Pressure Ulcers (Bed Sores)

Pressure Ulcers 1Pressure Ulcers or Sores, more commonly called Bedsores, are injuries to the skin and tissue underneath resulting from an extended period of pressure on the skin. Bedsore most often develops on skin that covers bony areas of the body, such as the heels, Ankles, hips, and tailbone

Those who are most at risk for bedsores are individuals that suffer from medical conditions, which limits mobility. These people typically are not able to change their positions frequently; they may require a wheelchair are confined to a bed for an extended time.

Unfortunately, bedsores can form quite quickly and are often difficult to treat. Several things can help prevent so`me before and help with healing,

Symptoms of Bed Sores

There are four states of bed sores based on their difference. According to the National Pressure Ulcer Advisory Panel, a professional organization that promotes education and prevention, as well as treat for Pressure rules, defines each stage as the following:

Stage I

The first stage and the beginning of a pressure sore have the following characteristics:

The skin is not yet broken
There is some reddish skin color on people with lighter skin color,
The skin does not blanch or lighten when it touched
People with darker skin may have some discoloration; there is not any blanching when the skin is touched
The area may be tender, firm. Soft, warm, cool, or painful compared to the surrounding areas of the skin.

Stage II
The other layer of skin (epidermis ) and part of the underlying layer of skin (dermis ) are damaged or lost.
The wound makes looks like a fluid filled blister or a ruptured blister
The would be pinkish or red and shallow

Stage III
At stage III, the ulcer is a deep wound.

The loss of skin will expose some level of fat
The ulcer from a crater shape hole in the skin
The bottom of the wound has some dead yellowish tissue.
The wound damage may extend beyond the primary wound to layers below healthy skin.

Stage IV
Stage IV ulcer shows significant loss of tissue
The wound may expose bone, tendons or muscles
The bottom of the wound of contains dead tissue that can be dark, hard crusty and yellow
The damaged tissue often extends beyond the primary wound to layers of healthy skin below

Unstageable Pressure Ulcer is considered unstable if the surface is covered with black, brown, yellow or dead tissue. It is not possible to see how deep the wound may be.

Deep Tissue Injury

A deep tissue injury may have the following characteristics:

The skin is purple or maroon, but the skin reposting
A blood-fill blister is present
In people with darks skin, there may be a shiny patch or change in skin tone may develop
The area is warm or cool compared to the surrounding skin
The areas skin is painful, mushy or film-like

Common Site of Pressure Sore (Bed Sores)

People who utilize a wheelchair, pressure sores often occur on the skin over the following areas:

Shoulder blades and spine
Back of legs and arms, where the skin rest against the chair
Buttocks and Tailbone

People who are confined to the bed – common sites include following:

Back of the ears
Hip lower back or tailbone
Back or side of the head
Heels, ankles and skin behind the knees
Shoulder and shoulder blades.

Etiology of pressure sores, eps8When should you see the doctor
You should see the doctor if you see early signs or symptoms of pressure ulcer when you change your position to believe the pressure on the area. If you do not see any improvement in 24-48 hours, you should contact your doctor. There can be signs of infection such a fever fringe, of odor, from the sore, increase heat and redness.

Causes of Bedsores or Pressure Sores

A bedsore is caused by prolonged pressure against the skin, which limits blood flow to the skin and tissues near it. There are other factors that limit the mobility and can put the skin at risk for damage and contribute to the growth of pressure sores. There are three main factors:

Prolonged pressure – when the skin and the tissues beneath are trapped between the surface of a bed or wheelchair and the bone, there is a lot or pressure. It may be greater than the pressure of the blood flowing through the capillaries ( blood vessels) that deliver needed oxygen, and essential nutrients for the skin cells. With the blood vessels unable to deliver this oxygen, the skin tissues and cells will become damaged and possibly die. These pressure sores tend to appear in areas where there is no padding with muscle or fat and lie directly over bone, such as the hip, heels, elbows, spine shoulder blades and tailbones
Friction – Resistance to motions occurs when the skin is dragged across the surface when you change position, or the care provider gives you. The friction can be greater if the skin is moist,
Shear – occurs when two surfaces move in the opposite direction. This can happen when your head is elevated on a bed, and your head naturally slides down the bed or the tailbone moves down the skin over the bone. Essentially there is pulling in the opposite direction, which may cause skin cells and blood vessels to become damaged from sustained pressure,

Risk Factors
People who are in danger of developing pressure sores if they have difficulty moving and are unable to simply change position while seated or in bed. Immobility may be due to:

