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06.12.

2010 Decubitus Ulcer Information and Stage…

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Decubitus Ulcer Information and Stages of Wounds by Expert's Name:
By Linda D. Pershall

More article s by Lin da Explanation of Decubitus Ulcers OR by Topic Name & State:
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Suggested Minimal A decubitus ulcer is a pressure sore or what is commonly called a "bed sore". It can range from a
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very mild pink coloration of the skin, which disappears in a few hours after pressure is relieved on
T erm Care Facilitie the area, to a very deep wound extending to and sometimes through a bone into internal organs. Find Experts
These ulcers, as well as other wound types, are classified in stages according to the severity of the
wound. Resources
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about new articles - All decubitus ulcers have a course of injury similar to a burn wound. This can be a mild redness of
join the ExpertPages the skin and/or blistering, such as a first-degree burn, to a deep open wound with blackened Rules of Evidence (State)
Mailing List now tissue, as in a third degree burn. This blackened tissue is called eschar. Rules of Evidence
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MECHANISM OF FORMATION Articles on Selecting &
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The usual mechanism of forming a decubitus ulcer is from pressure. However it can also occur Topic-specific expert
from friction by rubbing against something such as a bed sheet, cast, brace, etc., or from articles
prolonged exposure to cold. Any area of tissue that lies just over a bone is much more likely to develop a decubitus ulcer. Get listed in
These areas include the spine, coccyx or tailbone, hips, heels, and elbows, to name a few. The weight of the person’s body AttorneyPages.com
presses on the bone, the bone presses on the tissue and skin that cover it, and the tissue is trapped between the bone Get legal forms
structure and bed or wheelchair surface. The tissue begins to decay from lack of blood circulation. This is the basic Let us help you find an
formation of decubitus ulcer development. expert
NURSING CARE, PREVENTION AND TREATMENT OF DECUBITUS ULCERS
For Experts:
The common areas of decubitus ulcer formation and prevention is a basic nursing principle covered in nursing school
curriculum (LVN/LPN or RN) and most nursing assistant programs as well. Prevention consists of changing position every 2 Articles on attorney-expert
hours or more frequently if needed. This 2-hour time frame is a generally accepted maximum interval that the tissue can relations
tolerate pressure without damage. Prevention also consists of protection and padding to prevent tissue abrasion, and How to be a Succssful
maintaining hydration, nutrition and hygiene. Expert Witness and other
professional expert articles
The treatment for a decubitus ulcer involves keeping the area clean and removing necrotic (dead) tissue, which can form a
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breeding ground for infection. There are many procedures and products available for this purpose. The use of antibiotics,
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when appropriate is also part of the treatment. Some deep wounds even require surgical removal or debridement of necrotic
tissue. In some situations amputation may be necessary.
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The second portion of the treatment involves removing all pressure from the involved area(s) to prevent further damage of
tissue and to promote healing. Frequent turning is mandatory to alleviate pressure on the wound and to promote healing. Legal information
Along with cleaning, removal of dead tissue, and alleviating pressure, the individual must have increased nutrition to allow for Ask a legal question
proper healing of the wounds. Without all of these elements being in place, the wounds will not heal and, in fact, will quickly Find a lawyer
worsen.

PREVENTION

The basic treatment of decubitus ulcers is prevention. Prevention cannot be stressed too strongly. To this end, there are any
number of devices designed to protect and prevent the formation of decubitus ulcers. The decision of which device to use is
based on the location and severity of the wound. These devices may be a Medicare/Medicaid/Insurance-covered item when
medically necessary. Most insurance’s will cover any needed device, material, or equipment necessary to prevent and treat
decubitus ulcers. Prevention is the most humane and cost effective approach to care.

STANDARDS OF CARE

It remains true that decubitus ulcers are generally considered preventable and the development of decubitus ulcers is
evidence of some form of neglect [nutrition, hydration, positioning, infection control, etc]. Many paralyzed or terminal
individuals with very poor nutrition can remain free of decubitus ulcers. This is accomplished by good patient care often
being provided by family members and non-licensed hired caregivers. Professional medical personnel generally provide only

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06.12.2010 Decubitus Ulcer Information and Stage…
a minimum amount of medical assistance. Prevention is achieved by diligent care.

Decubitus ulcer formation and treatment in long -term care facilities

In long-term care facilities the rate of decubitus ulcer development is higher for a variety of reasons. Due to staffing
shortages, medical funding cuts and an array of issues, most long-term care facilities are chronically understaffed. This results
in patients not being turned, cleaned and fed as often as the ideal standard of nursing would dictate.

It is known that almost all decubitus ulcers are preventable. However the reality of long-term care concludes that if a patient
does not have massive weight loss, chronic infections, or wounds that do not heal in two weeks then that individual is
receiving a reasonable standard of care. It is not uncommon for small wounds to develop, be treated and heal quickly. This
is considered adequate care.

