A decubitus ulcer is a
pressure sore or what is
commonly called a "bed
sore". It can range from
a very mild pink
coloration of the skin,
which disappears in a
few hours after pressure
is relieved on the area, to
a very deep wound
extending to and
sometimes through a
bone into internal
organs. These ulcers, as
well as other wound
types, are classified in
stages according to the
severity of the wound.
All decubitus ulcers have
a course of injury similar
to a burn wound. This
can be a mild redness of
the skin and/or blistering,
such as a first-degree
burn, to a deep open
wound with blackened
tissue, as in a third
degree burn. This
blackened tissue is
called eschar.
Mechanism of decay from lack of blood pressure without
circulation. This is the damage. Prevention also
Formation basic formation of consists of protection
decubitus ulcer and padding to prevent
The usual mechanism of development. tissue abrasion, and
forming a decubitus ulcer maintaining hydration,
is from pressure. Nursing Care, nutrition and hygiene.
However it can also
occur from friction by Prevention and Sponsored Link
rubbing against Nursing Home Lawyer
something such as a bed
Treatment of Protect your loved one
sheet, cast, brace, etc., Decubitus from nursing home
or from prolonged neglect or abuse. Talk to
exposure to cold. Any
Ulcers a lawyer for free.
area of tissue that lies
The common areas of The treatment for a
just over a bone is much
decubitus ulcer formation decubitus ulcer involves
more likely to develop a
and prevention is a basic keeping the area clean
decubitus ulcer. These
nursing principle covered and removing necrotic
areas include the spine,
in nursing school (dead) tissue, which can
coccyx or tailbone, hips,
curriculum (LVN/LPN or form a breeding ground
heels, and elbows, to
RN) and most nursing for infection. There are
name a few. The weight
assistant programs as many procedures and
of the person's body
well. Prevention consists products available for
presses on the bone, the
of changing position this purpose. The use of
bone presses on the
every 2 hours or more antibiotics, when
tissue and skin that
frequently if needed. This appropriate is also part
cover it, and the tissue is
2-hour time frame is a of the treatment. Some
trapped between the
generally accepted deep wounds even
bone structure and bed
maximum interval that require surgical removal
or wheelchair surface.
the tissue can tolerate or debridement of
The tissue begins to
necrotic tissue. In some The basic treatment of Standards of Decubitus
situations amputation decubitus ulcers is
may be necessary. prevention. Prevention Care Ulcer
cannot be stressed too Formation and
The second portion of strongly. To this end, It remains true that
the treatment involves there are any number of decubitus ulcers are Treatment in
removing all pressure devices designed to generally considered Long-Term
from the involved area(s) protect and prevent the preventable and the
to prevent further formation of decubitus development of Care Facilities
damage of tissue and to ulcers. The decision of decubitus ulcers is
promote healing. which device to use is evidence of some form of In long-term care
Frequent turning is based on the location neglect [nutrition, facilities the rate of
mandatory to alleviate and severity of the hydration, positioning, decubitus ulcer
pressure on the wound wound. These devices infection control, etc]. development is higher for
and to promote healing. may be a Many paralyzed or a variety of reasons.
Along with cleaning, Medicare/Medicaid/Insur terminal individuals with
removal of dead tissue, ance-covered item when very poor nutrition can Due to staffing
and alleviating pressure, medically necessary. remain free of decubitus shortages, medical
the individual must have Most insurance's will ulcers. This is funding cuts and an
increased nutrition to cover any needed accomplished by good array of issues, most
allow for proper healing device, material, or patient care often being long-term care facilities
of the wounds. Without equipment necessary to provided by family are chronically
all of these elements prevent and treat members and non- understaffed. This results
being in place, the decubitus ulcers. licensed hired in patients not being
wounds will not heal and, Prevention is the most caregivers. Professional turned, cleaned and fed
in fact, will quickly humane and cost medical personnel as often as the ideal
worsen. effective approach to generally provide only a standard of nursing
care. minimum amount of would dictate.
Prevention medical assistance.
