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Bed Sore Treatment

treating bed sores nursing home patient

Individuals most at risk of developing bedsores typically have severe health conditions limiting their mobility, causing them to spend most hours in a chair or bed. Bedsores (pressure wounds, pressure ulcers, decubitus ulcers, pressure sores) develop when skin integrity degrades.

The injuries are often the result of prolonged pressure on the skin, restricting blood flow, and damaging underlying tissue on bony areas, including the tail bone, hips, ankles, and heels. Bedsores might develop within hours of prolonged immobility.

Medicare regulators have determined all bedsores are preventable if caregivers follow established protocols.

Pressure Sore Development

According to the National Pressure Injury Advisory Panel, pressure sores develop on bony areas, including the forehead, cheeks, nose, chin, clavicle, elbow, chest, genitalia, sacrum (tailbone), knees, anterior pelvic bones, dorsal feet, and toes.

Individuals with underlying health conditions are highly susceptible to degrading skin integrity and developing pressure ulcers. Lying in bed or remaining stationary in a wheelchair for a long time increases the potential of pressure ulcers.

Bedsores develop when the blood flow is restricted to the skin's dermis and epidermis layers for two hours or more.

A Stage 1 pressure sore develops as the tissue dies, creating a painful, reddened area that turns purple without immediate attention.

If the caregiving team fails to act quickly to treat a Stage 2 bedsore, tissue degradation breaks open the dying tissue, exposing the damaged area to infection. Within hours, worsening bedsores might extend to muscle, tendons, and bone.

Treating pressure sores require ample time to heal completely. Any health condition or the presence of diabetes or other diseases could slow down the healing process, taking days, months, or years for the sore to heal completely, even with the best treatment.

Pressure wounds tend to happen in specific areas, including:

  • Back of the head
  • Shoulder blades
  • Heels, toes, and ankles
  • Sides and backs of the knees
  • Buttocks area, including the hip bones and tailbone (sacrum)

Pressure Sore Risk Factors

Specific health factors might increase the potential risk of developing bedsores, including those who cannot sense pain, mobility-challenged patients, and those unconscious or bedridden.

The risk of developing a pressure wound rises significantly when the individual cannot reposition correctly or lack proper skin and nutritional care. Typically, people with diabetes, malnourishment issues, and circulation problems are at the highest risk of sores.

Common risk factors associated with the development of sores include:

  • The inability to move without assistance
  • Advancing age when the patient's skin is more fragile and thinner
  • Incontinence that might increase the potential risk of infection
  • Diabetic conditions that might reduce the sensation of pain
  • Existing infection

Pressure Ulcer Stages

The doctor or caregivers might accurately diagnose sores through a comprehensive inspection of the skin and underlying tissue. Skin sores are staged according to appearance, skin damage, and exposure of damage, tissue, joints, ligaments, muscle, tendons, and bone.

Health science and doctors identify the four stages of pressure wounds from the least severe to the most severe. The stages include:

Stage 1 - During the initial phase of bedsore development, the affected skin appears red and warm. People with darker tones could display purple or blue-hued pressure wounds where the skin might appear shiny or dull.

Typically, patients with a developing stage 1 pressure wound will complain that the area itches, stings, hurts, or burns. Alleviating the pressure on the affected area during the initial portion of a developing pressure might eliminate the discomfort.

Stage 2 – If the nursing team fails to take immediate action, Stage I bedsore skin might degrade to a blistering, scraping, open sore. At this stage, the skin becomes significantly discolored as the tissue dies, resulting in significant pain and discomfort.

Treatment for advanced-stage skin sores requires more than just alleviating pressure on the affected area. The health care team must supply appropriate skin care products that promote healing.

Stage 3 – A severely damaged skin caused by a progressively debilitating wound creates a crater-like open sore caused by extensive damage below the skin's top surface layers.

The care team must identify signs of infection and take appropriate measures to allow the tissue and allow new skin to grow.

Stage 4 – The severely damaged area now creates a life-threatening condition where the joints, tendons, ligaments, muscle, and bone might be exposed. At this stage, an infection from open wounds might spread to other areas of the bloodstream (sepsis) or bone tissue (osteomyelitis).

Without immediate attention by a competent wound care specialist, a stage IV open sore could claim the patient's life.

It might be challenging for the nursing team or wound care specialist to stage the open sore properly due to the presence of eschar (dry blood scab) or slough (shedding dead tissue). Slough can appear in various skin colors, including yellow, brown, green, gray, or tan.

