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

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

http://www.bedsores-pressure-sores.com/

Treatments and drugs

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, appropriate general care that manages risk factors for pressure sores. Stage III and IV pressure sores are more difficult to treat. In a person who has a terminal illness or multiple chronic medical conditions, pressure sore treatment may focus primarily on managing pain rather than complete healing of a wound. Treatment team Addressing the many aspects of wound care usually requires a multidisciplinary approach. Members of a care team may include:
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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, orthopedic surgeon or plastic surgeon, 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. Strategies to reduce pressure include the following:
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Repositioning. A person with pressure sores needs to be repositioned regularly and placed in correct positions. 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. People confined to a bed should change positions every two hours. Lifting devices are often used to avoid friction during repositioning. Support surfaces. Special cushions, pads, mattresses and beds can help a person lie in an appropriate position, relieve pressure on an existing sore and protect vulnerable skin from damage. A variety of foam, air-filled or water-filled devices provide cushion for those sitting in wheelchairs. The type of devices used will depend on a person's condition, body type and mobility.

Removing damaged tissue To heal properly, wounds need to be free of damaged, dead or infected tissue. Removing these tissues (debridement) is accomplished with a number of methods, depending on the severity of the wound, your overall condition and the treatment goals. Options include:
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Surgical debridement involves cutting away dead tissues. Mechanical debridement uses one of a number of methods to loosen and remove wound debris, such as a pressurized irrigation device, a whirlpool water bath or specialized dressings. Autolytic debridement, the body's natural process of recruiting enzymes to break down dead tissue, can be enhanced with an appropriate dressing that keeps the wound moist and clean.

Enzymatic debridement is the use of chemical enzymes and appropriate dressings to break down dead tissues.

Cleaning and dressing wounds Care that promotes healing of the wound includes the following:
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Cleaning. It's essential to keep wounds clean to prevent infection. A stage I wound can be gently washed with water and mild soap, but open sores are cleaned with a saltwater (saline) solution each time the dressing is changed. Dressings. A dressing promotes healing by keeping a wound moist, creating a barrier against infection and keeping the surrounding skin dry. A variety of dressings are available, including films, gauzes, gels, foams and various treated coverings. A combination of dressings may be used. Your doctor selects an appropriate dressing based on a number of factors, such as the size and severity of the wound, the amount of discharge, and the ease of application and removal.

Other interventions Other interventions that may be used are:

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Pain management. Interventions that may reduce pain include the use of nonsteroidal antiinflammatory drugs such as ibuprofen (Motrin, Advil, others) and naproxen (Aleve, others) particularly before and after repositioning, debridement procedures and dressing changes. Topical pain medications, such as a combination of lidocaine and prilocaine, also may be used during debridement and dressing changes. Antibiotics. Pressure sores that are infected and don't respond to other interventions may be treated with topical or oral antibiotics. Healthy diet. Appropriate nutrition and hydration promote wound healing. Your doctor may recommend an increase in calories and fluids, a high protein diet, and an increase in foods rich in vitamins and minerals. Your doctor may also prescribe dietary supplements, such as vitamin C and zinc. Muscle spasm relief. Muscle relaxants such as diazepam (Valium), tizanidine (Zanaflex), 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.

Surgical repair Pressure sores that fail to heal may require surgical intervention. The goals of surgery include improving the hygiene and appearance of the sore, preventing or treating infection, reducing fluid loss through the wound, and lowering the risk of cancer. 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. In general, though, most pressure wounds are repaired using a pad of the person's own muscle, skin or other tissue to cover the wound and cushion the affected bone (flap reconstruction).

Coping and support

By Mayo Clinic staff

Treating and preventing pressure sores is demanding on the at-risk person, family members and caregivers. Issues that may need to be addressed by the doctor, nursing staff and social worker include the following:
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Community services. A social worker can help identify community groups that provide services, education and support groups for people dealing with long-term caregiving or terminal illnesses. End-of-life 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. Residential care. 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.

http://www.mayoclinic.com/health/bedsores/DS00570/DSECTION=coping-and-support

Bedsores, also known as pressure sores or decubitus ulcers, 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, such as the hip bones, tailbone and heels of the feet, are most susceptible to bedsores. Non-mobile patients are vulnerable to the formation pressure sores when left lying for long periods of time in the same prone position. 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. This often happens if you use a wheelchair or you are bedridden, even for a short period of time (for example, after surgery or an injury). The constant pressure against the skin reduces the blood supply to that area, and the affected tissue dies. A pressure ulcer starts as reddened skin but gets progressively worse, forming a blister, then an open sore, and finally a crater. The most common places for pressure ulcers are over bony prominences (bones close to the skin) like the elbow, heels, hips, ankles, shoulders, back, and the back of the head.
Causes

