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Bed Sore Causes
Bedsores, also referred to as pressure sores, pressure ulcers, or decubitus ulcers, are damaged skin caused by a lack of proper blood flow to the skin because of pressure.
The pressure sore can occur in individuals at any age when bedridden, in a chair or wheelchair without the ability to reposition themselves.
The sore occurs from even minimal pressure on the skin when in contact with a bed, chair, wheelchair, splint, cast, or hard object such as a poorly fitting prosthetic (artificial device).
These decubitus ulcers usually appear over a bony prominence like the elbows, ankles, heels, tailbone, or hip bones. However, an ulcer can occur anywhere in the skin.
Bedsores can develop while hospitalized for a different medical condition, in a nursing home or an assisted living facility. Even a little decubitus wound can lengthen the stay in a medical facility until appropriate treatment is completed.
Bedsores are often life-threatening when left unattended, improperly managed, or caused by an underlying condition that minimizes their potential to heal.Common Reasons Medical Facility Patients Develop Pressure Ulcers
Various contributing factors cause decubitus sores, including:
- Pressure – Any pressure from an object, including a bed or chair, can reduce blood flow to the skin, especially over bony areas. When the blood flow is restricted for even a few hours, the skin can die, starting at the outer layers (epidermis). Next, a breakdown of the dead skin can lead to an ulcer (open sore). Healthy individuals usually do not develop bedsores. Most of us reposition our bodies without thinking, even while asleep.
- Traction – Any sheer force can restrict blood flow to the individual skin. Sheer force traction tends to stretch the skin, like when individuals incline or are propped up in bed. Forces of gravity naturally draw down tissue and muscle under the skin. However, the bed, chair, or other object's outer surfaces hold the skin's top layers in place, creating pressure and eventually a developing decubitus sore.
- Friction – Repeated friction by continuously rubbing against bedding or clothing can develop or worsen existing pressure sores. Over time, friction can wear off the skin's top layers, such as repeatedly being pulled across bed linens during repositioning.
- Moisture – Older individuals and healing patients can suffer bedsores caused by excessive moisture that weakens or damages the skin's outer protective layer. For example, any skin with extended contact with urine, feces, or sweat can easily break down, causing a pressure ulcer.
- Malnutrition – Dehydration, and malnutrition tend to increase the potential of developing a decubitus ulcer. Also, the lack of proper nutrition can slow down the healing process. Undernourished individuals often lack sufficient body fat necessary for cushioning muscles and tissue, particularly when deficient in zinc, vitamin C, and protein.
Even though many pressure ulcers cause significant itching and pain, when senses are dulled, the patient may experience no painful symptoms at all. A bedsore is categorized by how severe the damage is to the soft tissue.
According to the National Pressure Ulcer Advisory Panel, a decubitus ulcer can progress quickly to severe stages in many incidences, with the first noticeable signs appearing in stage III or IV.
- Stage I – Pinkish or reddish unbroken skin, sometimes challenging to see on darker-skinned individuals. Often, the sore is firmer, cooler, softer, warmer, or tender than skin in the nearby area. No ulcer is present.
- Stage II – Noticeable shallow skin loss, which could include blisters, abrasions, or both. The pressure ulcer is typically shallow in appearance with a red to pink base.
- Stage III – The decubitus ulcer's skin is worn away, sometimes into the deep layers of fat without exposing bones or underlying muscle.
- Stage IV – The skin has worn away, exposing underlying bones, tendons, and muscles.
- Non-Stageable – When the decubitus ulcer is covered with eschar (a crusty, thick surface) or debris, it sometimes cannot be appropriately staged through assessment.
- Deep Tissue Injury – Maroon or purple unbroken skin area that feels cool, warm, mushy, or firm than the surrounding area.
Usually, individuals who cannot move around have a more significant potential to develop bedsores when restrained, sedated, very weak, unconscious, or paralyzed.Pressure Ulcers and Squamous Cell Carcinoma
A study released by the National Institute of Health revealed a correlation between long-term bedsores and squamous cell carcinoma caused by chronic inflammation from recurring decubitus wounds.
The research revealed a potential risk of developing Marjolin's ulcers from recently degenerated or traumatized skin. The development of cancer usually results from substandard chronic wound care management.Most Commonly Asked Pressure Sores FAQs
Pressure sores develop when continuous pressure applied to the skin surface in one area restricts blood flow. Alleviating the pressure is the quickest way to get rid of bedsores. Immediately afterward, keep the injury clean and dry.
A wound care specialist will likely prescribe antibiotics in the presence of an infection at the wound site and utilize effective strategies like pressure-alleviating foam pads and pillows.
A surgeon may perform debridement in extreme cases when necrotic (dead) tissue is surgically removed, allowing new tissue to grow.
The wound should be regularly dressed with medicated gauze as an effective barrier against the risk of infection. The patient's nutritional needs must be met, including consuming vitamin C-ridge vegetables and fruit to promote rapid healing.
Sitting in the same position without movement for ninety minutes or more restricts blood flow to the buttocks and back of the legs. Not alleviating the pressure in time could result in skin damage and nerve damage from oxygen-depleted skin.
While anyone can develop decubitus wounds, the elderly, immobile, and those confined to wheelchair or bed for long periods are most at risk of developing skin injuries.
