Many of the families we represent are for injuries called bedsores. Bedsores are also known as pressure ulcers, pressure injuries, and decubitus ulcers. It is important to know that pressure ulcers do not “just happen.” They are, in the overwhelming majority of cases, a result of neglect, as a nursing home lawyer Trenton, NJ trusts can explain. In fact, Medicare makes nursing homes report pressure ulcers because they are quality of care indicators. Also, if a person in a hospital gets a severe wound, Medicare won’t pay for the treatment because the evidence shows that severe wounds should not happen at a hospital if proper care is given.
Understanding how these wounds are prevented and treated are essential to be a good advocate for your resident. The strategies to prevent the development and worsening of pressure ulcers are simple and straightforward. It is not complex medicine that’s going to prevent a pressure injury from occurring, it is simply basic nursing.
What is a bedsore?
A bedsore is formed when a person is simply not kept clean and dry or urine and feces and not moved frequently enough.
When a person is not moved enough the pressure between the bone and the surface they are lying on puts pressure on the skin in between. This pressure prevents blood flow to that area. Blood carries oxygen, and if oxygen cannot get to the skin than the skin begins to die. When the skin is not kept clean and dry of urine or feces, these substances irritate the skin and cause blistering, which can be the beginning of the skin damage.
Bedsores typically form on parts of the body where there is increased stress on the skin when a person is seated for a long period of time or lying in bed most of the time. These are areas you would think would be a problem. For example when a person is lying down most of the time, the buttocks, heels, and small of the back are the areas most likely to develop a bedsore.
How serious is a bedsore?
The seriousness of a bedsore can be minor, if it’s just redness or a rash, to very serious if it is a wound that exposes the bone. It’s important to know how medical professionals discuss bedsores to understand what is going on with your resident.
Bedsores are staged based on severity, like cancer. The stages of a bedsore are stage I (1) through IV (4). Stage I bedsore is the most minor and should heal easily. A stage IV bedsore, however, is very painful, will complicate rehab, and typically is an area that easily infected, which can lead to death. Below is a brief description of the 4 stages of a pressure officer.
Stage I – this is a simple redness to the skin doesn’t go away when pressure is relieved. It may look almost like a rash. Staff at hospitals and nursing homes are trained to look for redness on areas where pressure ulcers typically develop. To be clear, it is easy to stop this wound from developing if it is at stage I. Simply keeping the person off that area will be enough that the wound should heal in a day or so.
Stage II – a stage II pressure ulcer should also be something that is relatively easy to heal. This is where there is a blistering but it is confined only to the topical skin. Many times a stage II wound is formed when a person is not kept clean of urine and feces. Much like a stage I ulcer, a stage II ulcer should be fairly easy to heal if caught at this point. Simply keeping a person clean and dry and relieving the pressure off that area should be enough to heal a stage II pressure ulcer in a matter of days.
Stage III – a stage III pressure ulcer is much more serious. When you have a stage III pressure ulcer the wound has gone through the skin and damaged the tissue below. This can be a serious problem because infections can now occur in this open area. Stage III ulcers are painful. Stage III ulcers complicate rehab. Stage III ulcers also take a lot of resources from the body to heal making someone more susceptible to infection. If a person has a stage III wound a facility has got to address that wound with new tools. A stage III wound can take a long time to heal, so the sooner it is identified and treated the better.
Stage IV – a stage IV bone is the most serious of all pressure ulcers. It is where the wound is gone through the tissue below the skin and in many cases all the way down to the bone. Stage IV wounds are a very serious condition. Stage IV wounds will take a long time to heal. A stage IV wound is very painful. A stage IV wound is often the place where an infection starts, especially if it’s on the buttocks or in the small of the back because feces will oftentimes get into the wound. Stage IV wounds will typically require surgical treatments.
How do I prevent a wound from forming?
The care and treatment required to prevent a wound from forming are very simple and basic nursing. The best way to prevent a pressure injury is to just alleviate pressure. The maximum time a person should be in one position is 2 hours. This means that at a minimum people should be moved in a bed every 2 hours. In a wheelchair they should be moved even more, because the pressure on the buttocks and small the back is greater. If a person is sitting in a wheelchair which should be shifted once an hour. Moving a person in a better wheelchair does not mean completely moving them to a totally new position. It simply means to shifting the way from one part of the body to another part of the body. It is not difficult to accomplish.
It is also important to keep the skin clean and dry of urine and feces. Urine and feces can burn the skin. These skin burns can lead to more significant pressure injuries.
So the basic nursing tasks of keeping people clean and dry and being sure there turned and repositioned appropriately are the 2 most important ways in order to prevent a pressure injury from forming.
The proper nutrition is also very important to prevent or treat a wound, protein in particular. When a person is at risk of developing a wound or suffering from a wound, it is important to be certain that they are getting ample protein. Protein is the substance that the body uses as building blocks. If there is a wound, the body will attempt to heal the wound with protein. If a person is not getting enough protein through their normal diet they can also receive protein supplements.
Keeping a person clean and dry, being sure there turned and repositioned every 2 hours in a bed and every one hour in a wheelchair, and being certain that they are receiving good nutrition, are the best ways to prevent or treat a pressure ulcer.
Thanks to our friends and contributors from Davis & Brusca, LLC for their insight into bedsores and nursing home negligence.