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Gangrene from Bed Sores

bed sores gangrene nursing home patient

A prolonged lack of blood flow or the presence of infection could result in necrotic (dead) tissue, leading to gangrene. Sepsis (blood infection) and fever might be present if an infectious agent releases gas gangrene.

Initially, swelling and redness will appear at the affected site, followed by blisters or bleeding sores releasing a foul odor and discharge. Infection-associated gangrene produces cold and pale color skin in the infected wound or injury.

Gangrene is most likely to affect the limbs, hands, fingers, feet, and toes. However, internal organs and muscles can also be damaged by the dangerous condition.

Usually, a medical diagnosis is required to identify the health problem that professionals can treat using radiological imaging and laboratory tests.

Typically, gangrene is critical and requires emergency care. When antibiotics and therapy are effective, gangrene might resolve within days or weeks. If left untreated, gangrene can cause death.

Why Gangrene Occurs

Prolonged bed rest, with restricted mobility, might lead to pressure wounds and the development of gangrene. Freezing and severe burn injuries might also cause gangrene due to the prolonged interruption of blood flow to the damaged area.

Gangrene is prone to occur in various diseases, including:

  • Arteriosclerosis
  • Typhus
  • Raynaud's disease
  • Buerger's disease (thromboangiitis obliterans)

Dry and Moist Gangrene

The Greeks first identified gangrene during ancient times and called the disease gangraina (putrefaction) or tissue death. While most individuals identified gangrene as a health issue caused by a bacterial infection, medical professionals use the word to describe health problems caused by various factors, including blood vessel disease and peripheral artery disease (PAD).

Not all diagnoses of gangrene refer to an infection. Medical professionals differentiate gangrene as dry or moist.

Nearly all dry gangrene cases occur without infection. Alternatively, nearly every wet gangrene case is caused by some infectious bacteria, typically affecting the feet and hands.

Dry Gangrene

Dry gangrene usually develops by the gradual decreasing of blood flow to an extremity or other affected region. Most cases involve arteriosclerosis or diabetes with initial symptoms of feeling cold to the touch and discoloration.

As it worsens, gangrene will affect neighboring healthy tissue turning the affected region dry and dark. If care and therapy can contain the damaged tissue, it might eventually become completely dry, slough off, exposing healthier material below.

Treatment, including surgical debridement, could alleviate many complications associated with dry gangrene and improve blood circulation to the damaged area.

Wet Gangrene

Immediate and prolonged restriction of blood flow, especially in an extremity, could lead to moist gangrene. Often, gangrene develops from an arterial blood clot or severe burn. Healthier tissue surrounding the traumatic site will start leaking fluids, nurturing bacterial growth.

The degradation of existing bedsores might also lead to wet gangrene and places the patient at higher risk of death. This critical health issue is often the result of nursing home neglect and mistreatment.

At this stage, the pressure sores become challenging to treat even with surgical options and specialized wound care.

A worsening wound becomes discolored and swollen and often produces a foul odor. Without treatment, bacterial infections might quickly spread beyond the damaged and necrotic tissue, leading to death.

Doctors typically provide effective antibiotics after debriding (cutting away) diseased and damaged regions to stop infection growth.

Fournier's Gangrene (FG) Pressure Ulcers

A deadly form of necrotizing fasciitis, Fournier's gangrene, affects the perineum and genitalia. The characteristic of the debilitating disease's extremely rapid progression might claim the patient's life in days or weeks.

This form of gangrene is often the result of an advancing infection, bedsores, and sacral pressure sores. The disease's precipitous advancement causes massive destruction of the local region, requiring nearly immediate accurate diagnosis followed by an effective therapy to save the patient's life.

The disease's rapid progression and failure to accurately diagnose the condition may increase Fournier's gangrene's life-threatening properties.

Some of the early signs of the presence of necrotizing fasciitis include:

  • Local tenderness of the affected area
  • Edema
  • Perianal and genital erythema (blood vessel-dilated abnormal skin redness)

Subcutaneous blood vessel micro thrombosis (clumps of red blood cells, platelets, and white insoluble fibrin) exacerbates progressive necrosis and other body pathological changes.

Early detection and identification of Fournier's necrotizing fasciitis require aggressive debridement (or surgical removal) of the necrotic material followed by broad-spectrum antibiotics and fluid resuscitation.

