WHAT CAUSES BEDSORES TO DEVELOP?
A decubitus ulcer is a type of open sore that occurs on the skin and in its underlying layers, due to the pressure of tissues and their ischemia. Initially, the only symptom is a localized redness of the skin. Over time, this redness stops fading after pressure is applied to the area.
It eventually transforms to the cutaneous epidermis and becomes an open wound. Subsequent stages include decubitus ulceration and progressive necrosis where the skin permanently dies and stop regenerating. Although these changes can occur in any area exposed to pressure, we usually find them on the heels, medial ankles, the tailbone or buttocks.
Immobilization is a major factor that exposes people to bedsores. The elderly often have protein deficiency which is the result of malnutrition, reduced calorie intake of food and impaired absorption. This deficiency can significantly increase the chances of pressure ulcer formation. This is why the elderly should be particularly careful about taking a proper diet.
Another factor that is associated with permanent immobilization is the need to use adult pampers or catheterization of the person. A prolonged contact of the skin with contaminated urine or faeces in the diaper exposes people to maceration of the epidermis. If a pressure ulcer already exists in the area, this can lead to an infection of the wound. The patient’s awareness and mobility, or lack of them, are also major factors in the development of pressure ulcers. The risk of developing pressure ulcers is assessed by the Norton scale where risk is assessed, based on physical and mental condition, activity, mobility and incontinence.
HOW TO AVOID PRESSURE ULCERS FORMATION?
Treatment of pressure ulcers is a lengthy and often complicated process.The best form of patient care is prevention and proper hygiene. The easiest way to do this is by making sure that an immobile patient’s position is changed often, at least once every two hours.
Areas of the body that are particularly exposed to the pressure can be relieved by the use of special pads or ordinary towels and cushions. Hard rollers that can cause bedsores should be avoided. Delicate gentle patting of exposed areas on a daily basis can improve the blood supply. A good nutrition with a healthy amount of protein is also very effective.
Anti-bedsore mattresses can also be of great help. Depending on their design, these mattresses can prevent the development of pressure ulcers by different mechanisms of massage and compression. An elderly person can also benefit significantly by the help of a professional caregiver.
Drying of the skin and permanent moisture can both cause changes to the skin structure and increase the risk of pressure ulcers. It is necessary to thoroughly dry the skin after washing and toilet activities. Proper moisturizing should also be applied to the skin afterwards using lotions and creams.
Lastly, a person at risk should also get their skin inspected on a daily basis by a carer or skilled professionals. Skin should be checked at places where the fatty layer is particularly thin so that any newly formed changes can be detected in time. If any changes are detected, a qualified dermatologist should be contacted immediately.
WHAT TO DO IF THE DECUBITUS ALREADY EXISTS?
Decubitus ulcer is curable but treatment takes time. The success of therapy depends on the severity of the ulcer and the competence of the caregiver. In the treatment of pressure ulcers, many carers use prophylaxis approach since it can improve the condition of the skin and prevent the formation of additional ulcers.
Colloidal dressings are now widely accepted as a treatment for pressure ulcers. They are applied to decubitus ulcers for a period of about 7-10 days. The plasters are glued on clean, dried skin next to the wound so that they completely cover the existing pressure ulcer.
Depending on the condition of pressure ulcer, and presence or absence of exudate from the wound, carers can select from a range of dressings. In order to eliminate infections, individual polyurethane, hydrocolloid, hydrogel, alginate or silver ion addition dressings can be selected. The pharmacist, doctor or a qualified nurse can help with the selection of the right dressing.
Other forms of treatment for pressure ulcers such as ointments, powders or home-made mixtures, are not recommended. Not only do these treatments inhibit healing of the pressure ulcer, they can also cause it to become much worse.
Major bedsores that cannot be remedied with dressing are closed with the help of surgical methods.
Care of a bedridden patient should take into account the anti-bedsore procedure, because prolonged staying in one position may lead to local circulatory disorders.Staying in one position can cause ischemia and tissue damage. Wounds can go from the epidermis down to the bone tissue.
Decubitus ulcers are very hard to heal and expensive to treat. They are also quite painful and cause care problems for the affected person.
There are many health factors (internal) that can affect the development of decubitus wounds that are difficult to eliminate even for a doctor. This is because the ulcer is caused by the general health deterioration of the patient and impairment of many organs. Some of the health conditions leading to ulcer include anemia, impaired nutrient absorption, protein metabolism disorder, vitamin deficiencies and malnutrition among others. There are also a number of external factors that can lead to bedsores, many of which can be avoided through professional care.
STAGES OF ULCER PROGRESSION
Prolonged immobilization, lying down or sitting in one position causes local pressure. If blood cannot circulate properly in the vessels feeding the affected body parts, the tissues start to die slowly.
In the beginning there is redness, which may disappear when pressed with a finger. During this phase of ulcer progression, the disorder has not yet affected microcirculation of blood. This stage is called the 1stdegree of decubitus, according to the Torrance scale.
Prolonged time spent in the same position causes microcirculation problems and progress of the disorder to the 2nd degree of decubitus ulcer. During this stage, skin redness remains in place, and does not go pale when pressed with a finger.
