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The disabled, bedridden, and those in wheelchairs are more likely to develop bedsores (pressure ulcers, pressure injuries, decubitus ulcers) than other nursing home patients. Pressure ulcers can inflict pain on the person's skin and range from annoyance to a life-threatening condition.
Pressure injuries not only cause pain but can quickly lead to infections if left untreated, like endocarditis, cellulitis, and meningitis.
Areas on the body most afflicted with bed sores include the hips, heels, elbows, tailbone, shoulder blades, shoulders, and the back of the head. These areas tend to have only a little fat or muscle, allowing pressure to push skin tissue against bone.
Compromised skin integrity and tissue breakdown can develop in as little as thirty minutes when the individual does not move, restricting blood flow to the skin and underlying tissue, depriving the area of oxygen and nutrients.Causes and Risk Factors
Extreme pressure on skin tissue is the primary cause of decubitus ulcers, restricting the skin's blood flow and nutrients. According to Johns Hopkins Medicine, the three primary factors that result in bedsore include:
- Pressure. The applied pressure restricts blood circulation and other nutrients to the skin, resulting in skin and nearby tissues' weakness and death.
- Shear. When two contacting surfaces move in opposite directions, shear occurs. Shear wears down the skin and leaves it vulnerable.
- Friction. A surface rubbing against another one leads to friction. Just as with shear, friction weakens the skin and leaves it susceptible to bedsores and other conditions, particularly over areas of bone.
The risk factors for bedsores generally involve the patient's lack of mobility or change of position, which increases the instances of shear and friction forces on the skin. Among the risk factors are:
- Immobility. A patient cannot move because of poor health, paralysis, or other conditions that limit movement.
- Lack of hydration and nutrition. A patient needs nutrients to keep the skin healthy and robust.
- Disrupted blood flow. Certain medical conditions such as diabetes affect blood flow, depriving the skin of nutrients and making it vulnerable.
- Lack of sensory perception. Neurological disorders, spinal cord injuries, and other related conditions result in loss of sensation in the patient's unawareness of pain and bedsore development.
The primary method for preventing the development of bedsores is changing position. This method is not an option for every patient, particularly those who lack mobility.
Caregivers can prevent pressure ulcers through measures such as:
- Supportive surfaces
- Effectively managing chronic medical conditions
- Skin Care
People who develop pressure ulcers typically experience intense pain that can escalate to a deadly infection without treatment. Protecting vulnerable skin can help avoid bedsores and the health complications wounds can bring.Repositioning
According to the National Pressure Ulcer Advisory Panel, routinely changing position to alleviate pressure on the skin and underlying tissue is the simplest way to avoid pressure ulcers. Doctors recommend body repositioning at least once every two hours or less.
For example, if the patient has been sitting in the wheelchair for a while, have them stand, move, or adjust their body to a more comfortable position.
Occasional motion stops pressure from building up in skin surfaces and affecting the blood flow. Any person who was unable to move without assistance should have a caregiver or family member help.
Decreasing pressure points and increasing airflow are the main components to preventing bedsores.
If possible, check the patient's skin routinely to look for skin irritation, which might indicate the beginning stage of skin wounds. Re-distributing the weight more evenly can minimize pressure and allow airflow to areas that were previously covered.Supportive Surfaces
Doctors and patient care technicians will often recommend supportive surfaces and extra cushioning under high-pressure point areas on the shoulders, tailbone, back of the legs, and heels to alleviate pressure on the skin.
Supportive services are especially beneficial to less active people with limited mobility that might need assistance and repositioning, whether standing or sitting.
Using supportive surfaces such as additional padding and mattresses reduces the pressure applied to the skin. These dynamic surfaces either alter the air pressure below the surface from time to time or use silicone-coated beads that liquefy by having air pumped through. These surfaces are ideal for people who cannot move.
Supported devices could include foam pads, transfer boards, foam mattresses, and other pressure relieving supported devices to offload pressure on the leg, foot, arm, or hand.Nutrition
A healthy intake of water and nutrients enriches the skin and other tissues in the body. Vibrant, healthy skin is less vulnerable to pressure and other factors that could weaken it.
A well-functioning circulatory system can benefit the patient by delivering the nutrients consumed during healthy meals. Preventing bedsores might require eating a well-balanced, healthy diet rich in proteins, fats, and a few carbohydrates.
However, the dietitian working at the hospital or nursing home must ensure the patient's needs are being met when making meals, especially those with metabolic disorders like diabetes.Effectively Managing Chronic Health Conditions
Any patient experiencing chronic health issues could be at increased risk for developing decubitus ulcers, especially if their health problems involve cardiovascular system issues, poor circulation, and low blood flow.
Preventative treatment the nursing staff must monitor includes fluid intake on patients experiencing heart failure, maintaining dietary restrictions for seniors with kidney disease, and taking preventive measures to avoid medication interactions for those with poor circulatory function.Skin Care
Developing the best skincare habits can prevent the development of pressure ulcers. Many people succumb to developing pressure ulcers when the nursing staff fails to meet their incontinence needs.
A patient lying for hours in urine or bowel movement is exposed to enzymes and assets that can quickly cause skin breakdown, excoriation, and degradation.
Ongoing incontinence and the seniors' limited mobility or challenges to reposition their body weight could cause a developing bed sore on the buttocks, legs, and perineal area.
