BEDSORES

I. General Medical Background

A. Definition
Bedsores
More properly known as pressure ulcers or decubitus
Are lesions caused by unrelieved pressure to any part of the body,
especially portions over bony or cartilaginous areas.
Although completely treatable if found early, without medical attention,
bedsores can become life-threatening.
B. Classification
tage !
!s the most superficial, indicated by redness that does not subside after
pressure is relieved.
"his stage is visually similar to reactive hyperemia #a technical term for
e$cessive redness% seen in skin after prolonged application of pressure.
&an be distinguished from reactive hyperemia in two ways'
- (eactive hyperemia resolves itself within )*+ of the time pressure was
applied
- (eactive hyperemia blanches when pressure is applied, whereas a
tage ! pressure ulcer does not.
"he skin may be hotter or cooler than normal, have an odd te$ture, or
perhaps be painful to the patient.
Although easy to identify on a light-skinned patient, ulcers on darker-
skinned individuals may show up as shades of purple or blue in
comparison to lighter skin tones.
tage !!
!s damage to the epidermis e$tending into, but no deeper than, the
dermis.
!n this stage, the ulcer may be referred to as a blister or abrasion.
tage !!!
!nvolves the full thickness of the skin, e$tending into, but not through, the
subcutaneous tissue layer.
"his layer has a relatively poor blood supply and can be difficult to heal.
At this stage, there may be undermining that makes the wound much
larger than it may seem on the surface.
tage !,
!s the deepest, e$tending into the muscle, tendon or even bone.
-nstageable pressure ulcers
Are covered with dead cells, or eschar and wound e$udate, so the depth
cannot be determined.
C. Epidemiology
.ithin acute care, the incidence of bedsores is /.+0 to )102 within long-term
care, 3.30 to 3).402 and in home care, /0 to 560.
"here is the same wide variation in prevalence' 5/0 to 510 in acute care,
3.)0 to 310 in long-term care, and /0 to 340 in home care.
"here is a much higher rate of bedsores in intensive care units because of
immunocompromised individuals, with 10 to +/0 of !&- patients developing
bedsores
D. Etiology
Bedsores are accepted to be caused by three different tissue forces'
7ressure, or the compression of tissues.
hear force, or a force created when the skin of a patient stays in one
place as the deep fascia and skeletal muscle slide down with gravity.
8riction, or a force resisting the shearing of skin.
Aggravating the situation may be other conditions such as'
5
9$cess moisture from incontinence, perspiration or e$udate.
:ver time, this e$cess moisture may cause the bonds between epithelial
cells to weaken thus resulting in the maceration of the epidermis.
:ther factors in the development of bedsores include'
Age
;utrition
,ascular disease
<iabetes mellitus
moking
E. Pathophysiology
7ressure ulcers may be caused by inade=uate blood supply and resulting
reperfusion in>ury when blood re-enters tissue.
A simple e$ample of a mild pressure sore may be e$perienced by healthy
individuals while sitting in the same position for e$tended periods of time'
the dull ache e$perienced is indicative of impeded blood flow to affected
areas.
.ithin hours, this shortage of blood supply, called ischemia, may lead to
tissue damage and cell death.
"he sore will initially start as a red, painful area, which eventually turns
purple.
?eft untreated, the skin may break open and become infected.
Moist skin is more sensitive to tissue ischemia and necrosis and is also more
likely to get infected.
F. Complications
7ressure sores can trigger other ailments, and cause patients considerable
suffering and financial cost.
ome complications include'
Autonomic dysrefle$ia
Bladder distension
:steomyelitis
7yarthroses
epsis
Amyloidosis
Anemia
-rethral fistula
Gangrene
Malignant transformation #rarely%
ores often recur because patients do not follow recommended treatment or
develop seromas, hematomas, infections, or dehiscence.
7aralytic patients are the most likely people to have pressure sores recur.
!n some cases, complications from pressure sores can be life-threatening.
"he most common causes of fatality stem from renal failure and amyloidosis.
G. Diagnosis
<iagnosis is mainly through inspection
H. Prognosis
.ith higher stages, healing time is prolonged.
.hile about 6@0 of tage !! ulcers heal within eight weeks, only A30 of
tage !, pressure ulcers ever heal, and only @30 heal within one year.
!t is important to note that pressure ulcers do not regress in stage as they
heal.
A pressure ulcer that is becoming shallower with healing is described in terms
of its original deepest depth #e.g., healing tage !! pressure ulcer%.
II. General Bealth &are !nterventions
A. Deridement
B. Infection control
C. "#tritional s#pport
D. Ho$ to properly care for a edsore
E. Ed#cating the caregi%er
F. &o#nd inter%ention
3