Managing Pressure Sores to Avoid Gangrene

Pressure ulcers (bedsores, pressure wounds, pressure sores, decubitus ulcers) are usually the result of degrading skin integrity.

In a nursing home setting, immobility, interruption of blood circulation to the region, and increasing pressure on the region are the leading factors of pressure wound development.

Bedsores can develop if the nursing home resident remains immobile in bed or a wheelchair without changing position enough to alleviate restricted blood flow. Other ways that a pressure sore can develop might include extended time using a:

  • A prosthetic device that places pressure on an amputated leg or arm's stump
  • Tight-fitting oxygen tubing under the nose or around the ears
  • Tight-fitting fitting glasses on the bridge of the nose or behind the ear
  • Incorrect use of crutches under the arms
  • Rubbing or friction injuries causing cuts, lacerations, or bruising that damages skin

Pressure leading to an open wound, injury, or skin break could cause infections leading to bedsores, cellulitis, localized infection, or osteomyelitis (bone infection). If left untreated, the infections could result in sepsis (blood infection) or septic shock.

Sepsis is the immune system's response to a life-threatening infection. However, sepsis is a rapidly progressing disease that requires early detection and effective therapy for the patient's survival.

If the pressure sore develops an infection, leading to sepsis, the deadly infections associated with the sore can travel anywhere in the body, wreaking havoc on organs and tissue. Sepsis typically results in bacterial infection elsewhere in the body, including a UTI (urinary tract infection, influenza, or pneumonia.

Pressure Ulcers – A Serious Life-Threatening Nursing Home Problem

Applying pressure on the skin for just a few seconds can change the area's color once blood flow has stopped. Releasing the pressure restores the color as the circulatory system flushes the region again with oxygenated blood.

However, restricting blood flow for an extended time causes damage to the area. Those most at risk are mobility-challenged nursing home patients and others with some debilitating diseases.

The nursing staff is required to assess newly admitted patients or existing residents' skin integrity to determine who requires specialized care. The developed care plan might require the use of pressure-relieving cushions, mattresses, or other medical devices to offload body parts and minimize the risk of bedsores.

Pressure sores could develop nearly anywhere on the body. However, the places most affected by prolonged pressure include:

  • Tailbone (coccyx)
  • Buttocks
  • Back of the head
  • Shoulders
  • Back
  • Hips
  • Back of the ears and knees
  • Heels, ankles, and toes

Individuals with prosthetics following an arm or leg amputation have an increased risk of pressure sores when wearing an ill-fitting prosthetic device.

Any problem associated with the skin at the amputation site that contacts the device could result in an injury, including bedsores.

Hospital and nursing home staff must report any suspected sore to the Director of Nursing to ensure patients are treated quickly, even if the resident is not known to be at risk for decubitus sore or bacteria-related illnesses.

All steps to prevent disease, including changing the patient's position at least once every 90 minutes, must be taken to ensure well-being.

The 5 Stages of Pressure Ulcers

According to the CDC (Centers for Disease Control and Prevention), medical professionals categorize pressure sores from the least damage (Stage 1) to the most damage (Stage 4). The fifth stage of bedsores is unstageable due to specific circumstances.

Bedsores are injuries to the skin and deep tissue ranging from reddening to necrosis that might involve infections. The five stages of pressure sores include:

Stage 1

Initial stage bedsores involve intact skin damage that might be painful. The developing wound does not blanch, meaning pressing fingers against the skin to restrict blood flow and removing it does restore blood once the pressure is relieved.

Typically, a Stage 1 pressure sore feels firm or soft to the touch and is usually warmer or cooler than the surrounding region.

Stage 2

If Stage I worsens, skin breaks open, exposing underlying tissue that is painful and tender. The wound now appears as an abrasion (scrape), shallow crater, or blister packed with clear fluid.

In this advanced age, the skin and deep tissue might be permanently damaged due to necrosis.

Stage 3

The significantly advancing pressure sore exposes fat deep within a small crater but does not reveal bone, tendon, or muscle. Immediate medical attention is required to minimize the potential of a Stage 3 pressure sore advancing to a deadly condition.

Stage 4

Pressure ulcers allowed to degrade to the most advanced age creates a deadly problem involving extensive damage. The diagnostician can likely see exposed bone, muscle, and tendons.