Massive weight loss, massive deep wounds over Stage II and chronic infections continue to be an unacceptable standard of
care. Massive wounds are generally a strong indication of negligence in more than one area [hygiene, nutrition, infection
control, positioning, etc.].

Another emerging factor in long-term care is patient directed care. Alert and generally oriented individuals determine their
own care. These persons, though elderly and frail, are not declared incompetent. Patient’s rights, as it is currently practiced,
allows for patient refusal of medications, food, fluids and treatments such as turning. This often results in a lesser quality of
care being provided due to patient noncompliance. When this occurs, the ideal situation is to involve the patient, family, staff
and physician in a plan of care that will be acceptable and beneficial. Patient refusal of nutrition and positioning may lead to
the development of decubitus ulcers as well.

In summary: In almost all situations, the development of massive decubitus ulcers is evidence of some form of neglect.
Generally the neglect is in more than one area, i.e., hygiene and nutrition. It would be a very rare exception for this to not be
true.

Decubitus ulcers need to be viewed as a preventable injury, not an excusable one.

STAGES OF WOUNDS

Wounds are often categorized according to severity by the use of stages. The staging system applies to burn wounds,
Decubitus ulcers and several other types of wounds.

STAGE I

This stage is characterized by a surface reddening of the skin. The skin is unbroken and the wound is superficial. This would
be a light sunburn or a first degree burn as well as a beginning Decubitus ulcer. The burn heals spontaneously or the
Decubitus ulcer quickly fades when pressure is relieved on the area.

The key factors to consider in a Stage I wound is what was the cause of the wound and how to alleviate pressure on the
area to prevent it from worsening. Improved nutritional status of the individual should also be considered early to prevent
wound worsening. The presence of a Stage I wound is an indication or early warning of a problem and a signal to take
preventive action.

Treatment consists of turning or alleviating pressure in some form or avoiding more exposure to the cause of the injury as
well as covering, protecting, and cushioning the area. Soft protective pads and cushions are often used for this purpose. An
increase in vitamin C, proteins, and fluids is recommended. Increased nutrition is part of prevention.

STAGE II

This stage is characterized by a blister either broken or unbroken. A partial layer of the skin is now injured. Involvement is
no longer superficial.

The goal of care is to cover, protect, and clean the area. Coverings designed to insulate and absorb as well as protect are
used. There is a wide variety of items for this purpose.

Skin lotions or emollients are used to hydrate surrounding tissues and prevent the wound form worsening. Additional
padding and protective substances to decrease the pressure on the area are important. Close attention to prevention,
protection, nutrition, and hydration is important also. With quick attention, a stage II wound can heal very rapidly.

A wound can appear to be a Stage I wound upon initial evaluation, and actually be reevaluated as a Stage II wound during
the course of care. Quick attention to a Stage I Decubitus ulcer or pressure wound will prevent the development of a Stage
III Decubitus ulcer or pressure wound. Generally Decubitus ulcers or pressure wounds developing beyond Stage II is from
lack of aggressive intervention when first noted as a Stage I. [see notation].

STAGE III

The wound extends through all of the layers of the skin. It is a primary site for a serious infection to occur.

The goals and treatments of alleviating pressure and covering and protecting the wound still apply as well as an increased
emphasis on nutrition and hydration.

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06.12.2010 Decubitus Ulcer Information and Stage…
Medical care is necessary to promote healing and to treat and prevent infection. This type of wound will progress very
rapidly if left unattended. Infection is of grave concern.

STAGE IV

A Stage IV wound extends through the skin and involves underlying muscle, tendons and bone. The diameter of the wound
is not as important as the depth. This is very serious and can produce a life threatening infection, especially if not aggressively
treated. All of the goals of protecting, cleaning and alleviation of pressure on the area still apply. Nutrition and hydration is
now critical. Without adequate nutrition, this wound will not heal.

Anyone with a Stage IV wound requires medical care by someone skilled in wound care. Surgical removal of the necrotic or
decayed tissue is often used on wounds of larger diameter. A skilled wound care physician, physical therapist or nurse can
sometimes successfully treat a smaller diameter wound without the necessity of surgery. Surgery is the usual course of
treatment. Amputation may be necessary is some situations.

STAGE V

This is an older classification and not now used in all areas. A stage 5 wound is a wound that is extremely deep, having gone
through the muscle layers and now involves underlying organs and bone. It is difficult to heal. Surgical removal of the necrotic
or decayed tissue is the usual treatment. Amputation may be necessary is some situations.

Notation

It is possible for a wound to "go from a stage I wound to a stage III or IV" without the intermittent stage[s] being observed.
All wound stages were present just not obvious, hence the need to treat all wounds as serious with the potential of rapidly
worsening.

By: Linda D. Pershall. E-mail: email@ldhpmed.com


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