Some practices of skincare include:
- Inspecting the skin daily for any signs of bedsores,
- Protecting the skin through the application of talcum powder and lotion to vulnerable areas,
- Cleaning and drying the skin regularly prevents dangerous agents such as urine, moisture, and stool from sitting on the skin.
The nursing staff should conduct a comprehensive head-to-toe skin assessment at least every day to identify signs of any newly developing Stage I decubitus wounds. A quick diagnosis followed by an effective treatment can minimize skin damage and allow the wound to heal within one to three days.
Bedsores allowed to progress to a Stage II sore are more challenging to treat. The patient's health care provider will likely recommend pressure-relieving devices, extensive wound care, and the use of an effective barrier creams that avoid any further excoriation caused by exposure to body fluids.
However, even the best barrier cream cannot overcome the need to reposition the body at least once every two hours, keep the patient moving and active to prevent the sore from worsening.Active Exercise
Remaining active in exercising daily is an effective pressure ulcer prevention method. Many nursing home patients are mobility challenged due to a physical or cognitive disability, age, spinal cord injury, heavy medication use, or other health issues.
However, performing even the most effortless range of motion exercises while in a chair, wheelchair or bed can decrease the potential risk of developing decubitus wounds.
Start an exercise program with smaller tasks like lifting, bending, stepping forward and back, or twisting. The patient can lift their arm, move their hands, turn their head, lean forward, if possible, and readjust their body weight in exercise episodes lasting ten seconds or longer.
Encourage the patient to move about to increase airflow, so it hits all parts of the body.Other Preventive Measures
Minor steps people can take to prevent the formation of bedsore are:
- Checking on early-stage bedsores, which manifest as red spots on the skin that stay red when pinched
- Keeping an eye on bedsore "hot spot" areas, such as the shoulder blades, tailbone, buttocks, and the heels
- Taking preventive measures even without bedsores
Pressure ulcers bring notable amounts of pain to seniors and can escalate to deadly infections. By taking simple measures that prevent vulnerable skin, people can avoid bedsores and the problems they bring.Common Pressure Ulcer Injury FAQs
Our attorneys understand the families often have unanswered questions about why their loved one developed decubitus wounds while in a hospital or nursing home. Our law firm answered the most frequently asked questions below, providing needed health information to help a loved one.
If you need additional information, contact us today at (800) 926-7565 (toll-free phone call) or through the contact form to schedule a free consultation to discuss your right to obtain compensation.Can Pressure Ulcers Be Prevented?
According to the American College of Physicians, routinely repositioning
the patient's sitting or lying in bed or a chair can alleviate pressure and prevent tissue damage. Doctors often recommend special mattresses and other devices that alleviate pressure by "offloading" the patient's legs, ankles, heels, arms, and hands in a bed or wheelchair.
Nearly every pressure ulcer is caused by lying or sitting in the same position without movement for an hour or longer. People most at risk of developing decubitus sores include the elderly, obese, spinal cord injury victims, and those with other severe health problems.How Do You Prevent Pressure Sores In Bed?
According to Johns Hopkins Medicine, pressure ulcers develop in bed when the patient moves infrequently or fails to readjust their weight every hour or longer. The lack of movement on a bony area could put immense pressure on skin tissue, restricting blood supply to the wound area and damaging underlying tissue.
If the sword does begin to develop, the patient should keep the clean skin dry, receive wound care when necessary, and use pillows to "offload" pressure by elevating a leg, heel, ankle, arm, or hand off the bed's surface.How Do Nurses Prevent Immobile Patients from Developing Pressure Ulcers?
Nurses provide care and treatment to immobile individuals in hospitals and nursing homes by following care plans and turning and repositioning schedules written out with specific guidelines. If the patient is lying in bed, the nursing staff will reposition the patient every ninety minutes, even during sleeping hours.
The nursing staff will readjust the home's immobile patients' bodies every 30 to 45 minutes when seated in a wheelchair, recliner, or dining chair. The readjustment alleviates pressure, allowing airflow and the flow of blood into the area, preventing bedsores.How Long Does It Take to Heal a Stage 4 Pressure Sore?
A stage III bedsore can degrade to a stage IV decubitus ulcer and take less than a few hours if left untreated or improperly treated. At its final stage, the open wound likely appears with exposed muscles, tendons, and bones deep below the skin surface in the wound bed.
The doctor will likely need to perform a surgical debridement that cuts necrotic (dead) tissue away, creating an environment for healthier cell growth. If the wound has extensive tissue loss, the surgeon may elect to do skin grafting, harvesting sheets of skin from other areas on the legs or arms, or a cadaver donor.
If the open wound becomes infected, the victim could experience life-threatening problems if the infection reaches the blood system (sepsis) or bone tissue (osteomyelitis). Should the patient survive, they could heal entirely from a Stage IV decubitus sore in a few years, if possible.Personal Injury Attorneys Available to Protect Your Loved One from Developing Pressure Ulcers
Doctors, health care providers, caregivers, and nurses must follow established protocols to prevent their patients from developing skin breakdown that could lead to bedsores. Did your family member suffer from a pressure ulcer while under the care of a nursing home, assisted living facility, or hospital?
You likely can file a civil lawsuit seeking compensation for your damages. Call Nursing Home Law Center LLC at (800) 926-7565 to schedule a free initial consultation. Talk with an experienced attorney concerning your claim.
Our attorneys' network has provided legal representation for hundreds of families throughout the United States, recovering hundreds of millions of dollars on their behalf. Let us help your family too.