Doubtlessly, you have seen television commercials regarding nursing home abuse. One of the injuries commonly mentioned is bedsores. While these ads make it seem that bedsores only develop through utter neglect, the truth is they can develop rather easily when someone is incapacitated temporarily or permanently. When allowed to develop, pressure sores can have dire consequences.
What is Pressure Sore?
Also called pressure ulcers or decubitus ulcers, these afflictions are exactly what they sound like. They develop from prolonged pressure to the skin. Pressure sores develop over hours or days. Most heal with treatment but depending on the individual and their unique situation, some never heal but may only be managed. Anyone can get a pressure sore, but the following factors increase your risk:
- Over 70 years old as seniors are more likely to have mobility problems and skin that is easily damaged
- Confined to bed or a wheelchair following illness or surgery
- Partial or full paralysis
- Urinary and bowel incontinence
- Poor diet
- Medical conditions such as diabetes, peripheral artery disease, kidney failure, heart failure, multiple sclerosis, or Parkinson’s disease
Common Areas Where Pressure Sores Develop
Sores generally develop over the body’s bony areas that have little fat. People who spend a lot of time in wheelchairs tend to develop them on the tailbone or buttocks, shoulder blades and spine, and the backs of arms and legs where they may rub against the chair. People confined to bed can also get pressure sores on the back or sides of the head, the hips and the heels, ankles, and the skin behind the knees.
What Does a Pressure Sore Look Like?
Skin usually exhibits several symptoms indicating that pressure sores can develop. Look for skin discoloration, which appears differently on individuals with lighter or darker complexions. People with pale skin tend to get red patches, while those with darker skin show purple or blue spots. The affected area’s skin may feel warm, spongy, or hard to the touch and may also be itchy. Other warning signs include swelling, pus-like drainage, and tender areas.
Pressure sores fall into four different stages based on their severity, depth, and several other characteristics. Sores also look different at every stage. Stage One sores look like the above description. The skin is not broken, but the color of the area does not change after pressure has been removed for 30 minutes. Sores in this stage are the easiest to remedy.
Stage Two sores may be open and look like a cut or blister as the topmost layer of skin is broken, creating a shallow, open sore that is painful. Drainage may be present, and the surrounding area may be discolored.
In Stage Three, sores look like craters as the break in the skin extends through the dermis, the second layer of skin, reaching fat and subcutaneous tissue. These wounds typically need additional care with special cleaning or debriding agents along with antibiotics, either in cream or pill form. Sometimes, a medical provider may recommend a special bed or mattress.
Stage Four sores are the most serious as skin and deeper tissue become severely damaged as the wound grows larger. Muscles, bones, tendons, and joints may be visible. A lot of dead tissue and drainage are usually present. Sores at this stage require medical intervention, sometimes even surgery.
Sometimes, pressure sores don’t fit into the classic stages. These include sores covered in yellow, tan, green, or brown dead skin, making it difficult to determine how deep it is. Another type involves sores that developed deep below the skin, also known as a deep tissue injury. The area may appear maroon or dark purple and may have a blood-filled blister under the skin. These sores can quickly develop into Stage Three or Stage Four pressure sores.
A wound is not assigned a stage when there is full-thickness tissue loss, and the base of the ulcer is covered by slough or eschar and is found in the wound bed. Slough may be tan, grey, green, brown, or yellow. Eschar is usually tan, brown, or black.
How Pressure Sores Form
Bedsores develop because pressure limits blood flow to the skin, and the tissue immediately below it. Good blow flow delivers oxygen and nutrients to tissues. When these essential nutrients are missing, skin and healthy tissues become damaged and can lead to eventual cellular death. Fricton, in the form of skin rubbing against clothing or bedding, must also be present, with fragile skin being the most vulnerable. Shear, which happens when two surfaces move in opposite directions, must also occur. An example is when a person slides down in bed, the skin over the hip bones may stay in place instead of moving with the entire body.
How to Treat Pressure Sores
Treating a pressure sore quickly is the key to healing one. For Stage One sores, you should keep pressure off the area as much as possible. Maintaining good hygiene is essential. Wash the area with mild soap and water and pat dry. Never vigorously rub the developing sore.
Patients who begin to develop pressure sores should also review their diet to ensure that they get enough calories and protein as well as vitamins A and C along with zinc and iron, all of which are necessary for healthy skin. Additionally, look for possible causes such as mattresses, wheelchair cushions, transfer and turning techniques, etc., and make adjustments accordingly. For sores caused by friction, placing a protective transparent dressing over affected areas can help.
