California Elder Law Attorney Blog

There are several factors that have been acknowledged as things that put a person more at risk of developing pressure sores.

As soon as a person is spotted as a high-risk individual, certain measures have to be taken to reduce or eliminate the risk of him or her developing bedsores.

It is imperative that the care provider, whether it is a nurse or a family member, is knowledgeable about these risk factors in order to be able to prevent the unnecessary and painful development of pressure sores.

The risk factors will vary according to the patient's specific circumstances; nevertheless, this is a list of the 5 most common risk factors:

1. Being confined to a bed, chair, or wheelchair
Individuals who are confined to a bed, a chair, or a wheelchair, and who are not able to move by themselves, are at high risk of developing pressure sores extremely fast; in as little as a couple of hours, if the pressure is not relieved regularly.

2. Being unable to change positions without assistance
Persons who are in a coma, who are paralyzed, and who are recovering from a hip fracture or other injury that limits mobility, are extremely prone to bed sores.

These patients must be moved consistently at regular intervals, and this is very difficult on caregivers, reason why it is imperative to get a pressure mattress to help both the patient and the caretaker.

3. Losing bowel or bladder control
People who have to remain in bed for long periods of time or permanently and lose the capacity to control their bladder or bowels are in danger of getting bedsores because the continuous moisture on the skin due to urine, stool, or perspiration can irritate and weaken it.

4. Eating bad, having an imbalanced diet and/or dehydration
Pressure sores develop more easily when the body and skin of people who have lost most of their mobility are not adequately nurtured.

5. Losing mental awareness
A person who is losing mental awareness may not have enough sensory perception or capacity to take action to prevent the development of pressure sores.

Continue reading "What Are The Factors That Put a Person At Risk of Developing Bed Sores, Pressure Sores, and Decubitus Ulcers?" »

Examples of nursing home abuse related injuries include bed sores and pressure sores, decubitus ulcers, fall down injuries, head injuries, dehydration, restraint injuries, and sepsis. Sadly, these are only some of the many forms nursing home abuse may take. It is important that friends and family members communicate with their loved one to ensure that he or she is not being taken advantage of or mistreated in any way.

Nursing home neglect is a general term that encompasses many different situations that commonly result in patient injury or even death.

The duration of the neglect can occur over any period of time- days, weeks, months -- even years. Many situations involving nursing home neglect are reflective of a systematic problem at the facility, where shift-after-shift of nursing home employees fails to provide necessary care to patients in need.

Medical complications such as malnutrition, dehydration and bed sores are common consequences of nursing home neglect. In some situations, the aforementioned conditions of malnutrition and dehydration may contribute to the development of bed sores.

* Incontinence - Failure to keep patient clean, change soiled linens after an episode of incontinence, and re-position patients on a regular internals may contribute to the development of bed sores (similarly referred to as: pressure sores, pressure ulcers or decubitus ulcers).

* Dehydration - An inability to perceive thirst or anxiety over going to the toilet are some of the common factors that contribute to dehydration of nursing home patients. Staff must keep track of patients fluid intake and output.

* Malnutrition - We all know food is a basic requirement to keep our bodies functioning properly. Yet, when inappropriate foods (solid foods given to an are given to patients who can not eat them) or no staff assistance is provided to patients who are unable to feed themselves serious health problems may develop.

Nursing Home Liability for Neglect of Patients:

It is not necessary to distinguish the type of neglect nor establish actual intent on the part of the facility to pursue a cause of action premised on neglect. Rather, if your loved one suffered a bed sore or other type of injury due to inaction on the part of a caretaker, you may be entitled to pursue a claim for the resulting damages.

Continue reading "What is Considered Nursing Home Neglect?" »

Most, if not all Bed sores, pressure sores and decubitus ulcers should be prevented, and those which have formed need not necessarily get any worse says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Each patient's individual circumstances must be taken into consideration by the caregiver in order to develop a plan of care which will best assure the patient will not unnecessarily suffer from a pressure sore. The following generally represent some of the precautions which health care providers should, but too often fail to undertake:

1. An appropriate and thorough and systematic assessment must be made of the patient's risk for developing a pressure sore;

2. Appropriate periodic reassessment should be made of the patient's risk;

3. The patient should be bathed appropriately;

4. The patient's incontinence should be assessed and treated to assure that moisture on the skin does not contribute to the development of a pressure sore;

5. Appropriate nutrition and hydration must be maintained;

6. Repositioning of the patient should occur with a frequency to assure that the pressure is adequately relieved;

7. Use of appropriate support devices should be maintained to relieve pressure from troublesome areas;

8. Postural alignment, distribution of weight, balance and stability, and pressure relief should be considered when positioning persons in chairs or wheelchairs;

9. Appropriate lifting devices and techniques should be used to assure that shear and friction related injuries are avoided;

10. Education should be given to the patient, family, and caregivers on measures to be taken to avoid pressure sores, and appropriate documentation of such measures.

