Bedsores which are also named as pressure sore, pressure ulcers and decubitus ulcers are defined as injuries or development of ulcers on the skin and underlying tissue due to prolonged pressure on that area of skin.
Bedsores usually develop over the skin that covers the bony prominence as a result of continuous pressure and pressure in combination with friction of that area.
Most common sites where ulcers develop are heel, ankles, hips, buttocks, sacrum, and coccyx. Less common sites which may develop bed sores are elbows, ankles, back of cranium.
People who are at high risk of developing bedsores are those which are under a condition in which there are limits in their ability to change positions, requires w wheelchair or who are confined to bed for long periods.
Bedsores develop due to the inadequate supply of blood and resulting in reperfusion injury when blood re-enters tissue. Due to pressure blood supply is reduced to the particular area then these particular area tissues die. This dead tissue leads to the formation of bed sores.
Classification of bedsores is done on the stage of ulcer appearance
• Stage 1: At this stage, skin is intact with non-blanchable redness of the localized area over the bony prominence. The area of the skin affected is painful, firm, and warmer.
• Stage 2: In stage 2 there occurs partial thickness loss of dermis, due to which there appears shallow open ulcer with the red-pink wound. At this stage there occur open or ruptured fluid-filled blisters.
• Stage 3: At this stage there occurs a complete loss of thickness of the skin. The subcutaneous fat tissue is visible but bones, tendons and muscles neither are nor exposed.
• Stage 4: In this stage, full thickness tissue loss is seen even bones, tendons and muscles are exposed. There is present slough on some parts of the wound bed.
• Unstageable: At this stage, the actual depth of ulcer is not seen there appear slough and eschar in the wound bed.
There is no particular race incidences are seen. Bed sores can occur in individuals of any race.
The major cause of formation of bed sores or pressure ulcers is the blockage of blood supply to a particular area due to pressure for a long time on the vessel that is supplying blood.
There are three primary factors that contribute to formation of bed sores and are as follows
• Prolonged pressure: When the skin and the underlying tissue get enclosed and pressed between the bone and surface on which patient lie such as wheelchair or bed, and when pressure on these pressed tissues is more than the internal pressure between the vessels that supply oxygen and nutrients to the tissue. Due to this increased external pressure on the vessels the supply of oxygen and nutrients to the areas where it supplies is lost. Due to the deprivation of supply of nutrients and oxygen that area cells get damaged and eventually die forming the ulcer.
• Friction: In cases where the person is unable to stand by self and need caretakers to handle him, in such cases when the position of the patient is to be changed the friction may occur when the skin is dragged across a surface. This friction makes the skin more vulnerable to injury.
• Shear: When two surfaces move in opposite direction. In cases in hospitals when the hospital bed is elevated at the head, the patient can slide down the bed. Due to this act, the tailbone moves down, the skin over the bone stay in place and pulling in the opposite direction.
Risk factors leading to bed sores are as follows:
• General poor health and weakness.
• Injury and illness that requires bed rest or wheelchair use.
• Recovery after surgery.
• Age is another risk factor as the skin in older adults is more fragile, thinner, less elastic and drier.
• Weight loss is another risk factor to the development of bed sores. The loss of fat and muscles results in less cushion formation between the bones and bed.
• Excess of moisture also leads to bed sore formation as it leads to inhabitation of bacteria on the skin.
• Decreased mental awareness.
• Medical condition that affects circulation.
• In stage 1 the symptoms appear are as follows
The skin is intact.
The appearance of skin in the area of bed sore is red in appearance.
The site of the bed sore is painful, firm, soft, and warmer.
• In stage 2 symptoms appear are as follows
The outer layer of the skin is destroyed.
Ulcer appears in the form of shallow, pinkish-red.
Ulcer site can also appear as intact or ruptured fluid-filled blister.
• In stage 3 ulcer appear in the form of deep wound
Loss of skin usually exposes some amount of fat.
The ulcer has a crater-like appearance.
At the bottom of the wound, there is yellow dead tissue.
• In stage 4 the symptoms appear are as follows
There is exposure of muscles, bone, and tendons at the wound site.
At the bottom of the wound, there is a slough, crusty dead tissue.
• Blood cultures.
• The culture of tissue taken from the site of bed sore to test the type of bacteria infecting.
• Blood sugar levels in case of diabetic patients.
• Bone and joint infections.
• Cleaning and draining of the wound.
• Antibiotic treatment.
• Healthy diet intake.
• Muscle spasm relief medication.
• Removal of dead tissue.
• Relieving the pressure on the site of bedsores.
• Ecthyma gangrenosum
• Warfarin necrosis
• Pressure ulcer
• Pyoderma gangrenosum
• Skin appears blackish-bluish in color.
• Small boils appear on skin in multiple numbers.
• Burning and itching on eruptions.
• Indurated acne is present on skin, characterized by symmetrical distribution.
• Perspiration (sweating) of patient is sour smelling, excessive, and fetid odor.
• Patients feel that from pores of skin burning vapors are released.
• Tubercles are syphilitic.
• Veins show varicosity.
• Ulcers on skin are in the form of vesicles and with red edges.
• Abscesses are seen in bones (osteomyelitis).
• Pus containing eruptions and vesicles appear on skin which itches violently.
• Eczema on back of hands.
• Carbuncles are seen on legs having foul smell ulcers.
• During scarlet fever attack, few eruptions appear.
• Appearance of skin is purplish in color.
• Black and blue color swellings on skin.
• Ulcers, carbuncles, boils have bluish purple surroundings.
• Patient has bed sores which have black edges.
• Also good indicated medicine for cellulitis.
• Bleeding from all opening of body like mouth, anus, vagina and bleeding is black in color.
• Medicine also indicated for frostbites in which skin shows gangrenous damage to skin.
• Well indicated medicine for cicatrices which are blue, red and are very painful.
• Bad effects of mechanical injuries.
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