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Bedsores, also known as pressure ulcers, inflict pain to a person's skin and range from an annoyance to a condition that escalates and brings great harm to the body. People can take multiple measures to enhance bedsore prevention.
About one in ten patients who reside in nursing centers have bedsores which are very common when people are immobile for too long without moving.
Pressure sores form when pressure is applied to the skin for too long, restricting blood flow and nutrients, eventually killing tissue or leaving it at risk of infection.A High Risk for Developing Pressure Wounds
Typically, people at higher risk of developing pressure ulcers include those who are:
- Elderly with poor circulation
- Immobility challenged and always on a bed or wheelchair
- Lacking hydration and nutrition
- Experiencing disrupted blood flow such as diabetes
- Experiencing neurological disorders
Living with spinal cord injuries decreases one's sense of feeling, leading to the unawareness of pressure and bedsores. In addition, being confined to a bed or wheelchair for long is a challenge for patients with spinal injuries.
Bowel movement or bladder incontinence can also increase the risk of pressure ulcers.The Most Common Form of Pressure Sores
The most common type of bedsore is called a "decubitus ulcer." Decubitus ulcers (pressure ulcers) frequently develop on the tailbone, shoulder blades, and hip areas.
People with paralysis or stroke can also develop "tissue crush injuries" when one remains in the same position for long periods without moving, especially on a bed, which cuts off circulation to various areas.
When bedsores happen, the affected skin area may appear red and moist. Pressure sores can also be gray, white, or yellow, depending on their severity, location on the body, and duration since they appeared.
People with hydration issues usually have dry skin, while inflamed skin is often an indicator of infection, likely caused by rupturing bedsore.
Pressure sores are typically classified on different scales according to their severity which includes:
- Stage I: In the initial stage of bedsore development, red or pink skin appears with slight swelling, bruising, or discomfort that may be present without any open areas of skin.
- Stage II: As the bedsore stage progresses, the skin is intact but becomes thin and dry, accompanied by tissue damage and discoloration. Open areas may appear in the skin and can be painful when touched.
- Stage III: The condition of the bedsore is crucial now that the skin is open with dark red or purplish hue due to blood loss. The bedsore is not usually accompanied by pain because of the dead tissue, but blistering may occur in some cases.
- Stage IV: The open bedsore wound or ulcer presents an increased risk of infection and may appear charred, blackened, or heavily damaged. Extensive care is required when the pressure sores become open and exposed to outside environments.
- Unstageable: Typically, an unstageable pressure wound involves an open pressure sore containing debris, necrotic tissue, or other organic material that blocks the doctor's view to identify the extent of the injury.
Before preventing bedsores, people must understand what causes the condition to manifest in the first place. For example, the primary cause of pressure ulcers is applying extreme pressure on the skin, restricting blood flow and nutrients.
The three primary factors that result in bedsore include:
- Pressure: The applied pressure blocks the blood flow and other nutrients to the skin, resulting in the weakness and death of skin and nearby tissues.
- Shear: When two contacting surfaces move in opposite directions; for example, shear occurs when a patient is on a bed. Shear wears down the skin and leaves it vulnerable.
- Friction: A surface rubbing against another one leads to friction, for example, when on the bed. As with shear, friction weakens the skin and leaves it susceptible to pressure ulcers and other conditions.
The risk factors for pressure sores generally involve the patient's lack of mobility or change of position, which increases the instances of pressure, shear, and friction on the skin.
Risk factors for pressure sores include:
- Age: Older adults are more prone to bedsores because their skin is thinner and less elastic than younger adults, so it cannot withstand the applied pressure.
- Poor circulation: People with circulation problems have an increased risk of developing bedsores because the blood is restricted when pressure is applied to the area.
- Immobility: For example, a patient confined to a wheelchair or bed cannot move because of poor health, paralysis, spinal cord injury, or other conditions that limit movement and could develop pressure sores.
- Lack of hydration and nutrition: Routine nutrients and hydration keep the skin healthy and strong.
- 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 skin pressure that develops bed sores.
The nursing staff keeps the patient's skin dry, ensuring that any bowel movement or incontinence is taken care of immediately when the resident is stationary in a bed or wheelchair.Managing Bed Sores
Use pillows aligned to support the head, back, and buttocks when on a bed or wheelchair. Ensure that your family member is positioned at a 90-degree angle or slightly higher when sleeping or lying down.
Ensure that they are also placed in an elevated position with pillows beneath the shoulders, hips, and knees when sitting upright in chairs on beds or wheelchairs.
Maintain the blood circulation in your loved one's legs by moving their feet around and massaging them at regular intervals. In addition, ensure that they wear socks to keep their feet warm during the winter months.
Ensure that your family member is wearing clothes made of non-irritating materials.
Monitor the patient's feet for blood circulation every two hours to avoid the development of bedsores. If you see redness or discoloration, there is a high risk that bedsores may develop if left untreated.