It is essential to remember that every individual is different, and has different risk factors, thus requiring a customized plan of care and diligence in carrying out the plan of care.

Continue reading "Bed Sores and Neglect" »

It is important to note that bed sores do not always result from being in bed as the name would imply. Some of the most severe bed sores can also result from sitting for a prolonged period of time says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Thus, the location of the bed sores can depend upon the position of the patient. For individuals who are bed-bound, the sores are most likely to form on or around the heels, the hip-bone, and the lower back or tailbone. Pressure ulcers may also develop in a variety of other areas, including the spine, ankles, knees shoulders, and head, depending upon the position of the patient.

Bed Sore Risk Factors:

Pressure sores are more likely to develop persons who are at higher risk due to one or more risk factors. A number of risk factors have been identified which put individuals at higher risk. Once a person is identified as being at increased risk for pressure sores, measures should be undertaken to reduce or eliminate those risks. Thus, healthcare providers must be aware of these risk factors when caring for patients in order to prevent the unnecessary development of pressure sores. While risk factors may vary depending upon the particular circumstances, the following represents a list of the most common:

1. Confinement to bed, chair, or wheelchair. Persons confined to beds, chairs, or wheelchairs who are unable to move themselves, can develop pressure-induced injuries in as little as 1-2 hours if the pressure is not relieved;

2. Inability to change positions without help. (Eg., an individual in a coma, who is paralyzed, or recovering from a hip fracture or other mobility limitation.)

3. Loss of bowel or bladder control. Sources of moisture on the skin from urine, stool, or perspiration can irritate the skin.

4. Poor nutrition and/or dehydration. Bed sores are more likely to form when the skin is not properly nourished.

5. Decreased mental awareness. An individual with decreased mental awareness may not have the level of sensory perception or ability to act to prevent the development of pressure-induced injury. The lack of mental awareness may arise from medications.

Continue reading "What Are Some of the Bed Sore Risk Factors?" »

Common Names for Bed Sores

"Bed sores" owe their name to the observation that patients who were bedridden and not properly repositioned, would often develop ulcerations or sores on their skin, typically over bony prominences. These bed sores, which result from prolonged pressure, are also called "decubitus ulcers", "pressure sores," and "pressure ulcers ."

How Bed Sores Develop

Bed sores are a localized area of tissue injury that develops when soft tissue is compressed between a bony prominence and an external surface for a prolonged period of time. The external surface may be a mattress, a chair or wheelchair, or even other parts of the body. The soft tissues of the body, such as skin and muscle, depend upon blood vessels to carry nutrients to the tissues, and to remove waste products. Bed sores result when prolonged pressure prevents sufficient blood flow to supply the tissues with nutrients. The resulting bed sore represents the death of the involved soft tissues.

Bed sores can result from one period of sustained pressure; however, most bed sores probably occur as a result of repeated incidents of blood flow interruption without adequate time for recovery. In fact, low pressure endured for long periods of time is believed to be more significant in producing pressure ulcers than higher pressure for shorter durations.

Continue reading "Development of Bed Sores" »

Sepsis is a severe illness caused by infection of the bloodstream by toxin-producing bacteria. Sepsis can begin from any site of infection , including such common sources as urinary tract infection, pneumonia, and open wounds such as bedsores and cellulitus. Without timely and appropriate treatment, sepsis can result in death.

Statistics

This year in the U.S.

