Decubitus Ulcers, Bed Sores & Pressure Sores

Decubitus ulcers also called bedsores and/or pressure sores can be serious and life threatening. Failure of the nurses to reposition the patient, allowing them to stay in the same position for hours at a time causes bedsore/pressure sores. Failure by the nursing home to have a sufficient number of nurses aids to assist the patient in turning from side to side, change out urine soaked bed sheets or feces on the patients skin, may lead to skin or dermal breakdown leading to festering necrotic sores. If these ulcers are left untreated, these pressure ulcers can advance into septicemia, gangrene, and osteomylitis and even death. Many times these can be eliminated by the spending of resources "money" by a Nursing Home to hire additional nurses, aids, buy sufficient number of extra linens, gloves, gowns and dressings. Also, many times the nurses are not adequately trained, have criminal backgrounds of abuse or assaults, do not follow the patient individualized care plan, and do not follow the families wishes,or the doctor's orders and are verbally and physically abuse to our loved ones. Other Forms of Neglect & Abuse Nursing home abuse and/or nursing home neglect can take many forms including bedsores, skin ulcers, pressure sores, decubitus ulcers, septicemia, gangrene, malnutrition, dehydration, burns, sexual assault (rape), falls, overdoses, infections, osteomyelitis, threats, strangulations and deaths. Unfortunately most of theses abuses to a patient's dignity go unreported & unpunished. Nursing home law states that a nursing home must care for the resident in such a manner and in such an environment as will promote maintenance or enhancement of the quality of life of each resident. Duties of a Nursing Home

then call and speak to an attorney about your legal rights to a Nursing Home Negligence or Malpractice Lawsuit.. their final days of this earth are a living hell.bedsores-pressure-sores.. Nursing Home Neglect ? Talk to a Lawyer If you or a loved one have been the victim of neglect or abuse by a Nursing Home resulting in severe pressure sores. Shockingly a large percentage of nursing homes fail to protect the residents from nursing home abuse and neglect. nursing and psychosocial needs of the resident and is to be periodically reviewed and updated. Because money is the name of the game instead. infections or their wrongful death. investigators sometimes State inspectors overseeing the Nursing Home. psycholosocial well-being of each resident in accordance with a written plan of care. This plan of care describes the medical.. often times they quickly CLEAN UP THEIR ACT. in many cases the overall care and appearance of many of the nursing homes change . gangrene. bad Nurses seem to be dismissed and MOST IMPORTANTLY. rape..Further the nursing facility "must provide services and activities to attain or maintain the highest practicable physical. The nursing homes start to get cleaner. septicema. smell better. food taste improves. ignoring their duties and obligations under the law. they now have attorneys. . in that soon after lawsuits get filed. many nursing homes treat the residents like a bunch of cattle. instead of the "GOLDEN YEARS " they worked so hard for and deserve ! Nursing Home Abuse Attorney Nursing Home cases can be especially rewarding to me as an attorney. sexual assualt. the care to the patients improves. bedsores. Further the nursing home must conduct a comprehensive assessment that describes the patient's capability to perform daily functions and significant impairments. mental.When the owners and the Staff know that notes and photos are being taken. For many residents.

Treatments and drugs .

People using a wheelchair should change position as much as possible on their own every 15 minutes and should have assistance with changes in position every hour. Removing these tissues (debridement) is accomplished with a number of methods. dead or infected tissue. relieve pressure on an existing sore and protect vulnerable skin from damage. Options include: y y y Surgical debridement involves cutting away dead tissues. a whirlpool water bath or specialized dressings. can be enhanced with an appropriate dressing that keeps the wound moist and clean. The type of devices used will depend on a person's condition. Strategies to reduce pressure include the following: y y Repositioning. depending on whether surgery is required and what type of surgery is needed Relieving pressure The first step in treating a sore at any stage is relieving the pressure that caused it. your overall condition and the treatment goals. In a person who has a terminal illness or multiple chronic medical conditions. wounds need to be free of damaged. pressure sore treatment may focus primarily on managing pain rather than complete healing of a wound. A variety of foam. Special cushions. Members of a care team may include: y y y y y y y A primary care physician who oversees the treatment plan A physician specializing in wound care Nurses or medical assistants who provide both care and education for managing wounds A social worker who helps a person or family access appropriate resources and addresses emotional concerns related to long-term recovery A physical therapist who helps with improving mobility A dietitian who assesses nutritional needs and recommends an appropriate diet A neurosurgeon. appropriate general care that manages risk factors for pressure sores. Removing damaged tissue To heal properly. air-filled or water-filled devices provide cushion for those sitting in wheelchairs. Mechanical debridement uses one of a number of methods to loosen and remove wound debris. People confined to a bed should change positions every two hours.By Mayo Clinic staff Stage I and stage II pressure sores usually heal within several weeks to months with conservative care of the wound and with ongoing. mattresses and beds can help a person lie in an appropriate position. A person with pressure sores needs to be repositioned regularly and placed in correct positions. orthopedic surgeon or plastic surgeon. Lifting devices are often used to avoid friction during repositioning. Treatment team Addressing the many aspects of wound care usually requires a multidisciplinary approach. Autolytic debridement. Stage III and IV pressure sores are more difficult to treat. the body's natural process of recruiting enzymes to break down dead tissue. body type and mobility. pads. Support surfaces. depending on the severity of the wound. such as a pressurized irrigation device. .

