Prolonged pressure on the body that causes damage to the skin and underlying tissues is called a bedsore, pressure ulcer, decubitus ulcer or pressure sore. These ulcers tend to occur most frequently over bony prominences, such as the hips, heels, ankles, spine, elbows, shoulders, the back of the head or on the buttocks. The prolonged pressure typically occurs to people with medical conditions that keep them wheelchair bound or confined to bed. Complications from pressure sores cause 34,319 deaths annually, and seven percent of people die as a result of infections.
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These skin lesions are also caused by friction, humidity, temperature, medications, incontinence, shearing forces or unrelieved pressure on bony prominences. Decubitus ulcers can be life threatening as they are open wounds that can become infected. This is more common in nursing homes than hospitals.
Caregivers should be alert to early warning signs of pressure sores. The signs include skin redness, warmer areas, hard or spongy skin and erosion of the top layers of skin. Pressure sores are graded as to the degree of their severity.
The four stages of bedsores include:
Stage 1 -The skin is still intact, but is may appear reddened, painful, extra firm or soft and warmer or cooler than the surrounding skin. The skin does not blanch when touched.
State 2 – There is an open wound, and the outer skin layer is damaged or lost, plus the underlying tissue is damaged. Sometimes the wound may seem to be a ruptured fluid-filled blister.
Stage 3 – This is a deep wound with the loss of skin that typically exposes some fat. It has a crater appearance, and may have dead, yellowish tissue at the base of the wound.
Stage 4 – This ulcer is larger in scale with more tissue loss, and it may expose bone, tissue and tendons. At the bottom of the wound there is usually slough or dark, crusty dead tissue (eschar). The damage is greater and extends well beyond the primary wound below layers of healthy skin
Elderly people are certainly at high risk as their skin is thinner and they do not often eat very well. Malnutrition is one cause of pressure sores.
There are several medical conditions that contribute to decubitus ulcers. Vascular disease, diabetes, contracted joints, spastic paralysis, paralysis and any repeated trauma from shear forces or friction. Incontinence, whether urinary or fecal, will cause the skin to break down if the patient does not receive quality nursing care. Anyone that is bed bound is more likely to develop bedsores, especially if they are not mentally aware of their surroundings. Sedation and severe injuries are also a problem.
Many health care facilities use some scale, like the Braden Scale, to determine a patient's risk for developing bed sores. This scale was developed to assess six areas to measure the functional capabilities of the patient. Preventing decubitus ulcers is dependent on identifying risks.
These six subcategories include:
- Sensory perception
- Friction and shear
A thorough visual examination will also help determine a patient at risk. Assessing the patient's state of health, their mobility, posture, mental state, incontinence, skin integrity, nutrition, any vascular problems and a history of pressure ulcers each help determine the likelihood of a patient developing a new bedsore.
Bedsores are a preventable problem. There are several prophylactic measures that help, such as using a soft cloth for bathing while scrubbing gently. Use a moisturizing cream for the skin. Thoroughly dry the patient after a bath, particularly in the groin area and under the breasts. Bathing daily will dry out the skin, so as long as the patient has not soiled themselves limit some bathing days.
Make sure clothing is not too tight, and avoid clothing with thick buttons, seams and zippers that press on the skin. Try to keep the clothing from bunching up and causing pressure on the body. If the patient urinates or has a bowel movement, they should be cleaned up as soon as possible.
A patient that is unable to turn themselves should be repositioned every two hours. A patient in a wheel chair needs their weight shifted every 15 to 20 minutes. If the patient is unable to participate in physical therapy, then range of motion (ROM) exercises should be done daily. Special pillows, cushions and gel pads can be effectively used to take the pressure off those areas that are in danger of getting a pressure sore.
If a patient develops a pressure sore, they need to be evaluated and treated by a doctor.
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