If your family member has diabetes, they should be regularly checked for foot injuries and infections to prevent pressure sores from developing.
When your loved one is in the shower, ensure they remain seated and do not attempt standing up unless they can do so by themselves without assistance.Alzheimer's, Dementia and Developing a Pressure Ulcer
If your family member has Alzheimer's disease or another type of dementia that makes them more likely to try and stand independently, install a safety bar in the shower or a barrier on the bed.
Contact your loved one's physician in case of an injury or open wound to prevent bedsores from developing. Ensure that the physician measures the affected area and indicates a potential risk for emerging bedsores.
If you observe your affected family members trying to get out of beds or wheelchairs, assist them quickly to avoid developing bedsores.
If your loved one is at risk for pressure sores, ensure that the nursing staff updates the content of their medical records and indicates that this may happen if they do not follow specific protocols. This way, the nursing team will know what to do if the nursing resident develops bedsores while under their care.
Implementing these steps can prevent pressure sores in your loved ones while they reside in a nursing center.
In addition, pressure sore lawyers at Nursing Home Law Center at 1-800-926-7565 can assist you if your family member developed bed sores which could have been prevented by following proper medical care protocols like having an appropriate wheelchair.
Our law firm can take legal steps to stop the abuse and neglect immediately and forcefully ensure the nursing resident receives the best care, is relocated to another facility, or is hospitalized to ensure their health and well-being.Prevention of Bedsores
The primary method for preventing the development of pressure sores is changing positions and using specialized beds. However, this method is not an option for every patient, particularly those who lack mobility. Instead, caregivers can prevent pressure ulcers through measures such as:
- Repositioning: People can prevent most cases of bedsores if they move from time to time. Occasional motion stops pressure from building up in skin surfaces and affecting the blood flow. Doctors, nurses, and care professionals should move immobile seniors at least every two hours.
- Supportive surfaces: The use of 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 the mattress. These surfaces are ideal for individuals who cannot move.
- Nutrition: A healthy intake of water and nutrients enriches the skin and other tissues in the body. Reinforced, healthy skin is less vulnerable to pressure and other factors that could weaken it.
- Skin Care: The nursing staff keeps the resident's skin clean, hydrated, and well-nourished. Washing the skin with soap and water removes dead cells that increase vulnerability to pressure ulcers.
- Assist with toileting: Be proactive in changing the patient's position to avoid pressure on any part of the body long enough to cause bedsores.
The primary method for preventing bedsores is changing positions frequently. However, this method is not an option for every patient, particularly those who lack mobility in their lower limbs and cannot change positions independently.The Importance of Skincare
Skincare is of the utmost importance and ensuring that an aging person does not develop a pressure wound while staying at a nursing center or assisted living facility.
Proper skin care habits can maintain the skin and prevent risk factors for pressure ulcers. Some practices of skincare include:
- Inspecting the skin daily for any signs of bedsores
- Protecting the skin from sores through the application of talcum powder and lotion to vulnerable areas
- Cleaning and drying the skin regularly to prevent dangerous agents such as urine, moisture, and stool from sitting on the skin resulting in sores
Minor management steps people can take to prevent the formation of bedsores are:
- Checking on early-stage bedsores manifest as red spots on the skin that stay red when pinched
- Keeping an eye on pressure ulcer "hot spots," such as the buttocks and the heels
- Taking preventive measures even without a diagnosed pressure sore
- Follow protocols to prevent malnutrition and dehydration or other serious complication that can lead to sores
Pressure ulcers bring notable amounts of suffering to individuals and can escalate to deadly infections. However, by taking simple measures that prevent vulnerable skin, people can avoid developing a pressure sore and the problems they bring.How Do Hospitals Prevent Pressure Ulcers, and Why Don't Nursing Homes Use the Same Protocols?
Data reveals that hospitals have significantly fewer pressure ulcer events among elderly, immobile, and disabled people than nursing home residents. Statistically, hospitals have a rate of 5%, while nursing facilities have a 38% occurrence.
What are the differences between hospitals and nursing centers that cause this difference? The answer lies in the protocol for preventing pressure ulcers.
Hospitals take precautions to guard bedsores among their patients by frequently rotating their positions or changing them on special air mattresses in specialized beds to prevent bedsores.
The following are simple steps for a hospital to prevent bedsores from occurring:
- Initiate hourly turning of patients who have immobility issues.
- Inspect patients daily for any signs of pressure ulcers or other factors that cause wounds, such as infections or blood sugar irregularities.
Hospitals ensure that the patient has accurate health information in the plan of care that the nursing staff strictly follows to reduce problems with their diet, mobility issues, and overall quality of life, which can cause sores.
On the other hand, nursing homes and assisted living facilities do little to ensure that their patients get enough movement or attention from staff members who can monitor them regularly for any signs of a pressure ulcer. In addition, residents in nursing centers get less frequent opportunities to move around than hospital patients do.
