Dealing with bedsores in bedridden elderly

The first question that nurses would ask me is if my mom have any bedsore since she had been bedridden for close to three years. As it is common for bedridden patients to develop bedsores because they are lying down all the time.

In this post, I would share on how my mom develop bedsores and how I learned to manage her bedsores and what to use to turn her. Especially if they dislike sleeping sideways and would wiggle out of a sideway position.

How my mom started developing bedsores

My mom did not have any bed sores initially. As the bed we have is not too soft nor too hard. Also, she gets moved around during bed baths and diaper changes. And we have a few soft pillows that I use as wedge to nudge her sideways.

However when she first got admitted to Covid ward, she started having bedsores at her bum. Reason being the pillows in the hospital were hard- leather is sew over the pillow (so that stains do not go into the cotton) and the pillows are thick and hard. Also, I washed my mom almost each time I change her diapers but in the ward, I was not supposed to wash her because it would cause inaccuracy in the urine measurement (part of accessment is that the nurses need to weight the soiled diapers to determine the volume of urine produced and if I washed her then the reading would not be accurate and the nurses would not be happy about that).

So from there, she started having bedsores. My mom’s friends (former nurses) had warned me that once they get bedsores, it would be easy to get worse. Even if they are healed, it would be easy to get a relapse.

When my mom got warded in ICU last year, I was not allowed in to visit so for the first time in years, she spent about 5 nights without me. When she stabilized and was brought down to common ward when I could finally visit, the moment she heard my voice speaking to the nurse, she opened her eyes- and when I held her hand, she grabbed it on tightly. It nearly brought tears to my eyes…. despite Alzheimers, she could still remember me.

But then, it was then the bedsores issue really started…. she had 2 sores, one along her backbone and another at her bum. My mom is thin so the nurses said it was due to the bones protruding out at pressure points that cause the bedsores.

How I managed her bedsores (my mom dislike sleeping sideways)

A physiotherapist had advised me that it is important to turn my mom to avoid bedsores and if they have developed, then to avoid them from getting worse.  A little turning is better than none at all. Please don’t be complacent about that because it is much much easier to prevent the development of bedsores than to treat them after they have developed.

If your loved one is like my mom who dislike sleeping sideways, my suggestion is to try investing in a small (torso length) memory foam pillow. A soft one where it would bend according to the contours of the pressure. Turn them sideways and then place the pillow behind their back. I find with the small memory pillow, my mom seldom wiggle herself flat (yeah she can still be a little sneaky at times). And unlike normal pillow, these pillow do not get hot from body heat.

I do not turn my mom completely sideways especially now she had a trach tube in her throat, I do not want to risk adding any pressure or friction that may injure the tissues in her throat. I turn her a little, place the memory foam pillow behind her back and another one at her butt. Reason I don’t use the same pillow for her butt is because I am worried that it may get soiled. So far I find it is most effective method to keep her turned. And I have another booster that she can hug to keep her turned.

The position needed to be changed ideally every 2 hours- ie turn left, lie flat, then right, lie flat……The lie flat position is usually when they are about to take their meals. But I find I can turn her a little sideways during mealtimes….the nurse told me it is okay for her to take her meals (via nasogastric tube feeding) sideways but most important her head needs to be elevated (for tube feeding, at least the upper body need to be raised 30 degrees- ideally it would be at least 45 degrees).

Next comes dressing. The sore at my mom’s back is still there after a few months because the skin covering up had came off. I change her dressing daily- once during bed bath as it would wet the dressing so I put on a temporary one before doing a proper wound dressing later.

As my mom have a trach tube, I do daily dressing change and after that, I would then work on the bedsores. Last time I do not know how to do wound dressing but after doing dressing for her trach daily, I am now used to it.

How I do dressing for my mom’s sore at her back:

1. Remove the bandage on bedsore
I would remove the bandage (if the wound does not bleed, I use gauze and stick it with 3M micropore tape).

Tip on removing bandages– when the tape sticks to the skin- it is painful for them to remove. How to remove it easier is to use a cotton ball wet with saline water and then rub it against the tape. With water it would cause the stickiness to reduce and easy to be removed.  For the real sticky ones, use vaseline cream. However, if we change it daily, the tape would not get too sticky. If we wait for more than a day, the heat generated from the body would cause the tape to kind of infused with the skin so it gets painful to be removed.

2. Gently clean the wound with first saline solution (NSS solution) using a cotton swab, then Betadine (Povidone-iodine- antiseptic solution).

Important: When cleaning any wound, move the swab from inside to outside and after that discard it. Do not move the swab from outside to the wound as it would introduce infection into the body. When nurses do wound dressing, they just use the swab once then throw, and then use a new one.

Then I would put the sterile gauze on the wound and secure it with 3M micropore tape. For my mom, I use 3 pieces of gauze as I find it provides sufficient cushioning for her bedsore. If the wound bleeds like more, then I would use a wound dressing plaster to stick on the wound to prevent bleeding.

I use a disposable sterile dressing kit which would be disposed off each time after use….. As mentioned I use the same kit for first clean and change her trach tube dressing, then put in sterile gauze around her throat area. ….. after that I would use it for her bedsore wound dressing.

Do note if the wound starts to develop pus, gets bigger, or smells, please take them to the hospital as it is sign of infection on the wound that could be detrimental.

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