Pressure sores are a significant concern for the elderly, rehabilitating, and disabled in nursing homes, assisted living communities, and hospitals. Without immediate treatment, an early-stage pressure sore could progress to a dangerous decubitus ulcer, claiming the patient’s life in days.
Untreated skin sores can deteriorate quickly, causing the skin’s dermis and epidermis layers to die. Doctors, nurses, and nursing home staff members must provide wound care that prevents infection while promoting healthy tissue growth.
Are you the victim of nursing home neglect and developed preventable pressure ulcers? Did your family lose a loved one through bedsore negligence leading to wrongful death?
The personal injury attorneys at Rosenfeld Injury Lawyers, LLC can help. Our legal team will ensure your claim has the highest chance of success to get the compensation you need.
Our law office can file a claim on your behalf to hold those responsible financially and legally accountable. Contact us today at (888) 424-5757 (toll-free phone call) to discuss your case’s merits.
What Are Pressure Sores?
Pressure sores are often referred to as decubitus ulcers, pressure ulcers, pressure wounds, and bedsores. Pressure ulcers develop from unrelieved pressure against the skin on a bony prominence like the back of the head, shoulders, shoulder blades, elbows, tailbone, hipbones, back of the knees, heels, ankles, and toes.
The injury may result from external pressure by sitting in a chair or lying in bed for a prolonged period without readjusting body weight. Some nursing home patients develop pressure wounds from crossing their legs or placing one foot on top of the other for hours.
Skin damage can be excessive during the early stage that is easy to identify. The damaged area may feel warmer or cooler around the sore and appears reddened, purple, or maroon.
A quick diagnosis of an early-stage pressure ulcer may include blanching – pressing fingers on the affected area until it turns white. Damage may be verified when removing the fingers when regular coloring does not return to the area, confirming that the skin and underlying tissue have been compromised.
If left untreated, an early-stage (Stage I) pressure wound could degrade to a Stage II pressure sore, appearing as pus- or blood-filled blister or shallow open crater in the skin’s upper layers. The damage is caused by restrictive oxygenated blood flow and loss of nutrients to the affected area.
A pressure ulcer can advance to a life-threatening condition (Stage III & Stage IV), where the open crater becomes a deep tissue injury, exposing muscle, ligaments, tendons, and bone. Without sufficient health care, wound healing may take months, if possible.
Stage IV pressure sores are deadly and require immediate medical attention, daily management, and sometimes, surgical intervention (debridement) to cut away the dead tissue.
Shearing and Friction Wounds
Shearing or friction also causes pressure ulcers when the patient is slid across chair seats, support boards, linens, bedding, and pads. The friction causes burns, compromising skin integrity, and restricts blood flow to the damaged area, leading to pressure ulcers.
According to the National Pressure Ulcer Advisory, continuously moist skin also causes bedsores due to skin integrity loss. Mobility-challenged hospital patients and nursing home residents are often made to lie in their urine or excrement for long periods until nurses and nursing assistants can help them to the bathroom.
The Centers for Medicare and Medicaid Services (CMS) identifies every developing pressure sore as a “never event.” Medical science knows that nearly all pressure ulcer cases are preventable had the hospital or nursing staff followed procedures and protocols to prevent open wounds.
Pressure sores in nursing homes are usually the first indicator that the resident has been mistreated, abused, or neglected.
Pressure Sore Risk Factors
The Centers for Medicare and Medicaid Services (CMS) regulates all nursing homes, requiring a comprehensive assessment of every newly admitted patient to develop an effective care plan. The assessment evaluates every new resident’s risk of developing pressure sores.
The doctors and nursing staff must conduct follow-up assessments at least quarterly to make care plan adjustments if any health change is identified. The assessment should include a Braden scale assessment to identify the resident’s skin integrity and the potential risk of developing bedsores.
Contributing risk factors to bedsore development include mobility challenges, lack of activity and movement, limited access to nutrition and hydration, and exposure to moisture, especially residents with incontinence.
Immobile people are most at risk of bedsores, including those who cannot readjust their position at least once every two hours. Some of these individuals suffer from chronic wounds, ostomy wounds, spinal cord injuries, IV pressure sores, and chronic infections that compromise the body’s immune system.
Prolong use of antibiotics can also lead to pressure sores when the body is no longer able to fight a new antibiotic-resistant bacterial infection.
Staging Pressure Sores
The Pressure Ulcer Advisory Panel categorizes pressure wounds, pressure sores, bedsores, and decubitus ulcers in five stages (Stage I-Stage IV). Diagnosticians and wound care specialists use the staging to determine the extent of damage to ensure the resident receives appropriate treatment following ulcer care protocols.