Unstageable

The diagnostician might not accurately stage the wound's condition because of a thick covering over the sore that might be black, brown, green, gray, or yellow due to pus and other rotting material. Removing the coverage and exposing the damage might allow the wound care specialist to stage the wound.

At advanced stages, the nursing home resident experiences little to no pain because of their wounds' necrotic or severely damaged soft tissue. Contributing factors to open wounds, including exposure to bacteria, could result in blood (sepsis) infections or bone (osteomyelitis) infections.

Suspected Deep Tissue Injury (SDPI) could create severe complications if seemingly beginning stage bedsores hide deadly damage just below the skin surface. The damaged area must be treated immediately to minimize further damage and exposure to infections.

Pressure Ulcer Injury FAQs

What is a Pressure Injury?

Pressure injuries (bedsores, pressure ulcers, pressure sores, decubitus ulcer) refer to localized damage to the dermis and epidermis (skin and underlying soft material). The injuries typically occur due to pressure on a bony prominence like the back of the head, shoulders, back of the ears, elbows, coccyx (tailbone), hips, ankles, toes, and heels.

Decubitus sores might also develop by stress and pressure related to using prosthetics and other medical devices, like crutches, oxygen tubes, and fracture casts. In its early stage, bedsores present as a reddened intact skin. If left untreated, the injury could develop into excruciating painful, deadly, open ulcers.

What are the First Signs of a Pressure Ulcer?

Usually, caregivers can recognize developing bedsores by a discolored, reddened, or darkened area on the skin. Bedsore might appear shiny, bluish, or purple on African-American skin.

Nearly all beginning pressure sores feel warm and hard to the touch with surrounding soft tissue. Decubitus sores are usually the result of prolonged pressure on a body part that restricts blood flow to the area.

What is the Difference Between a Pressure Ulcer and a Non-Pressure Ulcer?

According to the National Institutes of Health, pressure ulcers result from prolonged pressure against the patient's skin and underlying tissue that restricts blood flow. Individuals most at risk for a pressure sore include mobility challenges in a chair or bed, including people with paraplegia and quadriplegia.

A non-pressure wound can develop from trauma, excessive moisture, or arterial/venous insufficiency. Some people with diabetes develop non-pressure wounds that require extensive medical care, including surgery to stop damage to the affected area.

How Long Does a Pressure Sore Take to Heal?

The length of time bedsores needs to heal completely depends on the severity of the wound and the quick reaction of a nursing home team treating the patient to prevent further damage. During the early stage, bedsores can heal completely in just a few days, often without any pain or discomfort.

Without treatment, the wound can quickly progress, causing significant damage to the skin and underlying tissue.

Some bedsores, especially those categorized as a stage IV wound, might never heal entirely due to severe necrosis or gangrene gas development. Debilitating bedsores might create gangrene that requires surgical intervention, including debridement (cutting away) of necrotic tissue to stop the damage from a decubitus ulcer.

Prognosis

Gangrene from bedsores can develop quickly. Pressure and other contributing factors, including infections, can lead to a life-critical problem when gangrene gas release from dying material harms the surrounding area.

According to statistics, up to 200,000 cases of gangrene are diagnosed every year. Many cases involve soft tissue scarring, requiring reconstructive surgery and repair.

In extreme cases, the surgeon might need to amputate (remove) the damaged body part that is most often a foot or hand. A lack of treatment allows the infected material to spread quickly to internal organs and other areas that might be fatal.

Patients diagnosed with dry gangrene usually have a better prognosis because the wound is less likely to become infected and worsen to wet gangrene. Dry gangrene cases usually do not involve sepsis or death, and instead, the localized necrotic tissue will eventually slough off.

Alternatively, wet gangrene is potentially fatal when restrictive blood flow causes severe necrotic damage that goes untreated. Patients with severe arterial disease often suffer complications where the affected region is deprived of nutrients and oxygen, potentially leading to gangrene.

Patients and caregivers should monitor an open wound's condition to notice any signs of infection, swelling, and aching pain. If the area ulcerates or feels cool to the touch, seek immediate medical attention.

Failing to act quickly might allow the advancing bedsores to degrade to a deadly condition in just hours to days.

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