If stretching and friction cause skin ruptures, blistering or deep damage up to the tissue barrier subcutaneous, these can be considered as symptoms of 3rd grade decubitus ulcer. During this phase, the edges of the decubitus wound will become noticeable, separated from the tissue by healthy erythema and surrounded by painful swelling. During this stage, you will see a yellow sebum (disintegrating tissue) or a red granulation tissue (healing stage) under the wound.
If the lesion covers the skin and subcutaneous tissue, and black necrosis becomes noticeable at the bottom of the wound, it marks the beginning of the 4thdegree of decubitus ulcer.
The 5th degree of decubitus ulcer is an advanced necrosis of deep tissues, up to the fascia and muscles. This is also the last stage of ulcer progression. It may even affect bones. Deep holes appear on the skin that can connect to each other and form cavities. The wound causes a leakage of black-brown tissue cells that have died. The wound also starts to cause a foul odour. This is the most serious condition of a decubitus wound.
Development of ulcer is painful and can become costly to treat if left unattended. This is why anti-decubitus treatment should be implemented as soon as the first signs of ulcers occur. If the disease is treated early on, there will be no chance for development of advanced stages.
The treatment consists primarily of supplementing nutritional deficiencies for the affected person. These consist mainly of proteins, micronutrients, vitamins, zinc, iron and vitamin C. The carer should also use specialized dressings recommended by the doctor. Non-toxic dressings are appropriate for use with this type of ulcer.
Specialized dressing helps keep the skin moist and does not stick to the affected tissue. It gives the possibility of adjusting the dressing to the form and size of the decubitus wound. The dressing is resistant to friction and damage and impermeable for bacteria.
Decubitus ulcer dressing is made of polyurethane membrane and sponges, hydrogel, hydrocolloid and dextranomer. Alginate dressing also uses active carbon and silver as well as enzyme purifying agents.
It is important not to stain or use iodine on the bedsores because they can give a wrong impression about the condition of the wound and also dry it up.
In the 1st and 2nd degree, pressure ulcers can be treated independentlyunder the instructions of a nurse, doctor or pharmacist.
However, when deep 3rd, 4th or 5th degree lesions develop, it is best to entrust treatment to a qualified medical professional. A medical doctor may surgically treat the resulting wounds by cleaning and removing dead tissue. A home care nurse can take care of the ulcer with the help of special dressing and advanced medical care technology.
PREVENTION OF PRESSURE SORES:
Bedridden patients have a high risk of developing pressure sores. The following steps must be followed by carers to prevent the development of ulcers for patients.
- When performing daily care, remember to thoroughly dry the skin: do not rub but gently rinse with a towel.
- Oiling the skin – Baby oil is the best for skin ulcer patients. Linomag in liquid and cosmetic petroleum jelly can also be used. These are easy to apply, due to their high consistency. Massage with delicate movement so that you do not damage the epidermis. Remember not to use powders or talc after moisturizing the skin as this will cause the formation of lumps in the skin folds.
- Be careful when caring for patients. For example, do not scratch their skin.When attaching dressings, use hypoallergenic adhesive tapes that are available at any pharmacy.
- Underwear and bed linen should be made of natural materials, frequently washed and always used when clean and dry. Moisture affects the browning and abrasion of the epidermis and provides a breeding environment for bacteria.
- Carers should use a mattress cover on the bed that can be changed with ease. The cover should be wide enough to be placed under the back of the patient, reaching from the end of the pillow to under the knees so that the lining does not rub against the patient’s skin. The sides should be tucked underneath the mattress. The simplest way to make such a cover is to fold extra sheets in half and position under the patients back. In addition to ensuring cleanliness, the additional sheet can be used to safely move the patient. The carer can move the patient by lifting them gently on the sheet while moving it up or sideways.
- In order to ensure proper hygiene, the carer should use nappy pants that do not restrict the access of air and can be changed when necessary. It is important to restrict contamination of the skin with urine and faeces and pads should be changed often.
- The carer should regularly change the position of the patient every 1-2 hours and even every 30 minutes when required. All the combinations should be used: on the back, on the stomach, on the sides, low or high sitting with the aid of headrest, depending on the condition of the patient. Carer should be particular about not damaging the patient’s skin while moving them around. The carer will also need to change the position of the patient at night. Changing position frequently will improve the microcirculation of blood under the skin. It also eliminates long-term pressure on one spot.
- The carer can also perform activities that improve the blood circulation under the skin, such as a very gentle massage and patting. This will also help in preventing pneumonia.
- An important element in prevention is the use of a pressure-changing anti-bedsore mattress. It should be noted, however, that the mattress itself is not enough to prevent pressure ulcers. The carer can prepare supports for heels, elbows and buttocks as well as rehabilitation cushions and knee or thigh rolls. Special hanging rests are available in the market for heels, torso and limbs that offer support for bedridden people.
- The carer should not forget about the use of an appropriate diet that should be checked with the physician. A good diet for decubitus ulcer patients includes vitamins, mineral salts and protein. Protein deficiency (mainly albumin) is the prime reason that causes the formation of pressure ulcers.
- Immobilized patient requires movement rehabilitation, adapted to the actual state of health. At home, the exercises should be performed under the supervision of a physiotherapist who can teach the family how to help the patient with them. If possible, the affected people should do the exercises advised by the physiotherapist by themselves.