The stages of pressure sores include:
Stage I – At the early-stage, a Stage I pressure sore appears reddened or purple and warm or cold around the sore compared to the surrounding area. Darker-skinned patients will have a purple or blue tint to the affected area. Stage I pressure sores may itch, hurt, or burn.
Stage II – If left untreated, an early-stage pressure wound can degrade to a Stage II bedsore with significantly more damage to the affected area appearing with a pus-or blood-filled blister, scrape, or shallow, open crater.
Stage III – At this progressive stage, the shallow, open crater is now a suspected deep tissue injury, exposing much of the underlying tissue. Typically, Stage III bedsores require immediate medical attention.
Stage IV – At this most advanced stage, the wound has severely damaged the area deep into the muscles, tendons, ligaments, joints, and bones. Infection is usually rampant and pain extreme. Stage IV bedsores require immediate hospitalization for urgent wound care to increase the individual’s survival chances.
Unstageable – Many pressure wounds cannot be accurately assessed due to accumulated eschar (black, tan, green, or brown tan necrotic tissue) and slough (brown, green, yellow, tan, or gray dead tissue). Before staging, a wound care specialist must remove the necrotic tissue to expose the depth, width, length, and severity of the pressure sore.
Bedsore staging is necessary for skin assessment to ensure that the resident receives the best treatment to begin the wound healing process.
Treatment of Pressure Ulcers
A wound care specialist, health care provider or doctor can begin the treatment of pressure ulcers once an assessment is completed. The patient’s Care Plan and wound treatment depend on the injury’s extent and the ulcer’s condition.
However, the best method for treating pressure sores includes:
- Antibiotics to reduce, eliminate, or control existing infections
- Localized wound care, including wet to dry dressings
- Lifestyle changes including frequent repositioning of the body
- Use of special offloading pads, cushions, and mattresses
- Surgical intervention including sharp debridement that cuts away necrotic (dead) tissue to allow healthy new tissue to grow
- Enzymatic debridement, where enzyme ointments are applied over the wound to dissolve granulation tissue
- Full-thickness and split-thickness skin graft, a surgical procedure requiring healthy skin removal and transplantation over the wound area in patients with skin infections, large open sores, deep burns, skin cancers, and bedsores
A patient’s prognosis for bedsore recovery depends on the severity and stage of the ulcer. An early diagnosis followed by immediate treatment can almost ensure a full recovery.
However, later stage bedsores can be life-threatening and require immediate hospitalization for urgent care.
Prevent Pressure Ulcers
Nearly all bedsores result from prolonged pressure to a bony part of the body, restricting oxygenated blood flow to the area. Relieving pressure on the skin in the affected area is the simplest way to prevent damage to the area and compromise the skin’s integrity.
Caregivers should ensure that the pressure is spread out and relieved, especially after the pressure has remained in one area for an extended time.
Spreading and relieving the pressure could involve:
- Repositioning the body at least once every 2 hours when confined to a bed
- Repositioning the body at least once every 15 minutes when in a wheelchair
- Avoid friction burns and shearing when slipping, slighting, or slumping in a chair or bed
- Recline a wheelchair, chair, or bed no higher than 30 degrees to avoid slipping
- Used pressure-relieving devices including pads, heel guards, mattresses, and chair cushions that spread and reduce pressure
- Use specialized support boards and support surfaces during transfers
- Avoid doughnut-shaped that are known to cause pressure-related injuries
Maintaining quality skin integrity is crucial to preventing pressure ulcers, including bathing to remain clean using mild soap and warm water for optimal skincare. Always avoid hot water and never scrubbed the skin hard.
Other necessary skin measures to prevent bedsores include:
- Use moisturizing lotions and creams to maintain soft skin and keep the area from becoming too dry to avoid damage to the epidermis skin level
- Patients with incontinence must keep the body clean and dry through bladder and bowel control and change clothing, sheets, and bedding that become wet or soiled
- Use protective wetness barrier lotions, ointments, and creams to protect the epidermis
- Use briefs and pads that Wick away moisture, urine, and other fluids from the skin
- Protect body areas from medical equipment, including oxygen tubing and masks
Perform a skin assessment every day to identify the early stages of a developing pressure sore, paying close attention to bony areas including the heels, ankles, knees, hipbones, tailbone, shoulder blades, shoulder, elbow, back of the head.
Take special care if overweight to minimize shearing injuries from skin folds or areas that rub together. Protect the back of the legs, buttocks, and elbows that rest against armchairs, wheelchairs, and braces to prevent friction burns.
Maintaining a good eating habit is crucial to improving skin integrity to protect against developing pressure sores.
Some of these habits could include:
- Consume a healthy diet was sufficient fluids and proteins
- Maintain a healthy weight void of any substantial weight gain or weight loss
- Avoid smoking and the use of tobacco products that can reduce blood flow and dry out the skin’s dermis, epidermis, and subcutaneous fat layers.
