What Are Bed Sores?

By Nursing Home Law Center

Bed sores may have many different names, including pressure sores or decubitus ulcers. No matter what term a provider uses, they all stand for the same thing – a painful medical condition that is largely preventable with appropriate measures.

A bed sore is an area of the skin that sustains damage as the result of pressure, friction, or shearing. When an area of the skin is under pressure for a sustained period of time, it restricts the blood flow to the area. Since the blood is responsible for delivering oxygen and important nutrients to the tissues, the area begins to die. Over time, a pressure ulcer forms.

Pressure ulcers are most likely to occur in patients that are wheelchair bound or isolated to beds. Unfortunately, pressure ulcers can develop quickly and lead to a number of dangerous or even life-threatening complications. They are most likely to occur over areas of the body with bony prominences, like:

• Heels
• Elbows
• Hips
• Tailbones
• Shoulders
• Ankles
• Back
• Back of the head

Stages of Bed Sores

A bed sore may be minor to start, but it can quickly progress through multiple stages and increase in severity. Providers classify bed sores in four stages:

• A stage 1 ulcer is simply an area of reddened tissue. It does not break the skin, but may be warm to the touch and painful for the patient.
• A stage 2 ulcer breaks the skin and begins to affect the tissue underneath. The area is usually painful and tender. It may look like a shallow crater or an abrasion.
• A stage 3 ulcer affects the under layers of skin and fat. It most often presents as a crater and the underlying tissue structures and fat may be visible.
• A stage 4 ulcer is the most serious and affects the bones, tendons, and ligaments. They may be visible.

In stages 3 and 4, a patient is vulnerable to complications that can be life-threatening. However, a patient may not experience pain, as the nerve endings involved become damaged and affect sensory perception.

Possible Complications from Bed Sores

Bed sores, as they progress through the stages above, can lead to serious medical complications. Some of the most common that may arise include:

• Osteomyelitis, or infection of the bone
• Septic arthritis, or infection of the joints or ligaments
• Cellulitis, or infection of the skin and tissues surrounding the wound
• Sepsis, a life-threatening infection that travels through the blood stream
• Necrotizing fasciitis, a bacterial infection that leads to rapid cell and tissue death
• Shock
• Organ failure

Preventing Bed Sores

Fortunately, it’s possible for providers to prevent bed sores from occurring. Proper prevention requires knowing the unique risk factors that each person has and addressing them systemically. General, conservative measures for the prevention of bed sores include:

• Changing bed sheets and soiled clothing promptly
• Use of tight bedding for immobile patients to prevent shearing
• Turning patients frequently to ensure proper blood flow
• Use of air fluidizing therapy beds such as the Clinitron bed, which facilities oxygenation of the tissues
• Preventing malnutrition through supervised administration of a healthful diet
• Preventing dehydration through oral or intravenous fluids
• Effective management of chronic conditions that may put a patient at increased risk for bedsores, such as vascular disease, renal impairment, or diabetes mellitus

Bed sores are painful medical conditions that can greatly affect a patient’s quality of life. By using some basic preventive techniques, nursing homes and their providers can stop them from occurring. When a bed sore does present, prompt treatment is necessary to prevent it from progressing into a more advanced sore or co-occurring with a complication which may become life-threatening.

Related Information

• How quickly can a bed sore develop in a nursing home or hospital patient?
• Is there a difference between ‘venous ulcers’ and ‘pressure ulcers’?
• Are all ‘sores’ considered to be ‘bed sores’?

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