a high protein diet. A stage I wound can be gently washed with water and mild soap. foams and various treated coverings. Pressure sores that are infected and don't respond to other interventions may be treated with topical or oral antibiotics. but open sores are cleaned with a saltwater (saline) solution each time the dressing is changed. Surgical repair Pressure sores that fail to heal may require surgical intervention. Other interventions Other interventions that may be used are: y y y y Pain management. others) particularly before and after repositioning. The goals of surgery include improving the hygiene and appearance of the sore. preventing or treating infection. Coping and support By Mayo Clinic staff . skin or other tissue to cover the wound and cushion the affected bone (flap reconstruction). Cleaning and dressing wounds Care that promotes healing of the wound includes the following: y y Cleaning.y Enzymatic debridement is the use of chemical enzymes and appropriate dressings to break down dead tissues. Antibiotics. It's essential to keep wounds clean to prevent infection. though. tizanidine (Zanaflex). such as a combination of lidocaine and prilocaine. and an increase in foods rich in vitamins and minerals. The type of reconstruction that's best in any particular case depends mainly on the location of the wound and whether there's scar tissue from a previous operation. Healthy diet. such as vitamin C and zinc. Advil. dantrolene (Dantrium) and baclofen may inhibit muscle spasms and enable the healing of sores that may have been caused or worsened by spasm-related friction or shearing. such as the size and severity of the wound. creating a barrier against infection and keeping the surrounding skin dry. including films. Topical pain medications. Muscle spasm relief. others) and naproxen (Aleve. Muscle relaxants such as diazepam (Valium). reducing fluid loss through the wound. Appropriate nutrition and hydration promote wound healing. Your doctor selects an appropriate dressing based on a number of factors. A combination of dressings may be used. gauzes. A variety of dressings are available. gels. In general. Your doctor may also prescribe dietary supplements. most pressure wounds are repaired using a pad of the person's own muscle. the amount of discharge. Interventions that may reduce pain include the use of nonsteroidal antiinflammatory drugs such as ibuprofen (Motrin. and lowering the risk of cancer. also may be used during debridement and dressing changes. debridement procedures and dressing changes. and the ease of application and removal. A dressing promotes healing by keeping a wound moist. Your doctor may recommend an increase in calories and fluids. Dressings.

A social worker can help identify community groups that provide services. Issues that may need to be addressed by the doctor. People with limited mobility who live in residential or nursing care facilities are at increased risk of developing pressure sores. Family and friends of people living in these facilities can be advocates for the residents and work with nursing staff to ensure proper preventive care. Physicians and nurses specializing in end-of-life palliative care care that focuses on managing pain and providing comfort can help a family determine treatment goals when the person with pressure sores is approaching the end of life. http://www. nursing staff and social worker include the following: y y y Community . Residential care. End-of-life care.Treating and preventing pressure sores is demanding on the at-risk person. family members and caregivers. education and support groups for people dealing with long-term caregiving or terminal illnesses.

back. tailbone and heels of the feet. hips. A pressure ulcer starts as reddened skin but gets progressively worse. and finally a crater. are a breakdown and ulceration of tissue due to a combination of the weight of the body on the surface of the skin and the friction of a resistant surface such as a bed. Areas where bony prominences are less padded by muscle and fat. Definition A pressure ulcer is an area of skin that breaks down when you stay in one position for too long without shifting your weight. such as the hip bones. ankles.Bedsores. Non-mobile patients are vulnerable to the formation pressure sores when left lying for long periods of time in the same prone position. after surgery or an injury). then an open sore. The most common places for pressure ulcers are over bony prominences (bones close to the skin) like the elbow. and the affected tissue dies. are most susceptible to bedsores. This often happens if you use a wheelchair or you are bedridden. Causes These factors increase the risk for pressure ulcers: y y y Being bedridden or in a wheelchair Fragile skin Having a chronic condition. The constant pressure against the skin reduces the blood supply to that area. shoulders. also known as pressure sores or decubitus ulcers. forming a blister. that prevents areas of the body from receiving proper blood flow . and the back of the head. heels. such as diabetes or vascular disease. even for a short period of time (for example.

