The Basics of Bed Sores

Why are so many elderly patients obtaining them in nursing homes?

Many of the cases we handle are claims regarding bed sores.  They are also called pressure injuries, pressure wounds, or decubitus ulcers.  These truly horrific injuries can complicate recovery, delay rehabilitation, and lead to death.  They are almost always avoidable with good basic nursing care.

Understanding the basics of how they form is essential to keeping your loved one free of these afflictions.

Pressure ulcers are formed when there is unrelieved pressure on an area of the body.  The unrelieved pressure prevents blood flow to the area under pressure.  Since blood carried oxygen, without good blood flow the cells under pressure don’t get oxygen and begin to breakdown and die.  This results in a pressure ulcer.

The number one tool to preventing pressure ulcers is simply to shift people in bed every two hours at a minimum.  In a chair, since pressure can be greater on some parts of the body, many medical professionals believe a person should be moved every hour.  Whether in the chair or bed, this process is called “turning and repositioning.”  This does not mean moving people out of bed to chairs, or turning them over on their stomachs.  It simply means shifting them off the areas under pressure.

There are known areas of the body that are at higher risk of skin breakdown then others.  These areas are called the “bony prominences,” and it’s easy to see why these areas can be trouble spots.  These are areas of the body where the skin is thinner, or there is naturally more pressure here when laying in bed or sitting in a chair.  The bony prominences include the small of the back (sacrum), the buttocks, the heels, the elbows, and the back of the head.

Wounds typically start small and form over time from the outside of the skin, and move into the tissue.  Pressure ulcers are staged 1 through 4 – Stage 1 being injury confined only to the skin, and Stage 4 through the underlying tissue all the way to the bone.  The stages are:

• Stage 1: a persistent redness to the skin.  If you push on it with your thumb the skin does not change color and stays red.
• Stage II: a blistering on the skin.  This can also be caused by or sped up by prolonged contact with urine and feces.
• Stage III: the skin breakdown is through the skin and into the tissue below.
• Stage IV: The tissue damage is deep and may go all the way to the bone.

Sometimes, if there’s a prolonged period of inactivity and a person is not moved for a long time, a person can get a Deep Tissue Injury (also called a DTI).  In these cases, a person generally first gets a deep purple bruise on the area, which will open up to a Stage III or Stage IV wound.  In these cases, the wound forms from the inside out.

If a person is suffering from a wound, there is a serious risk of infection.  All open areas of the skin pose a risk that a bacteria or microorganism can enter.  With a wound, there is a large open area.  This risk is compounded by the fact that a wound on the buttocks or small of the back may come into contact with feces which always has bacteria.  For this reason, it is very important that a wound be keep clean and dry.

The main cause of wounds in my experience is understaffing.  There must be enough aides simply be sure residents are being shifted in their beds.  Many elderly people cannot move themselves and require assistance with this basic task.  I’ve seen one aide responsible for more than 9 or 10 residents on the day shift.  In these cases it’s impossible for a CNA to turn and reposition all those people and get their other work done.

In addition to shifting people in bed, it is important to be sure they are getting the proper nutrition – mostly protein.  Protein is the building block of the body and wounds require tremendous resources in order to heal.  Being sure there is enough protein is paramount in order to heal a wound, or prevent one from forming in the first place.

If you have a bed bound resident or someone who cannot move themselves well without help, be sure that they are getting moved in bed frequently – at least every two hours in bed or every one hour in a chair.  If your loved one is at risk of or suffering from a bed sore, ask for a care conference and demand to know how they know turning is being done.  Ask the dietician to make certain the diet is correct.  Having the facts about bed sores can hopefully assist in avoiding them in the first place, or healing them if they’ve formed.

If you believe that a loved one has been the victim of any type of nursing home neglect or abuse, our nursing home abuse lawyers in New Jersey can help. For more information, call Davis & Brusca at 609-786-2540 or contact us online.