* Sepsis will occur in 2 of every 100 hospital admissions
* Approximately 400,000 men and women will develop sepsis
* Approximately 100,000 men and women will die from sepsis
* Septic shock will be the most common cause of death in intensive care units
* Septic shock will be the 13th most common cause of death

Signs and Symptoms of Sepsis

The signs and symptoms of sepsis arise differently depending on the nature of the underlying source of infection. For example, if sepsis begins with a bed sore, there may be such signs as inflammation, redness, and infection of the bed sore and surrounding area. If sepsis begins with a urinary tract infection, there may be flank pain and difficulty with urination. As sepsis progresses, more signs and symptoms will become noticeable, including:

* Fever or hypothermia (low body temperature)
* Hyperventilation
* Chills
* Shaking
* Inflammation
* Rapid heart beat (tachycardia)
* Confusion or delirium
* Hypotension
* Lactic academia
* Progressive organ system dysfunction

If a patient reports to a doctor with signs of an infection and demonstrates symptoms such as those described above, the physician should conduct appropriate tests to rule out sepsis.

Diagnosing Sepsis

There are a number of tests that can be ordered to determine whether sepsis is present when a patient presents with signs and symptoms that are consistent with sepsis. These include:

* White blood cell count that is low or high
* Platelet count that is low
* Blood culture that is positive for bacteria
* Blood gases that reveal acidosis
* Kidney function tests that are abnormal (early in the course of disease)
* Peripheral smear may demonstrate a low platelet count and destruction of red blood cells
* Fibrin degradation products are often elevated, a condition that may be associated with a tendency to bleed
* Blood differential -- with immature white blood cells seen

Treating Sepsis

Sepsis requires timely and appropriate treatment that generally requires monitoring in an intensive care unit (ICU), the removal of sources such as infected intravenous lines or surgical drains, surgical draining of sources such as abscesses, and "broad spectrum" antibiotic therapy. The type and number of antibiotics administered can be refined once blood cultures and other diagnostic testing identify the causative organism. Supportive therapy with oxygen, intravenous fluids, and medications that increase blood pressure may also be required for a good outcome. Further, dialysis may be necessary in the event of kidney failure, and mechanical ventilation is often required if respiratory failure occurs.

Complications from Sepsis

If not diagnosed and treated in a timely fashion, sepsis can result in severe complications. These include septic shock in which there is low blood pressure, low blood flow, and the failure of vital organs, such as the brain, heart, kidneys, and liver. Another complication is disseminated intravascular coagulation, a disorder of diffuse activation of the clotting cascade that results in the depletion of clotting factors in the blood. Sepsis can also result in death. The death rate can be as high as 60% for people with underlying medical problems. The longer diagnosis and treatment are delayed, the higher the likelihood of complication and death.

Continue reading "Sespis is a Severe Illness Caused By Infection of the Bloodstream" »

Infection from bed sores is a serious complication that can lead to serious injury and even death says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

There are several types of infection from bed sores that a patient can develop when their pressure sores are not promptly and adequately treated. Each year in the United States about one million people develop bed sores (also known as pressure sores and decubitis). Bed sores develop when the blood supply to the skin is cut off for two hours or more. Bed sores are a common ailment suffered by people who are bedridden or confined to a wheelchair.

Approximately sixty thousand people die as a result of infection from bed sores. Infection from bed sores occurs when bacteria develops in the affected area. These bacteria can cause significant damage to the skin, blood, bones, muscles, and other tissues in the affected area. Infection from bed sores is more likely in the presence of sweat, feces, urine, or other moisture when these materials come in contact with affected skin.

Infection from bed sores is preventable when proper and prompt care is administered to a patient who has developed bed sores. Proper diet and hygiene are crucial to prevent infection from bed sores. A diet rich in protein, vitamins and minerals can help to prevent bed sores and infection from bed sores. A person who is bedridden or uses a wheel chair should be shifted often to reduce prolonged pressure to certain areas. In order to prevent infection from bed sores, a patient's skin should be kept clean, dry, moisturized, and away from harsh chemicals. Patients who are incontinent or are at an increased risk of infection from bed sores should be monitored closely and checked frequently for any signs of infection from bed sores.

When a person develops a bed sore, the skin in the affected area first becomes discolored and may be tender and itchy. As the tissues begin to atrophy (die), blisters and open wound abrasions develop. These craters can grow to invade and destroy deeper soft tissues, muscles, bones, tendons, and joints. The potential for infection is high when a bed sore becomes exposed to external elements of moisture and bacteria.

Signs of infection from bed sores can include pus drainage from the bed sores; a foul smell from the wound; and tenderness, heat or redness in the skin surrounding a bed sore. If any of these symptoms of infection from bed sores are present a patient must receive adequate and immediate medical attention to avoid serious complications. Infection from bed sores can be treated with topical or oral antibiotics, and proper wound care and dressings.

