How is “Tissue Tolerance” Related to Prevention of Bed Sores?

By Nursing Home Law Center

A pressure ulcer is an unfortunately common occurrence in a nursing home setting. It can arise from a failure to properly turn a patient or change bedding.

Bed sores are painful and often occur through nursing home negligence. Pressure under the skin – namely caused by the bony prominences of the body – can restrict blood flow to different parts of the body and cause tissue damage and death.

Pressure ulcers are most likely to occur in the areas where prominent bones create additional friction and pressure on the surrounding structures – hips, heels, shoulders, tailbones, and ankles are particularly vulnerable to injury.

Blood is responsible for delivering oxygen and other nutrients throughout the body. When pressure restricts the delivery of nutrients, tissue can die quickly. The rate of this cell death depends on several factors, including a patient’s overall health and tissue tolerance.

What is Tissue Tolerance?

Tissue tolerance, as the name implies, is each patient’s unique ability to withstand pressure and prevent the development of a bed sore. A number of factors affect a person’s tissue tolerance, and providers break them into two broad categories:

• Extrinsic, or primary factors, are directly related to the management of the patient.
• Intrinsic, or secondary factors, include some factors outside of a provider’s control.

Extrinsic Factors

In some cases, providers can directly improve a patient’s tissue tolerance through appropriate management. To understand how this works, it’s necessary to know the common causes of bed sores:

• Friction. This occurs when a patient’s skin rubs against his or her bedsheets or clothing.
• Shearing. When two opposite forces interact, shearing occurs. A common example would be an immobile patient sliding down in bed – the body parts move, but the skin over the bony prominence (such as the tailbone) remains in place.
• Pressure. Particularly from lack of movement, pressure is one of the most common causes of bed sores.
• Moisture. Failure to change soiled clothing or bedding can create softer, more fragile tissue prone to bed sores.

Providers can directly affect a patient’s tissue tolerance by paying proper attention to extrinsic factors – for example, by making sure bedding is tight and clean, regularly changing patient clothing, turning immobile patients often, and ensuring that the bedding around an elevated patient is tight to prevent shearing.

Intrinsic Factors

Knowing the other factors that might affect a patient’s tissue tolerance is also essential to the prevention of bedsores. Intrinsic factors include:

• Demographics, like people over the age of 65, Caucasians, males, and patients with chronic diseases, are an indication of lower tissue tolerance.
• Poor nutrition can make the skin more fragile, specifically due to the lack of certain nutrients such as vitamin C and zinc. Low protein levels can also hinder skin healing.
• Poor oxygen delivery to the tissues can result in a lower tissue tolerance. Examples include chronic illnesses such as diabetes, a history of smoking, or other vascular diseases.
• Chronic diseases such as renal failure, cancer, and diabetes mellitus put people at higher risk for developing pressure ulcers.
• Pain, or a person’s perception of pain, can hinder his or her ability to move, and some sensory issues, like that of a spinal cord injury, can prevent a person from feeling pain and reporting symptoms.

By knowing the unique risk factors that affect overall tissue tolerance, providers can take preventive actions that can keep bed sores from occurring in the first place, including:

• A quality nutrition plan, supplementing with medication when necessary
• Effective management of chronic medical conditions
• Treatment for pain, leading to increased ambulation when possible
• Encouraging oxygen delivery to the muscles through movement

Systemic identification and treatment of the conditions and risk factors that affect tissue tolerance can help prevent bed sores.

Related Information

• What is a ‘deep tissue’ injury?
• Scientific Approach Used to Eliminate Development of Decubitus Ulcers
• Proper Wound Care for a Bedsore