Preventing Pressure Sores

According to the National Pressure Ulcer Advisory Panel, every health care provider, doctor, nurse, and the specialist must follow health information guidelines to prevent bedsores and pressure wounds. Patients providing self-care must reposition when stationary in bed or a chair to relieve the pressure on bony prominences.

Most at Risk

Individuals most at risk of developing skin sores include:

  • Mobility-challenged people spending most of the day in a chair or bed
  • Underweight and overweight men and women
  • Individuals with bladder or bowel incontinence
  • People that suffer from desensitization in any part of the body due to health conditions, paraplegia, or quadriplegia
  • You must change your position when spending lots of time immobile stationary

Self Treatment

Any self-care or treatment by a healthcare provider to prevent the development of pressure sores should include:

  • Using mild soap to clean the area without scrubbing hard
  • Applying skin protections and moisturizing cream each day to the affected tissue
  • Keeping the skin clean and dry to allow damaged skin cells to heal
  • Avoiding the use of strong soaps and talc powder
  • Alternating days to take a shower or bath to minimize excessive dry skin
  • Drinking plenty of water each day
  • Consuming a healthy diet
  • Wearing loose-fitting clothing to relieve the pressure and maximize blood circulation
  • Not wearing close with zippers, buttons or seems that press on the skin
  • Repositioning the resident at least once every 2 hours to alleviate the pressure on the body
  • Using every effect of medical treatment available to maximize the healing process for healthy skin
  • Leaning forward and to both sides every 15 minutes when stationary in a chair or wheelchair

Take immediate action if you, or caregivers, notice any redness, warmth to the touch, developing sore, or any other skin integrity change lasting a few days or longer. Any sore that drains pus or becomes extremely painful might become life-threatening.

Pressure Ulcers FAQs

What is the Fastest Way for Treating Pressure Wounds?

Treating decubitus wounds effectively might eliminate the patient's discomfort and save their life by not allowing the wound to degrade to a life-threatening condition. Stopping the progression of a building pressure sore requires immediate clinical attention, adjusting the patient's body to relieve pressure on the ankles, toes, knees, hips, heels, sacrum (tailbone), hands, elbows, shoulders, and back of the head.

Treatment typically requires skincare ointments and sterile dressings when the sores are allowed to open, exposing dead tissue, slough, eschar, joints, muscle, and bone.

What can Nurses do to Prevent Pressure Ulcers?

Bedsores usually develop when the patient is immobile for an extended amount of time. The nurse or medical team must reposition the patient's body every two hours to relieve pressure to the affected area.

Additionally, the patient must receive adequate nutrition and skincare every day, especially if they suffer from debilitating diseases and medical conditions.

How Effective is Positioning in the Prevention of Pressure Ulcers?

Bedsores usually develop due to a lack of repositioning when mobility-challenged patients remain stationary for hours at a time while in bed or in a chair. Relieving the pressure allows unrestricted blood flow to oxygenate and nourish the dermis and epidermis skin layers.

Covid-19

According to the National Pressure Ulcer Advisory Panel, treating patients suffering from Covid-19 (coronavirus) has caused significant bedsore development problems. Doctors have determined that keeping hospitalized Covid patients lying face down helps alleviate respiratory problems caused by inflaming lungs.

The advisory panel offers general pressure injury prevention health information for Covid patients, including:

  • Using pressure redistribution surfaces when a debilitated Covid-19 patient is lying on a mattress not explicitly designed for the prone position
  • Using positioning pillows and devices required for offloading pressure points
  • Training the medical team to avoid friction/shearing movement when repositioning the patient's body
  • Making small/micro-shift positioning changes when performing care while the patient is in a prone position
  • Assessing every pressure point before repositioning the patient or returning them to a supine position
  • Alternating the arms' positions from every fifteen minutes to every two hours while assessing skin integrity on the face, head, and arms
  • Documenting every skin assessment and preventative measure used by the medical team
  • Offloading and protecting breasts, genitalia, and other sensitive tissue

For the most effective medical treatment, the advisory panel recommends routine monitoring of sensitive skin around and under medical devices and avoiding the use of multiple dressing layers that could potentially increase pressure on the skin.

Outlook

Nearly all pressure wounds are preventable when caregivers follow established protocols to prevent, treat, and care for wounds at every stage. The nursing staff should assess the patient every day and keep the skin clean and dry while providing optimal attrition.

The nursing team must take steps to minimize risk factors, especially for older patients with incontinence, a higher low BMI (body mass index), or a medical condition that prolongs wound healing.

With the best treatment, healing is possible if the sore is caught in an early stage. More advanced open ulcers require specialized professional wound treatment.

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