Bed Sores and Pressure Ulcers
Pressure ulcers, also knows as bed sores, pressure sores and decubitus ulcers, can almost always be prevented or successfully treated.
Pressure ulcers, also knows as bed sores, pressure sores and decubitus ulcers, can almost always be prevented or successfully treated. It is important that an at-risk resident be maintained with proper hydration and nutrition. A resident confined to (or allowed to remain in) a bed or wheelchair who cannot be relied upon to turn or reposition themselves must be turned or repositioned by staff every two hours. Pressure relieving mattresses and special mattresses that automatically reposition the resident every two hours are also used.
Many medical articles have identified those most at risk for the development of pressure ulcers. These include elderly persons, the chronically ill, the immobile, the weak or debilitated, residents with altered mental status and residents who are incontinent.
Pressure ulcers are generally preventable and avoidable. The basic treatment of decubitus ulcers is prevention. Prevention requires adequate numbers of skilled staff ensuring proper pressure relieving devices are utilized, proper nutrition and hydration is maintained and that the resident remain clean. The most important factor in the development of pressure sores in unrelieved pressure. Friction (skin against sheets) is another known cause. Wheelchair bound residents must be trained in proper repositioning techniques. Additionally frequent thorough assessment must occur. The Braden and Norton scales are two commonly utilized assessment protocols.
Pressure ulcers are generally classified in four stages.
- Stage I represents intact skin with signs of impending ulceration.
- Stage II represents a partial-thickness loss of skin. This lesion may present as an abrasion, blister, or superficial ulceration.
- Stage III represents a full-thickness loss of skin with extension into tissue beneath the skin. This lesion presents as a crater with or without undermining of adjacent tissue.
- Stage IV represents full-thickness loss of skin and subcutaneous tissue and extension into muscle, bone, tendon, or joint capsule. Sinus tracts and severe undermining commonly are present. A bedsore can, without proper intervention proceed from State I to Stage IV.
A pressure ulcer must be kept clean. Surgical debridement is often necessary. This involves removing the necrotic (dead) tissue. In severe pressure ulcer cases, reconstructive surgery may be necessary.
If a pressure ulcer is not resolved through appropriate treatment it may continue to grow. At a certain point infection will set in and amputation may be required. If advanced sepsis develops amputation may not be sufficient and a resident will die.