Infection from bed sores can include gangrene (tissue death), bone infections (osteomyelitis), blood infections (sepsis), infectious arthritis, and scar carcinoma (cancer of scar tissue). Sepsis alone kills fifty percent off all people who develop this infection. When a patient develops an infection from bed sores, unacceptable standards of care are most likely to blame. Infection from bed sores is highly preventable in a nursing home facility and is often the direct result of nursing home abuse and neglect.

Continue reading "Infection from Bed Sores" »

Many different microbes can cause sepsis. Although bacteria are most commonly the cause, viruses and fungi can also cause sepsis. Infections in the lungs (pneumonia), bladder and kidneys (urinary tract infections), skin (cellulitis), abdomen (such as appendicitis), and other areas (such as meningitis) can spread and lead to sepsis. Infections that develop after surgery can also lead to sepsis.

Who is at risk for sepsis?

* Very young people and elderly people

* Anyone who is taking immunosuppressive medications (such as transplant recipients)

* People who are being treated with chemotherapy drugs or radiation

* People who have no spleen (the spleen helps fight certain infections)

* People taking steroids (especially over the long term)

* People with long-standing diabetes, AIDS, or cirrhosis

* Someone who has very large burns or severe injuries

* People with infections such as the following

o Pneumonia

o Meningitis

o Cellulitis

o Urinary tract infection

o Ruptured appendix

People with advanced bed sores, pressure sores and decubitus ulcers (stage 3 or stage 4) are particularly susceptible to developing infection- both in the wound itself and potentially systematically says California Nursing Home Abuse and Neglect Attorney Steven C. Peck. In order to minimize risk of infection, care should be taken to keep the wound clean and dry. Dressings should be changed on a regular basis as ordered by a treating physician.

The following may indicate infection within the wound itself:

* Increased pain in the wound
* Edema (swelling)
* Reddening of the wound (erythema)
* Increased fluid accumulation
* Heat in the wound area
* Unusual smell

Occasionally, an infection that originates in the wound itself, can spread throughout the entire body. These situations can pose a significant health risk to the individual. Signs of systematic infection include:

* Elevated white blood cell count
* Elevated body temperature
* Cellulitis (skin infection)
* Osteomyelitis (bone infection)

Because infection is a frequent complication for people with bed sores, physicians and other medical professionals should make the monitoring of existing wounds a priority. Wounds should be documented and photographed to assist in the evaluation of woulds as they heal.

Continue reading "Elders With Bed Sores, Pressure Sores and Decubitus Ulcers Are Particulary Susceptible to Developing Life Threatening Infections" »

Bedsores are classified into stages, depending on the severity of skin damage:

* Stage I (earliest signs of skin damage) - White people or people with pale skin develop a lasting patch of red skin that does not turn white when you press it with your finger. In people with darker skin, the patch may be red, purple or blue and may be more difficult to detect. The skin may be tender or itchy, and may feel warm or cold and firm.

* Stage II - The injured skin blisters or develops an open sore or abrasion that does not extend through the full thickness of the skin. There may be a surrounding area of red or purple discoloration, mild swelling and some oozing.

* Stage III - The ulcer becomes a crater and that goes below the skin surface.

* Stage IV - The crater deepens and reaches into a muscle, bone, tendon or joint.

Because broken skin can allow bacteria to enter, bedsores are extremely vulnerable to infection. This is especially true if the sore is contaminated by urine or feces. Signs of infection in a bedsore can include:

* Pus draining from the sore
* A foul smelling odor
* Tenderness, heat and increased redness in the surrounding skin
* Fever

Continue reading "The Stages and Symptoms of Bed Sores, Pressure Sores and Decubitus Ulcers" »

Bedsores, also called pressure ulcers or decubitus ulcers, are areas of broken skin that can develop in people who:

* Have been confined to bed for extended periods of time
* Are unable to move for short periods of time, especially if they are thin or have blood vessel disease or neurological diseases
* Use a wheelchair or bedside chair (a hospital chair that allows a patient to sit upright next to the bed)

Bedsores are common in people in hospitals and nursing homes and in people being cared for at home. In the United States, approximately 9% of all hospitalized patients develop bedsores. Three percent to 14% of people in home care get them and so do 3% to 12% of all nursing home residents. People transferred from hospitals to nursing homes are particularly vulnerable, with 10% to 35% having sores when they are admitted to the nursing home says California Nursing Home Abuse and neglect Attorney Steven C. Peck.