Prevention is achieved It is known that almost all
by diligent care. decubitus ulcers are
preventable. However Another emerging factor
the reality of long-term in long-term care is
care concludes that if a patient directed care.
patient does not have Alert and generally
massive weight loss, oriented individuals
chronic infections, or determine their own
wounds that do not heal care. These persons,
in two weeks then that though elderly and frail,
individual is receiving a are not declared
reasonable standard of incompetent. Patient's
care. It is not uncommon rights, as it is currently
for small wounds to practiced, allows for
develop, be treated and patient refusal of
heal quickly. This is medications, food, fluids
considered adequate and treatments such as
care. turning. This often results
in a lesser quality of care
Massive weight loss, being provided due to
massive deep wounds patient noncompliance.
over Stage II and chronic When this occurs, the
infections continue to be ideal situation is to
an unacceptable involve the patient,
standard of care. family, staff and
Massive wounds are physician in a plan of
generally a strong care that will be
indication of negligence acceptable and
in more than one area beneficial. Patient refusal
[hygiene, nutrition, of nutrition and
infection control, positioning may lead to
positioning, etc.]. the development of
decubitus ulcers as well.
In summary: In almost all Stage I
situations, the
development of massive This stage is
decubitus ulcers is characterized by a
evidence of some form of surface reddening of the
neglect. Generally the skin. The skin is
neglect is in more than unbroken and the wound
one area, i.e., hygiene is superficial. This would
and nutrition. It would be be a light sunburn or a
a very rare exception for first degree burn as well
this to not be true. as a beginning Decubitus
ulcer. The burn heals
Decubitus ulcers need spontaneously or the
to be viewed as a Decubitus ulcer quickly
preventable injury, not fades when pressure is
an excusable one. relieved on the area.
Stages of The key factors to
consider in a Stage I
Wounds wound is what was the
cause of the wound and
Wounds are often how to alleviate pressure
categorized according to on the area to prevent it
severity by the use of from worsening.
stages. The staging Improved nutritional
system applies to burn status of the individual
wounds, Decubitus should also be
ulcers (see Appendix considered early to
Two) and several other prevent wound
types of wounds. 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 during the course of Medical care is
cover, protect, and clean care. Quick attention to a necessary to promote
the area. Coverings Stage I Decubitus ulcer healing and to treat and
designed to insulate and or pressure wound will prevent infection. This
absorb as well as protect prevent the development type of wound will
are used. There is a wide of a Stage III Decubitus progress very rapidly if
variety of items for this ulcer or pressure wound. left unattended. Infection
purpose. Generally Decubitus is of grave concern.
ulcers or pressure
Skin lotions or emollients wounds developing Stage IV
are used to hydrate beyond Stage II is from
surrounding tissues and lack of aggressive A Stage IV wound
prevent the wound form intervention when first extends through the skin
worsening. Additional noted as a Stage I. [see and involves underlying
padding and protective notation]. muscle, tendons and
substances to decrease bone. The diameter of
the pressure on the area Stage III the wound is not as
are important. Close important as the depth.
attention to prevention, The wound extends This is very serious and
protection, nutrition, and through all of the layers can produce a life
hydration is important of the skin. It is a primary threatening infection,
also. With quick site for a serious especially if not
attention, a stage II infection to occur. aggressively treated. All
wound can heal very of the goals of protecting,
rapidly. The goals and cleaning and alleviation
treatments of alleviating of pressure on the area
A wound can appear to pressure and covering still apply. Nutrition and
be a Stage I wound upon and protecting the wound hydration is now critical.
initial evaluation, and still apply as well as an Without adequate
actually be reevaluated increased emphasis on nutrition, this wound will
as a Stage II wound nutrition and hydration. not heal.
Anyone with a Stage IV bone. It is difficult to
wound requires medical heal. Surgical removal of
care by someone skilled the necrotic or decayed
in wound care. Surgical tissue is the usual
removal of the necrotic treatment. Amputation
or decayed tissue is may be necessary is
often used on wounds of some situations.
larger diameter. A skilled
wound care physician, Notation
physical therapist or
nurse can sometimes It is possible for a wound
successfully treat a to "go from a stage I
smaller diameter wound wound to a stage III or
without the necessity of IV" without the
surgery. Surgery is the intermittent stage[s]
usual course of being observed. All
treatment. Amputation wound stages were
may be necessary is present just not obvious,
some situations. hence the need to treat
all wounds as serious
Stage V with the potential of
rapidly worsening.
This is an older
classification and not www.expertlaw.com
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