special foam cushions. (There are many items made specifically for this purpose -. Your health care provider will give you specific care directions. Your health care provider will give you specific treatment and care instructions. such as after spinal or brain injury or if you have a neuromuscular disease (like multiple sclerosis) Malnourishment Mental disability from conditions such as Alzheimer's disease -. when pressed. steps must be taken immediately: Relieve the pressure on that area. your health care provider will give you specific instructions on how to clean and care for open ulcers. It is very important to do this properly to prevent infection. Avoid further trauma or friction. from Stage I (earliest signs) to Stage IV (worst): y y y y Stage I: A reddened area on the skin that. Treat the sore based on the stage of the ulcer.) Improve nutrition and other underlying problems that may affect the healing process.check a medical supplies store. and sheepskin to reduce the pressure. Once a pressure ulcer is identified. Stage III: The skin breakdown now looks like a crater where there is damage to the tissue below the skin. Powder the sheets lightly to decrease friction in bed. Stage IV: The pressure ulcer has become so deep that there is damage to the muscle and bone. The sore should be covered with special gauze dressing made for pressure ulcers. The area around the sore may be red and irritated. First Aid Any new or changing pressure sore should be discussed with your doctor or nurse. .y y y y y Inability to move certain parts of your body without assistance. dead tissue. This indicates that a pressure ulcer is starting to develop. If the pressure ulcer is at Stage II or worse. is "nonblanchable" (does not turn white). Keep the area clean and free of dead tissue. and sometimes tendons and joints. Use pillows. Generally.the patient may not be able to properly prevent or treat pressure ulcers Older age Urinary incontinence or bowel incontinence Symptoms & Signs Pressure sores are categorized by severity. Stage II: The skin blisters or forms an open sore. pressure ulcers are rinsed with a salt-water rinse to remove loose.

or your caregiver. or mental disabilities. An infection can spread to the rest of the body and cause serious problems. well-balanced meals that contain enough calories to keep you healthy. take the following steps: y y y Change position at least every two hours to relieve pressure. and powders from medical supply stores. and confusion are signs that the infection may have spread to the blood or elsewhere in the body. Call Immediately for Emergency Medical Assistance if Contact your health care provider if an area of the skin blisters or forms an open sore. when pressed. weakness. Signs of an infected ulcer include: A foul odor from the ulcer Redness and tenderness around the ulcer Skin close to the ulcer is warm and swollen Fever. do not turn white. Donut-shaped or ring-shaped cushions are NOT recommended. Prevention If bedridden or immobile due to diabetes. Use items that can help reduce pressure -. sores. Pay special attention to the areas where pressure ulcers often form. Do Not Do NOT massage the area of the ulcer. incontinence. Look for reddened areas that. you should be checked for pressure sores every day. Also look for blisters. circulation problems. foam padding. Contact the provider immediately if there are any signs of an infection. Massage can damage tissue under the skin.New medicines that promote skin healing are now available and may be prescribed by your doctor. need to check your body from head to toe.pillows. You. . or craters. sheepskin. Eat healthy. They interfere with blood flow to that area and cause complications. In addition.

Keep skin clean and dry. . clean the area and dry it well. The pressure cuts off the blood supply. Place a pillow under calves to keep your heels off the mattress. In a wheelchair.html Information on preventing bed sores Bed sores (pressure sores) are caused by pressure-typically prolonged and over bony parts of the body in people who are restricted to a bed or chair. not squarely on the hip. Do not lift the head of your bed greater than 30 degrees to prevent sliding and friction.y y y y Drink plenty of water (8 to 10 cups) every day. skin tissue starts to die. without blood's oxygen and nutrients. which can cut off circulation. tendons. Do not use donut-ring cushions. Place a pillow between the knees. Following are ways to prevent bed sores: y y y y y Change position in bed at least every two hours. including range-of-motion exercises for immobile patients.allrefer. Exercise daily. Find a sitting or lying position that is 30 degrees toward one side of your body or the other. http://health. and bone. If you're able to move yourself. After urinating or having a bowel movement. change position at least hourly. shift position every 15 minutes. Use a special bed mattress or wheelchair cushion. A doctor can recommend creams to help protect the Bed sores start with skin redness or a blister. but can progress to a deep wound that damages muscles.

