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Bedsores, often referred to as pressure ulcers, are injuries or wounds involving damage to the skin and underlying soft tissue due to prolonged pressure applied to the skin. These wounds, common among nursing home residents, can develop quickly and be difficult to treat. Nursing home residents deserve compassionate, thorough medical care to prevent severe injury.
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Why Do Bed Sores Happen?
Bedsores are most common in areas where the bone protrudes close to the skin, such as the hips, tailbone, ankles and heels. Pressure cuts off blood flow to the affected area, which ultimately results in tissue death and other complications. Most at risk for this medical complication are elderly individuals who have medical problems that prevent them from moving easily, including bedridden patients and those confined to a wheelchair.
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Bedsores are also common among patients who are confined to a bed for medical purposes, including quadriplegics, paraplegics, individuals in a coma, people affected by some form of paralysis and those who are recovering from surgery. The condition is more common in elderly patients, who have thin, fragile and dry skin compared to other people.
In patients confined to a wheelchair, bed sores generally begin on the tailbone, buttocks, shoulder blades, spine or the backs of the arms and legs. For patients who are bedridden, the most common places for a bedsore to appear are on the sides or the back of the head, ears, shoulder blades, heels, ankles, areas behind the knees, the tailbone, lower back or hip.
Manual Repositioning Can Save Lives
Medical experts generally agree that these at-risk patients should be moved at least once every 2 hours to reduce the amount of pressure exerted on their skin, and thus prevent bed sores. In the nursing home setting, staff members should manually reposition patients who cannot move themselves on a regular basis to prevent the formation of bed sores.
If left untreated, bed sores can become infected. Infections can lead to death. It can be difficult to treat bed sores after they become severe, so the emphasis in a nursing home should be to prevent them from developing in the first place. Nursing homes who fail to prevent bed sores from developing may be guilty of neglecting residents. Nursing home neglect is a key cause for filing a private civil lawsuit against the facility.
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The Four Stages Of A Bedsore
As they progress, bedsores go through four distinct stages, becoming more severe as time passes, according to WebMD.
A stage 1 bedsore has not yet broken through the skin. The skin, while intact, will appear reddened. The sore at this point only affects the epidermis, the upper layer of the skin.
If touched, the skin remains red, rather than returning to the normal skin color as usual. This is a sign that pressure is cutting off blood flow to the area, which could lead to tissue death if left unameliorated. Stage 1 bedsores can be painful, soft, warm, firm or cold when compared to normal skin.
The first step in treating a bedsore at any stage is to remove the pressure. This is paramount to allow blood flow to return to the area. The area can also be washed with cool water and mild soap to remove the possibility of germs on the skin.
Moving into stage 2, the epidermis (outer layer of skin) and dermis (second layer of skin) have broken and a shallow wound is forming on the area. The wound is generally red or pinkish in color. It may resemble a ruptured blister, or actually leave a blister that is filled with pus.
The area around the sore will be red, swollen and warm to the touch. Bedsores in stage 2 can be very painful, and may ooze clear pus.
Again, the best treatment for a pressure sore is to remove the pressure. The next step is to clean the wound (it may be tender) with water and dry it gently. Your doctor or a nursing aide can prescribe a painkiller to help with the discomfort of the sore.
In stage 3, the wound has deepened to expose fatty tissue beneath the skin. The pressure ulcer at this point takes on the appearance of a large crater filled by yellowish, dying tissue. The internal tissue may also appear black if it has already died. The sore may smell bad and show signs of infection, including reddened edges, pus and heat.
Treatment at this stage is more difficult. As before, the pressure must be removed from the area immediately. A doctor may also attempt to debride the wound, cutting out the dead tissue so that new tissue can grow in its place. A special mattress that circulates air flow around the wound may be suggested as well.
In stage 4, the sore has extended deep to expose tendons, muscles or bone. The base of the wound, which appears like a crater, is crusty and dark in color since it has died. Bedsores at this stage are extremely serious. There is no doubt at this point that the wound has become infected; it will appear red around the edges, exude pus, a bad odor and heat.
Surgery may be required to correct a stage 4 bedsore. If the infection worsens, the patient may die. While antibiotics should already have been prescribed, antibacterial and antiviral drugs become an absolute necessity at stage 4. The infection, if left untreated, can lead to sepsis, a blood infection that is fatal in many cases.
How Nursing Homes Can Prevent Bedsores
Nursing homes have a legal obligation to provide residents with adequate and prompt medical attention. Since bedsores are common among nursing home residents, especially ones who are confined to a bed or wheelchair, these injuries should be on the nursing home staff’s radar.
Most reputable nursing homes have a set policy for preventing bedsores. In many cases, nursing homes will identify patients who are at-risk of bedsores and take proactive steps to prevent the complication from occurring. It’s a good policy to manually reposition patients who cannot move of their own accord at least once every two hours to reduce the pressure.
Monitoring Patients For Complications
The nursing home should also monitor at-risk patients frequently for the development of bed sores. Some residents, including those with diabetes, live at a higher risk of developing bedsores because they have decreased blood flow to the skin. These patients should be checked for bedsores regularly.
After bedsores develop, efforts can be taken to prevent the condition from worsening. Nursing home staff members can provide the resident with various supportive devices to help, including trapeze bars above the bed to prevent friction while moving around. Cushions should be placed in wheelchairs to ease the pressure against the skin. Some patients require specialized beds.