For Stage Two sores, follow the above recommendations but clean the area with a saline solution as the salt in the water removes extra fluid and loose material. Apply a thin foam or a hydrocolloid dressing or saline dampened gauze and check for signs of healing with each dressing change. If signs of infection appear, seek treatment from a medical professional for alternative wound care.
Patients or their home caregivers can clean sores in Stage One or Stage Two, but medical professionals should clean and treat all Stage Three and Stage Four sores because of their seriousness.
When to Seek Medical Help
Stage and Stage Four pressure sores can become infected, so patients and their caregivers should constantly monitor these wounds for signs of infection. Infected sores will also take longer to heal. Signs of infection include:
- Pus that is thick, yellow, or green
- Skin that is warm to the touch
- Swelling and tender around the sore
- Black areas starting to form
- The sore begins to smell
- An increase in drainage
- Fever develops
Infections can also spread to other areas of the body. Look for higher fever, chills, confusion, or difficulty concentrating, weakness, and rapid heartbeat as indicators that the infection has spread.
Complications From Untreated Sores
All complications are serious and some can even be life-threatening. Cellulitis, an infection of the skin and attached soft tissues, can occur. Patients with nerve damage often don’t feel the pain of this infection. Bone and joint infections can occur, including septic arthritis, which can damage cartilage and tissue. Bone infections can reduce limb function. Long-term wounds that don’t heal can develop into squamous cell carcinoma. In rare cases, even sepsis can occur.
Other complications can include:
- Heart infection
- Autonomic dysreflexia, a sudden onset of excessively high blood pressure
Pressure Sores on the Mend
As you learn how to heal pressure sores, you’ll want to look for signs that the area has begun to mend. As the sore heals, it gets smaller, and less fluid drains from it. New, healthy tissue that is light red or pink starts growing at the bottom of the sore and may look lumpy and shiny. Signs of healing may take two to four weeks after treatment begins.
Only when sores have healed completely can you reapply pressure to the area. Look for skin that is unbroken with normal coloring. Scars sometimes remain and may be a different color from surrounding skin. Note that scar tissue will be weaker than normal skin. Limit pressure to the area for 15 minutes the first time and then inspect it for redness. If you find redness, note how long it takes to fade. Redness that fades within 15 minutes means that no damage has occurred. After three successful 15-minute trials, you can increase pressure to 30 minutes per session using the same 15-minute benchmark for fading. Rebuild skin tolerance by increasing pressure by 30 minutes each day. If a pressure trial is unsuccessful, hold at that level until you achieve three successful pressure applications.
Preventing Pressure Sores
You can prevent pressure sores on your skin or a loved one by taking several measures. some of the following suggestions are also applicable if you want to prevent an early stage pressure sore from getting worse.
Use Foam Pads, Pillows, or Special Mattresses
Padding, which can also include foam wedges, seat cushions, and mattresses over will help take the pressure off sores. Avoid resting directly on your hip bone. Place pillows so that your weight resides on the fatty portion of the buttocks and to keep feet and ankles apart. A pillow under the calves will also lift the ankles slightly. Powder bedsheets lightly so the skin doesn’t rub on them.
Change Position Frequently
When in bed, change position every two hours. If you are unable to do so on your own, have a caregiver help you. When in a wheelchair, sit straight and upright so that you can move about more freely. Change positions every 15 minutes. Avoid slipping or sliding when changing positions. Also, try to avoid positions that put pressure on the sore.
Check for Sores Daily
Caregivers should check areas that patients can’t see. Keep skin clean and moisturized.
Smokers are more likely to get pressure sores because of the damage the habit does to blood circulation.
How Centric Healthcare Can Help
Patients who develop pressure sores usually have limited mobility. They may be recovering from surgery or have multiple issues that come with aging. Whether the situation is permanent or temporary, a home health aide from Centric Healthcare can help you or your loved one take care of a variety of needs that include companionship, grooming, eating, and personal hygiene. Our staff is trained to spot small problems and help you avoid them before they develop into bigger ones. We also can provide residents of Rochester, the Twin Cities, and surrounding areas with skilled nursing services to help patients deal with a variety of medical conditions. Contact us today to learn how we can give you peace of mind and make life easier.