By Nursing Home Law Center
Bedsores vary in appearance, depending on how advanced the bedsore is. In addition to appearance, they can be swollen, hard, and warm to the touch, especially in early stages. Knowing how to recognize a bedsore is an important part of maintaining the health of a patient, especially one who cannot fully care for him or herself.
Bedsores are a malady that can develop when blood does not properly flow to an area of the body due to continuously applied pressure. The skin and tissue begin to die or necrotize. This can lead to infection and even death. Bedsores are sometimes referred to as pressure sores or decubitus ulcers.
Stage I bedsores have just begun to develop. The skin has not broken yet and the tissue is still alive. The infection risk is still small.
Pressure sores in the earliest stage will present with a red appearance. Later they may change to a purplish hue. The affected area may be hard to the touch and warmer than the rest of the body. Staff may notice swelling in the area.
Stage II bedsores may show blistering of the skin. Abrasions may appear. At this stage the outer layers of skin are dying and breaking open. Infection is now a significant risk.
At Stage III, the skin has worn away to reveal the underlying tissue. The tissue itself is damaged. The wound will become a crater as more living tissue dies and wears away. Infection is a severe risk and the area may begin to give off a foul odor.
Stage IV is the most severe stage of pressure sore. The sore has gone unnoticed and untreated long enough to become a life-threatening affliction. Infection is a virtual certainty if hospital staff do not act swiftly and decisively.
At this stage the skin and the tissue underneath has died and worn away. The muscle underneath can be seen, and sometimes even the bone is noticeable.
A bedsore can develop anywhere, but some parts of the body are more vulnerable than others. Areas with more fat have more cushioning, and therefore more protection from unrelieved pressure. Areas without a lot of fat lack this protective layer. They include:
It is vital that hospital staff turn their comatose and other immobile patients frequently every day to prevent the development of bedsores. Other devices which relieve pressure, such as heel boots or specially designed mattresses, can also help.
Prevention is not enough by itself, however. No matter how dedicated a staff is, a bedsore can develop, even in a patient who you regularly turn and who lays on a pressure-relieving mattress. For this reason, it is crucial that hospital staff check their patients for signs of developing bedsores. Bedsores can occur despite precautions, but no bedsore should ever be allowed to reach stage II without treatment.
Once a bedsore appears, treatment depends on how advanced it is. At stage I, the skin has not yet broken. Extra care must be taken to keep pressure off the area. It must remain clean and dry. If proper care is given, the area should heal on its own unless other aggravating factors are keeping blood supply from reaching it.
At stage II, a small wound has developed, or a blister. The same plan of care applies, but with a bandage or dressing to protect the compromised skin.
At stage III, the skin and underlying tissue suffer severe damage. Debridement, which is chemical or surgical removal of the tissue, may be necessary. The patient may require anti-biotics to prevent infection. After debridement, a wound vac will keep the area dry and allow it to heal. Depending on the size of the wound, some surgery could be required.
At stage IV, the skin and tissue have died and the muscle and bone underneath are exposed. Surgery or amputation may be necessary.
***Warning: Many of these photos are extremely graphic in nature and may not be suitable for younger viewers.
Bed Sore Photos: You can see video and pictures of bed sores at these websites:
Bed Sore Video:
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