  1. Paralysis
  2. Sedation
  3. Coma
  4. Recovery after surgery
  5. Injury or Illness that requires bed rest or wheelchair use
  • Pressure Ulcers 3Age – A Person, who is older is likely more fragile, thinner, less elastic. and drier skin, than younger adults. Older adults also produce new skin at a slower rate, which can make the skin valuable to damage.
  • Lack of sensory perception – Individuals with spinal cord injury or neurological disorders and other conditions can result in a loss of sensation. The inability to feel pain or discomfort can result in not being as that one person has bedsores or need to change their position.
  • Weight Loss is common during prolonged illness, muscle atrophy, and wasting for away are common for people with paralysis. The loss of muscle and fat results in less cushioning between the bone and bed or wheelchair.
  • Poor hydration and nutrition- People need enough fluids protein, calories, minerals, vitamins in their daily diet to maintain healthy skin and present the detection of tissues.
    Excessive moisture or dryness – Skin that becomes moist from sweat or lack of bladder control is at higher risk of becoming injured with increase friction between the skin and clothing or bedding. Very dry skin increases friction as well.
  • Bowel incontinence- Bacteria can form from fecal matter and cause serious local infections and lead to life-threatening infections, which can affect the entire body.
  • Medical conditions can affect the blood flow- Health issues that affect the blood flow such as diabetes and vascular disease, increase the risk of tissue damage.
  • Smoking – Smoking can reduce the blood flow and limits the amount of oxygen in the blood. Smokers tend to develop more severe wounds, and wounds will heal slower.
  • Limited alertness – People who do not have a full mental awareness or have the rawness lessened by trauma, medications or disease may be unable to take actions to prevent or care for pressure sores.
    Muscle Spams – People who have a frequent muscle spasm or involuntary muscle movement may have increased the risk of developing pressure sores from frequent friction and shearing.

Pressure Ulcers 4Complications from Bed Sores
Sepsis occurred when bacteria entered bacteria enter the bloodstream through broken skin and spread through the body, Its a rapidly processing, life -threatening condition that can cause organ failure
Cellulitis is an infection of the skin and attached soft tissues. It can cause serious pain, swelling a redness. Individuals with nerve damage often will not feel pain with conditions. Cellulitis can lead to life treating complications.
Bone and joint infections – Infections from a pressure sore can burrow into joints and bones. Joint diseases or aspect this can cause damage to the tissue and cartilage. Bone infection or osteomyelitis can reduce the function limbs and joints. This infection can be life threatening.
Cancer can cause the development of squamous cell carcinoma that develops inc chronic, non-healing wounds (Margolin ulcer) This type of cancer is aggressive and usually requires surgery.

Test and diagnosis

Evaluating Bedsore

  • When the doctor is evaluating the sores by:
  • Determining the size and depth of the ulcers.
  • Check if there is any fluids, debris or bleeding in the wound, that can indicate severe infection
  • Detecting orders that can indicate dead tissue or infections.
  • Check the area around the wound for signs that the tissue damage or infection
  • Check for pressure sore on the body

Questions that the doctor may ask:

  • When dd the pressure sore first appears?
  • Have you had and pressure sore in the past?
  • What type of care assistance is available to you?
  • What medication conditions have you ben diagnosed with and what is your daily treatment?
  • What is your normal daily diet?
  • How much water and other fluids do you consume each day?
  • What is the degree of your pain?

Test
The doctor can order the following test

Blood test to check heat
Tissue cultures to indicate bacterial infection or fungal infection in the wound, to determine what stage the score is in.
Tissue cultures can check for cancerous tissue in a chronic nonhealing wound.

Treatment and Medication

Stage I and II users heal within a few weeks to months with conventional care of the wound and ongoing care Stage III and IV ulcers are more difficult to treat

Reduce Pressure

The first step in treating bedsores is reading the pressure that initiated it in the first place. A few options include the following:

Repositioning: If you have a pressure sore, you will need to be repositioned on a regular basis and placed into the proper position. If you use a wheelchair, you may need to shift your weight every 16 minutes or so. You can ask for help to be repositioned every hour or so. If you are restricted to bed, your position will need to be changed every two hours.

If you have enough strength, you may be able to use as devices such as a trapeze bar to reposition yourself. Caregivers can also use bed linens to help move and lift you to reduce friction and shearing

Using support surfaces

Use a bed mattress and special cushion to help you lie at the right position and relieve pressure on any sores and protect skin. If you are in a wheelchair, use a cushion, style includes foam, air-filled and water-filled. Select one that suits your condition, body type, and mobility.

Cleaning and dressing wounds include the following:

Cleaning is important for keep wounds clean and prevent infection. If the affected skin is not broken ( stage I wound) you should wash it with water and mild soap gently and pat dry. Clean open sores with saltwater or saline, solution each time the dressing is changed.
Applying dressing – A dressing provides healing by keeping a wound moist, creating a barrier against infection and keeping the surrounding skin dry. Dressing choice includes gauzes, films, foams, gels and treated coverings. A combination of dressing may be used.

Your doctor will select a dressing that is best for you based on the seriousness, sizes, amount fo discharge, and ease of removing the frequently include on the sore.

