Family members who have somebody in long-term care must be vigilant about bedsores or decubitus ulcers. Bedsores are skin wounds caused by prolonged pressure on the skin which is in contact with a wheelchair or bed. Bedsores take a long time to heal, are painful and usually a precursor of life-threatening complications like bone infections and skin infections.
How Bedsores Form
Bedsores tend to form in areas where there is least muscle and fat padding, especially right over a bone. The shoulder blades, tailbone, elbows, heels and hips are common bedsore sites. Bedsores can occur even if a patient is in bed for twelve hours.
As blood flow stops or slows in the compressed area between the bed or wheelchair surface and the bone, circulation is impeded. If the tissue does not get enough nutrients and oxygen, the skin can die in even half a day, though evidence is unlikely to be noticeable for days or weeks.
If an illness, spinal cord injury or surgery causes immobility, the immobilized body’s pressure on some areas can break the skin down. In bed, the majority of risky areas are the heels and buttocks. The ankles, shoulders, most ear rims, hipbones and toes are also at risk. In a wheelchair, the most dangerous parts are the buttocks and tailbones, spine, shoulder blades as well as backs of legs and arms that touch the chair.
For bedsores, age is the main risk factor because older people tend to have vulnerable skin. In immobile seniors, even a simple skin tear can develop into a bedsore. Other risk factors include lack of pain perception, smoking, malnutrition, fecal or urinary incontinence, dementia and diabetes.
Treatment for Bedsores
Conditions like immobility, thin skin and diabetes make treating bedsore challenging. Stage 1 bedsores will often disappear when there is consistent and prompt repositioning. This requires a physician’s written orders.
Stage 2 bedsores require multi-disciplinary approach that coordinates the doctor, nurse, the aides and physical therapist. To determine the treatment, a careful analysis of the wound’s precipitation is necessary. Changing the bed, skin care, clothing or cushioning can help. There are other things which can aid with bedsore healing.
- Wound cleaning and debridement. A saline solution may be used to treat open sores when changing the dressing. Debridement involves removing the damaged tissue. Usually, surgical debridement is recommended in order to remove damaged, infected or dead tissue. Nonsurgical treatments include the use of the body’s enzymes, whirlpool bath hydrotherapy, irrigation with pressurized water and topical debriding enzyme application.
- Dressings. It is important to use the right bandaging to accelerate healing and protect the wound. The wound must be kept moist and the surrounding skin dry. Semi-permeable and transparent dressings can be helpful in retaining moisture and encouraging new skin growth. Topical antibiotics may be used for treating infected wounds.
- Improved Nutrition. Green, orange and dark red vegetables are rich in nutrients needed to fight bedsores. They have zinc and vitamin C which can really help.
Even with the best medical care, surgery may be necessary for bedsores. It is possible to take healthy tissue from a part of the body that will be used to reconstruct the damaged area. Recovery from bedsores will be long process with frequent complications.
- Regular Repositioning. To prevent bedsores, it is imperative to re-position the body at least every thirty minutes in a wheelchair or two hours in bed. Also, using special beds, mattresses and pillows is equally important.
- Leg Support. The patient must not lie directly on his hipbones and must support the legs correctly using a pillow or foam pad. The support must be placed under the legs from the calf’s middle to the ankle ensuring the ankles and knees are kept from touching.
- Inspection. Inspection is necessary to detect bedsores in the early stages while they can be cured more easily. Although this requires caregivers to get up personal and close with the patient, Bradford Place, a leading assisted living facility in Benchmark Court Swansea IL, believes that this process is essential.