These factors increase the risk for pressure ulcers:

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Being bedridden or in a wheelchair Fragile skin Having a chronic condition, such as diabetes or vascular disease, that prevents areas of the body from receiving proper blood flow

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Inability to move certain parts of your body without assistance, 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 -- 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, from Stage I (earliest signs) to Stage IV (worst):
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Stage I: A reddened area on the skin that, when pressed, is "nonblanchable" (does not turn white). This indicates that a pressure ulcer is starting to develop. Stage II: The skin blisters or forms an open sore. The area around the sore may be red and irritated. Stage III: The skin breakdown now looks like a crater where there is damage to the tissue below the skin. Stage IV: The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes tendons and joints.

First Aid

Any new or changing pressure sore should be discussed with your doctor or nurse. Once a pressure ulcer is identified, steps must be taken immediately:

Relieve the pressure on that area. Use pillows, special foam cushions, and sheepskin to reduce the pressure. Treat the sore based on the stage of the ulcer. Your health care provider will give you specific treatment and care instructions. Avoid further trauma or friction. Powder the sheets lightly to decrease friction in bed. (There are many items made specifically for this purpose -- check a medical supplies store.) Improve nutrition and other underlying problems that may affect the healing process. If the pressure ulcer is at Stage II or worse, 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. Keep the area clean and free of dead tissue. Your health care provider will give you specific care directions. Generally, pressure ulcers are rinsed with a salt-water rinse to remove loose, dead tissue. The sore should be covered with special gauze dressing made for pressure ulcers.

New medicines that promote skin healing are now available and may be prescribed by your doctor.

Do Not

Do NOT massage the area of the ulcer. Massage can damage tissue under the skin. Donut-shaped or ring-shaped cushions are NOT recommended. They interfere with blood flow to that area and cause complications.

Call Immediately for Emergency Medical Assistance if

Contact your health care provider if an area of the skin blisters or forms an open sore. Contact the provider immediately if there are any signs of an infection. An infection can spread to the rest of the body and cause serious problems. 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, weakness, and confusion are signs that the infection may have spread to the blood or elsewhere in the body. Prevention

If bedridden or immobile due to diabetes, circulation problems, incontinence, or mental disabilities, you should be checked for pressure sores every day. You, or your caregiver, need to check your body from head to toe. Pay special attention to the areas where pressure ulcers often form. Look for reddened areas that, when pressed, do not turn white. Also look for blisters, sores, or craters. In addition, take the following steps:
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Change position at least every two hours to relieve pressure. Use items that can help reduce pressure -- pillows, sheepskin, foam padding, and powders from medical supply stores. Eat healthy, well-balanced meals that contain enough calories to keep you healthy.

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Drink plenty of water (8 to 10 cups) every day. Exercise daily, including range-of-motion exercises for immobile patients. Keep skin clean and dry. After urinating or having a bowel movement, clean the area and dry it well. A doctor can recommend creams to help protect the skin.

http://health.allrefer.com/health/pressure-ulcer-pressure-sore-prevention.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. The pressure cuts off the blood supply; without blood's oxygen and nutrients, skin tissue starts to die. Bed sores start with skin redness or a blister, but can progress to a deep wound that damages muscles, tendons, and bone. Following are ways to prevent bed sores:
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Change position in bed at least every two hours. In a wheelchair, change position at least hourly. If you're able to move yourself, shift position every 15 minutes. Do not lift the head of your bed greater than 30 degrees to prevent sliding and friction. Find a sitting or lying position that is 30 degrees toward one side of your body or the other, not squarely on the hip. Place a pillow under calves to keep your heels off the mattress. Place a pillow between the knees. Do not use donut-ring cushions, which can cut off circulation. Use a special bed mattress or wheelchair cushion.

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Wear special pads to protect skin that rests against braces and other devices. When moving someone, lift rather than drag. Use assistive devices, such as transfer boards and mechanical lifts. Try placing a sheepskin under a body part to decrease friction. Keep the skin clean and dry. Do not massage bony areas. If incontinent, use a protective cream on skin that may come in contact with urine or feces. 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. Keep sheets clean and free of wrinkles. Maintain good nutrition.