If pressure ulcers develop, continue using the prevention steps above to alleviate pressure while protecting the skin’s integrity. Keep the sore area slightly moist, clean, and covered.
Avoid using skin cleansers on an open wound, and don’t clean the area with an antiseptic solution like hydrogen peroxide.
Pressure Ulcer Injury FAQs
Our personal injury attorneys know that you have many unanswered questions about handling bedsores and pressure wounds of a loved one in a nursing home or hospital. Our legal team is answered some of those questions below. Contact us today at (888) 424-5757 for more answers and legal advice on how to resolve this problem.
What Happens If A Pressure Ulcer Is Not Treated?
Untreated bedsores can progress to a life-threatening condition that can claim the patient’s life within days. An advancing pressure wound creates a Suspected Deep Tissue Injury (SDTI), exposing muscle, tissue, ligaments, tendons, bones, and joints well below the subcutaneous fat layer.
The deep crater, likely filled with eschar and slough (dead tissue), exposes the body to germs, leading to a life-threatening infection of the blood (sepsis) or bones (osteomyelitis). Advanced stage bedsores require immediate hospitalization for urgent medical attention to improve the chance of survival.
Why is Preventing Pressure Sores Also Known As Bedsores So Important?
Medical professionals providing caregiving to nursing home residents and hospital patients must follow established protocols to prevent the development of pressure sores (bedsores, pressure wounds, pressure ulcers, decubitus ulcers).
Any pressure sore allowed to degrade could become deadly when a deep infection in an open wound causes septic shock, gangrene, or other life-threatening condition. Advanced bedsores in their final stages require immediate medical attention and a hospital or emergency room.
Can a Pressure Ulcer Turn into Sepsis?
Sepsis is the body’s out-of-control response to a severe infection, releasing toxic chemicals in the bloodstream to save itself. Sepsis is a medical emergency, often inflicting individuals with compromised immune systems due to chronic illnesses, opened wounds, or another disorder.
This life-threatening bloodstream infection often develops in individuals who are bedridden or chair-fast suffering from medical issues, including urinary tract infections or pneumonia. Pressure sores (pressure ulcers, decubitus ulcers, pressure wounds, bedsores) contribute to developing deadly sepsis.
The Centers for Medicare and Medicaid Services (CMS) identifies a pressure wound as a “never event” in that it is nearly always preventable if caregivers follow established bedsore prevention protocols.
Why Is It Important To Put Pressure Over An Injury?
Applying pressure over an injury could cause damage to the skin, leading to a pressure sore when the area is deprived of oxygen-ridge blood and nutrients. In some scenarios, the restricted blood can clot, travel to other areas of the body, and lead to pulmonary embolism (PE) or deep vein thrombosis (DVT).
If the injury is bleeding, elevate the affected area above the heart level to reduce blood flow until medical professionals arrive. Additionally, You may use a sterilized, clean dressing over an open wound to stop the bleeding or protect against any signs of infection.
What Can I Do To Prevent or Treat A Pressure Ulcer?
Any steps you can take to support your health care, including improving your skin integrity, can minimize developing a pressure ulcer. If possible, move around, change your position at least once every 15 minutes to alleviate pressure on the skin to keep blood flowing.
You may need medical attention if you notice any signs of infection, experience pain, or see the beginning signs of a developing pressure ulcer. The skin may quickly deteriorate and feel warmer or cooler to the touch than the surrounding area, which is often an early indicator that the area may be damaged due to restricted blood flow.
How Long Can You Live with a Stage 4 Bedsore?
According to the National Pressure Ulcer Advisory Panel, patients suffering from a Stage IV pressure sore receiving the best treatment have a good prognosis. Without treatment, the patient can die within hours if a septic shock occurs due to an uncontrollable infection caused by an open wound.
However, survival does not always equate to a full recovery. In many cases, the wound will heal entirely, or nearly entirely, within three months to a year or two, if possible.
Hiring a Pressure Sore Injury Attorney to Resolve a Negligent Wound Care Compensation Claim
Were you or a loved one injured by preventable negligence? Are you the victim of abuse or mistreatment? Contact our nursing home negligence lawyers to schedule a free consultation to discuss your rights and legal options.
At Rosenfeld Injury Lawyers LLC, the medical malpractice attorneys can determine your case’s merits to proceed with a personal injury claim.
Our nursing home infection lawyers accept personal injury cases using signed contingency fee agreements. The arrangement ensures you only pay for our services if we obtain compensation on your behalf.
Anyone who lost a loved one from a preventable death has the right to file a wrongful death lawsuit to recover damages, including medical bills, lost past and future earnings, loss of companionship, funeral costs, pain, and suffering.
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