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Three major factors in the development of pressure ulcers are (1) prolonged pressure on a part due to the weight of the body or a limb; (2) a shearing force that exerts downward and forward pressure on tissues beneath the skin (this can occur when the patient slides downward while sitting in a bed or chair, or when bedclothes are forcibly pulled from under the patient); and (3) nutritional status: good nutrition is essential for preventing pressure ulcers and healing already existing ones; a dietary deficiency should be suspected with a loss of 5 per cent or more of body weight or a serum albumin level below 3.5 mg/dl.
A pressure ulcer usually occurs over a bony prominence at the sacrum, hip (trochanter), heel, shoulder, or elbow. The lesion begins as a reddened area, which can quickly involve deeper structures and become an ulcer.
In Stage 1 the area of skin is deep pink, red, or mottled. Digital pressure on the area will cause temporary blanching for up to 15 minutes after pressure is released. The skin will feel very warm and firm or tightly stretched across the area. At this stage no destruction of tissue has occurred and the condition is reversible. It is essential that the area be relieved of prolonged pressure, and that shearing forces be avoided. The reddened area may need protection by covering it with either a transparent film or a skin barrier.
Stage 2 is characterized by blistering, cracking, or abrasion of the skin. The surrounding skin is reddened and probably will feel hot or warmer than normal. Since there is now an opening in the skin for the entrance of bacteria, treatment must include cleaning the wound and providing some type of dressing or cover in addition to relieving pressure on the area.
Stage 3 is characterized by a craterlike sore with involvement of the underlying structures. Bacterial infection is almost always present at this stage and accounts for continued erosion of the ulcer and the production of drainage. Irrigation of the wound usually is done each time the dressing is changed. Wound débridement may be necessary to promote healing.
At Stage 4 there is deep ulceration and necrosis involving underlying muscle and possibly bone tissue. At this point the ulcer usually is extensively infected. It can be dry, black in color, and covered with a tough accumulation of necrotic tissue, or it can be wet and oozing dead cells and purulent exudate. Deep and extensive ulceration and tissue loss may require surgical repair with myocutaneous flaps to close the defect.
Topical applications vary widely. The diligence with which the prescribed regimen is carried out greatly influences its effectiveness. Guidelines summarizing current recommended practice for the treatment of pressure ulcers (publication number 95-0653) are available from the Agency for Health Care Policy and Research, P.O. Box 8547, Silver Spring, MD 20907-8547 (telephone 800-358-9295).
bedsorePressure ulcer, see there, aka decubital ulcer.
de·cu·bi·tus ul·cer(dē-kyū'bi-tŭs ŭl'sĕr)
Synonym(s): bedsore, bed sore, pressure sore, pressure ulcer.
Patient discussion about bedsore
Q. I ask a client's Dr. to script flexaril for a lower back spasm and he made it for a drug called zanaflex? I am unfamiliar with zanaflex, what is the difference between it and flexaril 25mg? Benefits? Risks? I got him to order the air mattress and extended bed because client is 6'3" and is already bedridden on my 1st day..try to beat the skin breakdown, already stage I decubitis ulcers. I tried to talk the client into slideboard and lift away arm wheelchair...noway..he wants to walk bent with a rolling walker. He already had a lift chair delivered, so he just goes from bed to lift chair. He refuses to let me bathe him. He can't see, and he has me check his draw up on insulin to make sure it's right. He sends the P.T. man right back out the door after he signs the sheet. Difficult pt.!