Bedsores can lead to severe medical complications, include bone and blood infections, bacterial infection in a joint, a wound that is deep enough that it exposes bone, and - rarely - scar carcinoma, a form of cancer that develops in scar tissue.

Bedsores form where the weight of the person's body presses the skin against the firm surface of the bed. In people confined to bed, bedsores are most common over the hip, spine, lower back, shoulder blades, elbows and heels. In people who use a wheelchair, bedsores are most common on the lower back, buttocks and legs. This pressure temporarily cuts off the skin's blood supply. This injures skin cells and can cause them to die. Unless the pressure is relieved and blood flows to the skin again, the skin soon begins to show signs of injury. At first, there may be only a patch of redness. If this red patch is not protected from additional pressure, the redness can form blisters or open sores (ulcers). In severe cases, damage may extend through the skin and create a deep crater that exposes muscle or bone.

Muscle is even more prone to severe injury from pressure than skin. A bedsore can involve several layers of damaged tissue.

The pressure that causes bedsores does not have to be very intense. Normally, our skin is protected from being injured by pressure because we move frequently, even when asleep.

Although pressure on the skin is the main cause of bedsores, other factors often contribute to the problem. These include:

* Shearing and friction - Shearing and friction causes skin to stretch and blood vessels to kink, which can impair blood circulation in the skin. In a person confined to bed, shearing and friction can occur when the person is dragged or slid across the bed sheets. This can also occur when the head of the bed is raised more than 30 degrees. This increases shearing forces over the lower back and tailbone.

* Moisture - Wetness from perspiration, urine or feces can make the skin too soft and more likely to be injured by pressure. For this reason, people who can't control their bladders or bowels (people who are incontinent) are at high risk of developing bedsores.

* Decreased movement - Bedsores are common in people who can't move because they are paralyzed, recuperating from surgery for a prolonged time, being treated in intensive care for a long time, or are incapacitated by severe arthritis, stroke or a neurological problem such as multiple sclerosis. (People who can move without assistance have a lower risk of bedsores because they can shift their weight periodically.)

* Decreased sensation - Bedsores are common in people who have spinal cord injuries or other neurological problems that decrease their ability to feel pain or discomfort. Without these feelings, the person cannot feel the effects of prolonged pressure on the skin.

* Circulatory problems - People with atherosclerosis, circulatory problems from long-term diabetes or localized swelling (edema) may be more likely to develop bedsores. This is because the blood flow in their skin is weak even before pressure is applied to the skin. People with anemia are also at risk because their blood cannot carry enough oxygen to skin cells, even though circulation may be normal.

* Poor nutrition - Studies show that bedsores are more likely to develop in people who don't get enough protein, vitamin C, vitamin E, calcium or zinc.

* Age - Elderly people, especially those over 85, are more likely to develop bedsores because skin usually becomes thinner with age. Also, as we age, fat tends to shift away from the body surface, where it acts as a cushion, to deeper areas of the body.

Continue reading "What are Bedsores, also called Pressure Ulcers or Decubitus Ulcers?," »

Pressure sores, also called bed sores, occur when the skin breaks down from constant pressure, especially from sitting or lying in one position for any extended period of time. The pressure cuts off the blood supply to the underlying skin, fat, and muscle. These sores usually occur over bony prominences--tailbone, buttock, heel, shoulder blade, elbow, and occasionally the back of the head. However, pressure sores are not limited to these areas, and can occur other places as well. Sores may also develop from friction to the skin. This is called shear, and may result from sliding across a bed or wheelchair seat. Because the skin is much more likely to break down if it is moist or infected, incontinence of bowel or bladder can add to the problem.

Several interacting risk factors have been identified in the development of pressure sores:

* Immobility or inactivity
* Decreased sensation
* Bowel or bladder incontinence
* Poor nutrition
* Older age
* Obesity--the extra weight can contribute to the formation of sores
* Underweight--the bony prominences can contribute to the formation of sores
* Dry skin and or dehydration
* Moist skin
* Smoking
* Diabetes, anemia, or cardiovascular disorders
* Cognitive confusion

Pressure sores begin as relatively benign problem, but can quickly progress to a more serious problem if left untreated.

* Stage 1--A small area of warm, reddened or purpled skin that does not return to its natural color when pressed.
* Stage 2--The outer layer of skin breaks down. Blistering and swelling as well as warmth and redness may be seen.
* Stage 3--Live tissue dies. The sore extends down into the deep skin layers and to the fat and muscle immediately beneath the skin. This hole or crater has a foul smell.
* Stage 4--The sore extends down to the deep muscle, possibly down to the bone. Infection may occur and may tunnel under the skin, increasing the size of the sore.