When moving someone. such as transfer boards and mechanical lifts. Keep sheets clean and free of . Cabot P. lift rather than drag. Recognizing Pressure Sores Pressure sores are classified in four stages. Do not massage bony areas.cabotprotectives.O. Use assistive devices. Keep the skin clean and dry. Try placing a sheepskin under a body part to decrease friction.L. Maintain good nutrition. Do not let feces or urine remain in contact with skin for extended periods of time. Check skin at least daily for signs of pressure problems. http://www. If incontinent. CREAM can be effective to help prevent the development of stage one and stage two pressure sores. use a protective cream on skin that may come in contact with urine or feces.y y y y y y Wear special pads to protect skin that rests against braces and other devices.

These changes need to be frequent. repositioning needs to avoid stress on the skin. Your doctor and other members of a care team can help develop a strategy that's appropriate whether it's personal care with at-home assistance or professional care in a hospital or residential setting. Position changes are key to pressure sore prevention. and body positions need to minimize the risk of . And wounds may still develop with consistent.Prevention By Mayo Clinic staff Bedsores are easier to prevent than to treat. but that doesn't mean the process is easy or uncomplicated. appropriate preventive care.

you can do wheelchair push-ups raising your body off the seat by pushing on the arms of the chair. Protecting bony areas. it's best to lie at an angle with cushions supporting the back or front. foam mattress pads. Heels can be cushioned or "floated" with cushions below the calves. Special cushions. Skin that is vulnerable to excess moisture can be protected with talcum powder. Specialized wheelchairs. Rather than lying directly on a hip. Pressure-release wheelchairs. Bed elevation. Daily skin inspection is important for identifying vulnerable areas of skin or early signs of pressure sores. which tilt to redistribute pressure. Cushions should also be used to relieve pressure against and between the knees and ankles. Skin care Protecting and monitoring the condition of the skin is important for preventing pressure sores and identifying stage I sores before they worsen. Bony areas can be protected with proper positioning and cushioning. air-filled mattresses and water-filled mattresses can help a person lie in an appropriate position. gel. Various cushions including foam. Protecting skin. and water. Hospital beds that can be elevated at the head should be raised no more than 30 degrees to prevent shearing. Your doctor or other care team member can recommend an appropriate mattress or surface. People with enough upper body strength may be able to reposition themselves with the assistance of a device such as a trapeze bar. Skin should be cleaned with mild soap and warm water and gently patted dry. Repositioning in a bed Repositioning for a person confined to a bed includes the following recommendations: y y y y y Frequency. Special mattresses and support surfaces. Cushions. Repositioning should occur every two hours. Self-care. but people with more mobility may be able to inspect their skin with the use of a mirror. Inspecting skin. . Dry skin should have lotion applied. regular skin inspections and good nutrition. Other strategies include skin care. y y y Bathing.or air-filled cushions can relieve pressure and help ensure that the body is appropriately positioned in the chair. Or a norinse cleanser can be used. People using a wheelchair should change position as much as possible on their own every 15 minutes and should have assistance with changes in position every hour. Using bed linens to help lift and reposition a person can reduce friction and shearing. Repositioning in a wheelchair Repositioning in a wheelchair includes the following recommendations: y y y y Frequency. relieve pressure and protect vulnerable areas from damage. provide some assistance in repositioning and pressure relief. Repositioning devices. Care providers usually need to help with a thorough skin inspection. If you have enough strength in your upper body.pressure on vulnerable areas. A physical therapist can advise on the appropriate placement of cushions and their role in regular repositioning.

darker urine. urinary catheters or rectal tubes.y Managing incontinence. Other strategies Other strategies that can help decrease the risk of pressures sores include the following: y y Quit smoking. quit. stimulates appetite and strengthens the body overall. dry or sticky mouth. dry skin. . or constipation. protein. frequent diaper changes. However. such as vitamin C and zinc. Stay active. Feeding assistance. Some people with limited mobility or significant weakness may need assistance with eating in order to get adequate nutrition. dietitian or other members of the care team can recommend dietary changes that can help improve the health of your skin. If you smoke. Nutrition Your doctor. Your care team can advise on how much fluid to drink and signs of poor hydration. protective lotions on healthy skin. Adequate hydration is important for maintaining healthy skin. A physical therapist can recommend an appropriate exercise program that improves circulation. Fluids. thirst. Your doctor may also prescribe dietary supplements. y y y Diet. builds up vital muscle tissue. You may need to increase the amount of calories. Care may include frequently scheduled assistance with urinating. such as decreased urine output. Limited mobility is a key factor in causing pressure sores. Urinary or bowel incontinence should be managed to prevent moisture and bacterial exposure to skin. vitamins and minerals in your diet. Talk to your doctor if you need assistance quitting. daily exercise that is appropriately matched to a person's abilities is an important step in maintaining healthy skin.

mayoclinic.For Bed Sores (Anti Decubitus) Gel Cushion Full Back Suppor .

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