Treatment to Remove Damaged Tissue

For pressure sores to heal properly, the wound needs to be free of damaged, dead or infected tissues. Debridement or removing this tissue can be done through a variety of different methods, depending on how severe the wound is and the overall condition of the patient.
Surgical debridement – involves cutting away dead tissue
Mechanical debridement loosens and removed wound debris. This can be done through low-frequency mist ultrasound or special dressing, which provides pressure irrigation.

Autolytic debridement aids the body’s natural process of breaking down dead tissue through enzymes. The method may be used on a smaller, and untreated wounds and involves special dressing to keep the wound from being moist and clean.
Enzymatic debridement invokes using chemical enzymes and appropriate dressing to break down dead tissue.

Other methods of treatment include the following:

  • Pain management- By taking medications, you may be able to get some pain relief that can often be caused by pressure ulcers. Non-steroidal anti-inflammatory such as ibuprofen (Motrin IB, Advil, others) and naproxen (Aleve, others) โ€” may reduce pain Using these medications may be helpful before and after deposition, debridement operation, and dressing changes. Topical pain medication may also be used during debridement.
  • Antibiotics – Infected pressure sores that are not responding to other methods of intervention and may need to be treated with topical or oral antibiotics.
  • Diet – You should eat healthy foods, consuming increase calories and fluid, high-patient dies and increase vitamins and minerals, specifically vitamin C and zinc.
  • Managing Incontinence – Urinary and bowel incontinence can cause excessive bacteria and moisture on the skin, which increase the risk of infection. Managing incontinence should help improve healing, managing frequent diaper changes, protective locations and health skin, through rectal tubes and urinary catheters.
  • Muscles spasm relief= Spams related to friction or shearing can cause worst bedsores. Muscle relaxants – such as diazepam (Valium), tizanidine (Zanaflex), dantrolene (Dantrium) and baclofen (Gablofen, Lioresal) โ€” may inhibit muscle spasms and help sores heal.
  • Negative pressure therapy ( vacuum-assisted closure, or VAC0 This therapy uses such to clean a wound. It may be contributing to healing some pressure essential.

A pressure sore that does not heal may require surgery. The goal of the surgery includes improving hygiene and appearance of the painful, treating infection or prevention, reducing fluid loss through the wound as well as lowering the risk of cancer.
If you need knee surgery, the procedure depends primarily on the location of the of the wound and whether it has scar tissue from a previous operation. In general, most pressure sores are leporid using a pad of your muscle, skin or other tissue to cover the would and cushion the affected bone. (Flap reconstruction).

Bed Sore Prevention

A bedsore is easier to prevent than to treat. However, it does not mean prevention is easy or simple. Unfortunately, wounds may still develop with consistent, promote preventive care.

Your doctors and other members of the care team can help develop a good strategy its personal care with at-home assistance.

Position changes are necessary for preventing pressure sores. The changes need to be frequent; repositions needs to avoid stress on the skin and decrease pressure on vulnerable areas. Other methods include taking good care of your skin, maintaining good nutrition, exercising daily quitting smoking.

Reposition in a Wheelchair

  • Shift your weight frequently If you use a wheelchair, shifting your weight about every 15 minutes. As for help with reposition
  • Lift yourself -If possible, you have sufficient upper body strength, do wheelchair pushups – elevating your body off the seat by pushing on the arms of the chair.
  • Look into a specialty wheelchair. Other wheelchairs allow you to tilt them; which can relieve pressure.
  • Select a cushion that reduces pressure. Use the cushion to relieve pressure and help ensure your body is well-positioned in the chair. Use the gel; water filled or air filled questions.

Repositioning In the Bed

  • Consider the following recommendation when repositioning in a bed
  • Reposition yourself frequently – Change your body position every tow hours
  • Look into devices to help your Repositioning If you have enough upper body strength try to reposition yourself with a trapeze bar
  • Try a specialized mattress that uses cushions with foam; water filled air filled, mattress to hep with positions, to reduce pressure and protect vulnerable areas.
  • Adjust the elevation of your bed. Your hospital bed can be elevated at the head. However, it should be raised no more than 30 degrees.
  • Use a cushion to protect bony areas. Rather than laying directly on the affected area, lay at an angle with pillows supporting the back or front. You can also use a cushion to relieve pressure on the knees and ankles. You can use a cushion to float you heals.
  • Skin Care is important for preventing pressure sores and identifying Stage I sores earlier to treat them before they become worst

Clean the affected skin gently with made soap and warm water m no rinse cleanser. Pat dry gently
Protect the skin. Use talcum powder to protect skin and risk for excess moisture. Watch for buttons on the clothing and wrinkles in the bedding that irritates the skin.
Inspect the skin daily – identify areas at risk or have early signs of pressure sores. You will probably need the help of a care provider to do a through skin inspection.
Manage incontinence to keep the skin dry -If you have urinary or bowel incontinence, take steps to prevent exposing the skin to moisture and bacteria. You care may frequently include schedule help with urinating, frequent diaper change, protective lotions on healthy skin.

 


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