Stage IV is the most advanced form of a skin wound where the skin has ulcerated exposing the tissue’s deeper layers, muscle, tendons, ligaments, and bone. While it might take a few months to a couple of years to heal completely, a Stage 4 bedsore can develop as quickly as a few hours without intervention.
The medical team has many opportunities to stop a decubitus wound from the grating to its life-threatening stage (Stage 4). Initially, the decubitus wound will appear as a reddened area that might feel warm or cooled to the touch.
If allowed to degrade, a Stage I pressure wound with develop a small crater where the skin integrity is severely compromised. Within hours without treatment or alleviating the pressure to the affected area, the small crater can grow larger and open to expose the deeper layers of skin tissue.
According to the Pressure Ulcer Advisory Panel, a decubitus ulcer in its most advanced age might be filled with necrotic skin with the presence of an infection that, when cleared away, exposed bone, muscle, and the tissue’s deeper layers.
According to the Mayo Clinic, the initial signs of a developing skin sore are apparent to nearly anyone where the affected areas appear dark, discolored or redden. African-American skin often appears shiny, bluish, or purple in the initial stages of a developing decubitus sore.
Typically, the area appears warmer cooled to the touch. The wound care team knows that even a tiny portion of damaged skin could signify a more significant problem if blood flow does not reappear in the area after alleviating pressure.
The prognosis of a developing decubitus wound found early and treated immediately is good. According to the Centers for Medicare and Medicaid Services (CMS), every skin wound can be prevented when protocols and procedures are followed.
Pressure sore treatments provided by a competent health care provider can minimize skin damage and diminish the risk of creating a life-threatening condition. A Stage I (initial stage) bedsore can heal entirely within a few days.
A Stage II pressure wound (progressing sore) could heal entirely within three days to three weeks. Some Stage III decubitus wounds are significantly more challenging and could take months or up to a year or more to heal.
The most advanced stage (Stage IV) decubitus ulcers might take many years to heal, if possible. At this stage, the wound has grown open significantly, exposing bone and muscle.
Unstageable pressure sores are typically filled with necrotic skin and other debris that must be removed before a wound care specialist can accurately diagnose the extent of the damage in the treatment required for healing.
Many adult nursing home residents are at risk for developing decubitus ulcers and bedsores, especially those with vascular disease, blood circulation problems, infection, or other health conditions.
However, with proper care and skin management by a competent doctor, bedsores are almost always preventable.
A lack of treatment could allow the pressure sore to decline, resulting in tissue death, nerve damage, risk of infection, and other symptoms in the affected areas.Treating Pressure Ulcers
The Mayo Clinic recommends treating a bedsore or decubitus ulcers by initially reducing pressure on the affected areas.
Next, the wound care specialists should control the patient's pain, initiate wound care, maintain good nutrition, and prevent infection.
A daily full-body assessment should be completed to assess the skin for additional wounds.
Treatment should also include repositioning, ensuring that the patient's position is changed and turned at least once every ninety minutes.
The healthcare provider, primary care physician, nurse, medical assistance, or others should keep the skin clean and dry.
The American College of Physicians and Mayo Clinic recommends every health care provider treating bedsores use hydrocolloid and foam dressing to reduce the pressure wound's size.
The use of support surfaces, foam pads, supportive pillows, and dressings concomitantly with protein supplementation can optimize wound healing.
Treatment might also include debridement, where necrotic (dead) tissue is removed through a surgical procedure (cutting away) or water irrigation that gently flushes out tissue damage in an open decubitus sore.Diagnosing Decubitus Pressure Ulcers
Typically, doctors diagnose pressure wounds through a comprehensive examination and full-body skin assessment to identify any restricted blood supply areas.
The physician will also assess the patient's medical health information, nutritional status, general health, and mobility problems.
Other contributing factors, including psychological conditions, loss of consciousness, spinal cord injury, and previous bedsore damage, are also assessed.
The doctor will likely order a routine blood test to assess high blood sugar levels in people with diabetes, the presence of infection, high blood cholesterol, and any indicators of severe blood poisoning, including delirium, sweating, rigors, elevated white blood cell count, and fevers.
Diagnosticians can also use the Braden scale (ranging between 1 and 23) to determine every factor of pressure ulcers except shear and friction.
The Braden scale identifies:
- The skin's moisture levels
- The skin's sensation and sensory parameters
- The patient's activity levels
- The patient's mobility abilities to control or reposition body position and posture
- A nutritional assessment
- Assessment of the affected skin to determine shearing forces and friction forces
Patients and score 18 or less on the Braden scale are diagnosed with having a heightened risk of developing decubitus sores. Patients scoring between nineteen and twenty-three are considered at average risk of developing pressure injuries.Inferior Care Can Cause Pressure Ulcers. Get Help Now
Were you or a loved one injured from a pressure sore while under the treatment and care of a hospital, healthcare provider, doctor, nursing home, or assisted living facility?
You can likely seek financial recovery for your damages.
Call Nursing Home Law Center LLC (800) 926-7565 for a free initial consultation to speak with an experienced attorney concerning your claim.
Our decubitus ulcer injury attorneys have helped hundreds of families from across the United States recover maximum compensation for injury caused by bed sore acquired at medical facilities and care centers. Let us help you.