Recognizing Pressure Sores

Pressure sores are classified in four stages. Cabot P.O.L. CREAM can be effective to help prevent the development of stage one and stage two pressure sores.

http://www.cabotprotectives.com/Uses/Bed-Sores/Pressure-Sores-Ulcers-more/

Prevention
By Mayo Clinic staff

Bedsores are easier to prevent than to treat, but that doesn't mean the process is easy or uncomplicated. And wounds may still develop with consistent, appropriate preventive care. 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. These changes need to be frequent, repositioning needs to avoid stress on the skin, and body positions need to minimize the risk of

pressure on vulnerable areas. Other strategies include skin care, regular skin inspections and good nutrition. Repositioning in a wheelchair Repositioning in a wheelchair includes the following recommendations:
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Frequency. 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. Self-care. If you have enough strength in your upper body, you can do wheelchair push-ups raising your body off the seat by pushing on the arms of the chair. Specialized wheelchairs. Pressure-release wheelchairs, which tilt to redistribute pressure, provide some assistance in repositioning and pressure relief. Cushions. Various cushions including foam, gel, and water- or air-filled cushions can relieve pressure and help ensure that the body is appropriately positioned in the chair. A physical therapist can advise on the appropriate placement of cushions and their role in regular repositioning.

Repositioning in a bed Repositioning for a person confined to a bed includes the following recommendations:
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Frequency. Repositioning should occur every two hours. Repositioning devices. People with enough upper body strength may be able to reposition themselves with the assistance of a device such as a trapeze bar. Using bed linens to help lift and reposition a person can reduce friction and shearing. Special mattresses and support surfaces. Special cushions, foam mattress pads, air-filled mattresses and water-filled mattresses can help a person lie in an appropriate position, relieve pressure and protect vulnerable areas from damage. Your doctor or other care team member can recommend an appropriate mattress or surface. Bed elevation. Hospital beds that can be elevated at the head should be raised no more than 30 degrees to prevent shearing. Protecting bony areas. Bony areas can be protected with proper positioning and cushioning. Rather than lying directly on a hip, it's best to lie at an angle with cushions supporting the back or front. Cushions should also be used to relieve pressure against and between the knees and ankles. Heels can be cushioned or "floated" with cushions below the calves.

Skin care Protecting and monitoring the condition of the skin is important for preventing pressure sores and identifying stage I sores before they worsen.
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Bathing. Skin should be cleaned with mild soap and warm water and gently patted dry. Or a norinse cleanser can be used. Protecting skin. Skin that is vulnerable to excess moisture can be protected with talcum powder. Dry skin should have lotion applied. Inspecting skin. Daily skin inspection is important for identifying vulnerable areas of skin or early signs of pressure sores. Care providers usually need to help with a thorough skin inspection, but people with more mobility may be able to inspect their skin with the use of a mirror.

Managing incontinence. Urinary or bowel incontinence should be managed to prevent moisture and bacterial exposure to skin. Care may include frequently scheduled assistance with urinating, frequent diaper changes, protective lotions on healthy skin, urinary catheters or rectal tubes.

Nutrition Your doctor, dietitian or other members of the care team can recommend dietary changes that can help improve the health of your skin.
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Diet. You may need to increase the amount of calories, protein, vitamins and minerals in your diet. Your doctor may also prescribe dietary supplements, such as vitamin C and zinc. Fluids. Adequate hydration is important for maintaining healthy skin. Your care team can advise on how much fluid to drink and signs of poor hydration, such as decreased urine output, darker urine, dry or sticky mouth, thirst, dry skin, or constipation. Feeding assistance. Some people with limited mobility or significant weakness may need assistance with eating in order to get adequate nutrition.

Other strategies Other strategies that can help decrease the risk of pressures sores include the following:
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Quit smoking. If you smoke, quit. Talk to your doctor if you need assistance quitting. Stay active. Limited mobility is a key factor in causing pressure sores. However, daily exercise that is appropriately matched to a person's abilities is an important step in maintaining healthy skin. A physical therapist can recommend an appropriate exercise program that improves circulation, builds up vital muscle tissue, stimulates appetite and strengthens the body overall.

For Bed Sores (Anti Decubitus) Gel Cushion Full Back Suppor http://www.mayoclinic.com/health/bedsores/DS00570/DSECTION=prevention