The best way to treat a pressure sore is to avoid developing one in the first place. Pressure sores can be prevented in the following ways:

* If you can, keep mobile.
* Unless advised differently by your physician, drink a lot of fluids and eat a well-rounded diet.
* If you are not mobile, your position must be changed at least every two hours.
* Your bed should be fitted with a mattress or a mattress pad that is capable of alternating and distributing the pressure applied by the body on the mattress. Foam "egg-crate" mattresses are not recommended for prevention.
* You should use padding or boots for pressure points (e.g., elbows, heels). Nurses, physical therapists, and/or physiatrists (physicians specializing in rehabilitation medicine) are the best sources of guidance about prevention of pressure sores.
* If you use a wheelchair, it is important that you sit on a cushion that distributes your weight. A gel-filed cushion is often recommended. Ask your physician or physical therapist about an evaluation by a seating specialist. Sitting on pillows, towels, or foam pads may add to your risk of developing pressure sores.

The treatment of pressure sores becomes more difficult as the sore advances in severity. A Stage 1 sore is usually well managed by eliminating the source of the pressure. This should result in a rapid resolution of the early pressure sore. Stage 2 sores can be treated by medication and protective coverings, under the advice of a physician or wound specialist who may be a nurse of physician. The treatment for a Stage 3 or 4 sore often involves long-term dressings, a special bed, medications, (including antibiotics if there is insufficient healing), and perhaps even surgical intervention.

Continue reading "Pressure Sores, Bed Sores and Decubitus Ulcers" »

Electronic Stimulation (ES) has been demonstrated to reduce or eliminate interfering spasticity, or involuntary muscle activity, in multiple sclerosis. The involuntary muscle activity may take the form of spontaneous muscle contractions or it may occur when voluntary movement is initiated. A variety of ES protocols have been employed. Some investigators and clinicians have used inexpensive portable stimulators and skin electrodes [placed on the spastic muscles, or over the muscles that work against the spastic muscles or on areas of skin that receive the same nerve supply as the spastic muscles]. The intensity of ES may be minimal, with only a tingling sensation felt by the user. In other protocols, the intensity of ES is increased to assist with joint movement. The intensity of ES should never cause discomfort. Other clinicians have surgically placed microelectrodes over the dorsal columns of the spinal cord. Stimulation protocols varied from one to two hours each day to intermittent use all day long, as needed.

As a result of ES, spasticity has been reduced, pain was less, bowel and bladder function improved and walking was more normal [with longer step lengths and greater walking velocity] says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Continue reading "Management Of Spasticity" »

Among the many factors that contribute to pressure sores, bed sores and decubitus ulcers are spasticity, joint contractures, muscle paralysis and poorly fitting wheelchairs. Electronic Stimulation (ES) may reduce the risk by reducing the involuntary movements in spasticity, by improving joint range of motion, and by increasing the bulk of muscles that cushion the bony prominences and so distribute pressures more evenly over the skin.

Once a pressure sore, bed sore and decubitus ulcer has occurred, ES may be helpful in speeding the healing process says California Nursing Home Abuse and neglect Attorney Steven C. Peck. While most of the research in this area has been done in spinal cord injury or diabetes, the findings are applicable to multiple sclerosis. Possible mechanisms include improving the oxygen supply to the skin and the muscle in the area of the sore, improving the rate of deposition of connective tissue, or scar, and minimizing the infection in the wound. The chance of healing is, of course, better if the pressure sore is a partial thickness lesion, meaning that only the more superficial layers of the skin are missing. In this case, the skin can grow from the base or bed of the dermis, similar to the way grass grows after mowing. If the sore is deep enough to go through the skin, it must heal in from the sides and surgery is often needed. If there is infection underlying the skin and in the exposed bone, surgical intervention is required to clean the area and to graft skin and sometimes muscle over the bony prominences. After wound closure, the mechanical integrity of the skin will not return to normal and it will be necessary to continue routine skin checks and to use custom seating devices for pressure relief as needed.

Successful ES protocols have included daily stimulation for a total time of two or more hours. Some investigators have employed a very low intensity, direct current. Others have used a pulsatile current and created a muscle contraction in the area of the pressure sore. Electrodes may be placed adjacent to the wound or one of the electrodes may be placed in the wound. In the latter case, an electroconductive dressing is used as the electrode.

