibiotics for spreading cellulitis (otherwise of little use)
Remove dressings with care
Healing usually satisfactory but, if not, surgical intervention with debridement of necrotic tissue and skin grafting may be necessary