Many nursing homes fail to implement the same established protocols in their residents' care. The American Health Care Association recommends that nursing facilities use the same protocols as hospitals when caring for immobile and vulnerable residents to ensure they do not develop bedsores.Warning Signs of Skin Breakdown in Elderly Loved Ones
A patient's skin is often the first indicator that something is wrong. By knowing what to look for during a regularly scheduled visit, you can help protect your family member from further injury.
There are several warning signs of skin breakdown in elderly nursing home residents. In some cases, it is not easy to detect these signs because they may not manifest suddenly and require immediate action. Keep the following in mind:
- Skin color changes: it can become pale, blotchy, or dark because of blood clotting under the skin's surface. Check the feet' soles for dark discolorations typically caused by blood pooling there because of poor circulation. Even slight changes to normal pigment can indicate a more significant problem.
- Bruising and swelling can be caused by injury or other underlying conditions, such as blood clots. The area around the bruise will feel firm to the touch and warm to the skin. Blood supply may also be slower in that part of the body due to decreased circulation, causing skin tissue above the clot to die.
- Small, red dots on the skin are caused by broken capillaries from poor circulation or aging. These "spider veins" do not burst and require no treatment, but a doctor or other healthcare provider should still check them to ensure that nothing more serious is causing them.
A pressure sore commonly develops at the following sites:
- The skin over any bony prominence that presses into a mattress, such as ankles and heels. If you notice reddened or bruised skin with no history of injury, it may indicate an area of pressure sore development.
- The tailbone, especially if the patient has to sit for extended periods.
- The skin under an immobile patient's back can be difficult to monitor because the patient cannot feel any pain in this area and is not easily seen when lying down. Unfortunately, this is a common site for bedsores among nursing home residents who have paralysis or other temporary or permanent loss of sensation.
- The skin over the shoulder blades, especially if the patient has to remain stationary for extended periods restricting blood supply. These are common body areas for pressure sore development among patients with paraplegia or quadriplegia.
According to the Pressure Ulcer Advisory Panel and the American College of Physicians, skin irritation and the lack of barrier cream contribute to the degrading skin integrity and other health conditions.
The presence of skin tears, erythema, or open wounds that are stages 1–3 of the Braden Scale can help diagnose weakened skin integrity.
Skin tears are usually defined as recent breaks in the continuity of the epidermis resulting in blood leakage under the dressing. In contrast, Stage I is characterized by non-blanchable erythema in pressure areas with or without tissue damage.Surgical Debridement and Other Treatments for Bedsores
In advanced stages, pressure injuries (decubitus ulcers) are typically diagnosed due to the necrotic tissue where the wound has become blackened, exposing muscle, bone, and tendons below.
Typically, the surgeon will perform debridement of the dead tissue at this stage, creating a healthier environment more conducive to healing. However, debriding (surgically removing) dead tissue on the elderly does not always produce the desired outcome due to their age, comorbidities, or other health problems that could minimize the healing process.
Typically, Stage IV (life-threatening) bedsores should be treated only by an advanced medical team specializing in pressure sore care. These doctors and nurses have dedicated their entire careers to understanding the science of wound care and how best to treat those wounds.
In the event of non-life-threatening bedsores, as is most often the situation with elderly nursing home residents, a podiatrist, specialized caregiver, or another medical professional familiar with pressure sore care can provide treatment.
However, in severe cases involving untreated Stage II or Stage III ulcers, the health care provider might use sterile products, including barrier creams, for regular dressing changes and other treatments to avoid infection.
Ask their doctor for tips on how often these vital dressings are changed for patients who are not unconscious and can understand verbal instructions. This frequency will be dependent upon the wound's stage and whether there is any drainage involved. Contact a doctor immediately if you notice a strong odor, redness spreading from the wound, or increased swelling around it.
For nursing home residents who cannot understand verbal instructions, change their dressings at least once a day to remove any drainage and keep the skin clean and dry. Consult a doctor if you notice a strong odor, redness spreading from the wound, or increased swelling around it.
There are also topical treatments that can be applied to the skin surrounding pressure wounds to reduce pain and promote faster healing. These include silver-based or zinc-based wound dressings designed to reduce odor, promote faster healing times, and prevent infection in wounds with necrotic tissue.Hiring a Nursing Home Neglect Attorney to Resolve Your Compensation Case
Were you or a loved one diagnosed with preventable severe bedsores caused by the nursing staff not following pressure wound care protocols?
Did you lose a loved one through a preventable death after suffering a horrific life-threatening decubitus ulcer?
At the Nursing Home Law Center, our affiliated elderly abuse attorneys can help you pursue justice and seek the financial compensation your family deserves.
Call our law office at (800) 926-7565 (toll-free phone number) or use the contact form today to schedule a free case evaluation.
All confidential or sensitive information you share with our legal team remains private through an attorney-client relationship.Resources: Bedsore Prevention