Continue reading "Minimizing The Risk Of Pressure Sores, Bed Sores, Decubitus Ulcers And Treating Skin Lesions" »

Healthcare professionals routinely check patients for early signs of erythema, or skin redness. But visual inspections sometimes fail to detect reddening of the skin and other indicators of tissue damage, especially in people with darkly pigmented skin. If undetected, these at-risk sites can develop pressure ulcers says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Beyond ulcers looms a more serious risk for these patients - that of pressure-induced, deep-tissue injury, which occurs below the skin and is often not diagnosed visually until it has reached a dangerous, advanced stage.

Healthcare practitioners may be able to reduce their patients' risk of these complications by supplementing their visual inspections with a low-cost, handheld imaging device that could detect both early-stage pressure ulcers and the more serious deep-tissue injuries.

In addition to the human costs of pressure ulcers, there are monetary burdens, as well. The cost to heal a pressure ulcer is estimated to reach $40,000 for certain ulcers, Sprigle notes. In the United States alone, the costs associated with healing ulcers and worker productivity losses exceed $2 billion a year.

Continue reading "Healthcare Professionals Should Routinely Check Bedridden / Wheelchaired Patients For Skin Redness" »

A pressure ulcer, bed sore, decubitus 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, bed sore, decubitus 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. says California Elder Abuse Attorney Steven C. Peck.

Causes:

These factors increase the risk for pressure ulcers:

* 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
* 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

Pressure sores are categorized by severity, from Stage I (earliest signs) to Stage IV (worst):

* 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.

When to Contact a Medical Professional

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:

* Change position at least every 2 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.
* 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.

Continue reading "Pressure Ulcers, Bed Sores and Decubitus Ulcers Caused By Lack Of Positioning and Neglect" »

Pressure sores are common conditions among patients hospitalized in acute- and chronic-care facilities. Studies have suggested that, at any given time, 3-10% of hospitalized persons have pressure sores and 2.7% develop new pressure sores.3 Among a selected population, the incidence rate for the development of a new pressure sore has been demonstrated to be much higher, with a range of 7.7-26.9%.

Two thirds of pressure sores that develop in hospitalized patients occur in patients older than 70 years.4 As elderly individuals become the fastest-growing segment of the population, with an estimated 1.5 million people living in extended-care facilities, the problem of pressure sores will have an even more profound influence on the American economy.5 Most studies found the prevalence rate of pressure sores in patients in nursing homes to be 3-6%. However, other studies reported prevalence rates as high as 25-33% says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Pressure sores also occur with a higher frequency in young patients who are neurologically impaired.5 Immobility and lack of sensation make these patients susceptible to developing pressure sores. The incidence rate of pressure sores in these patients has been demonstrated to be approximately 5-8% annually, and 25-85% of these patients develop a pressure sore at some time. Once again, the treatment of pressure sores in this patient population represents a financial challenge, with an average cost per admission of a patient with a pressure sore of $78,000 at one hospital.

Continue reading "Bed Sores, Pressure Sores and Decubitus Ulcers Are Common Conditions In Acute Care and Long Term Care Facilities" »

The following information was copied verbatim from the AHCPR Guidelines, which is consistent with the recommendations of the National Pressure Ulcer Advisory Panel (NPUAP) Consensus Development Conference:
Stage 1

Nonblanchable erythema of intact skin, the heralding lesion of skin ulceration. In individuals with darker skin, discoloration of the skin, warmth, edema, induration, or hardness may also be indicators.

A Stage I pressure ulcer is an observable pressure related alteration of intact skin whose indicators as compared to the adjacent or opposite area on the body may include changes in one or more of the following:
skin temperature (warmth or coolness), tissue consistency (firm or boggy feel) and/or sensation (pain, itching).
The ulcer appears as a defined area of persistent redness in lightly pigmented skin, whereas in darker skin tones, the ulcer may appear with persistent red, blue, or purple hues.
Stage 2

Partial thickness skin loss involving epidermis, dermis, or both. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.
Stage 3

Full thickness skin loss involving damage to or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.
Stage 4

Full thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., tendon, joint capsule). Undermining and sinus tracts also may be associated with Stage 4 pressure ulcers.

Continue reading "Pressure Ulcer and Bed Sore Staging: What It Means and What To Look For" »