BedsoresDefinition:Bedsores are also called decubitus ulcers,pressure ulcers, or pressure sores. Thesetender or inflamed patches develop whenskin covering a weight-bearing part of thebody is squeezed between bone &another body part, or a bed, chair, splint,or other hard object.
Description:Each year, about one million people in theUS develop bedsores ranging from mildinflammation to deep wounds that involvemuscle and bone. This often-painfulcondition usually starts with shiny red skinthat quickly blisters & deteriorates intoopen sores that can harbour lifethreatening infection. Bedsores are notcancerous or contagious. They are mostlikely to occur in people who must use.Wheelchairs or who are confined to bed.
In 1992, the federal Agency for HealthCare Policy and Research reported thatbedsores afflict.•10% of hospital patients•25% of nursing home residents•60% of quadriplegics.The Agency also noted that 65% of elderlypeople hospitalised with broken hipsdevelop bedsores and that doctors fees fortreatment of bedsores amounted to$2,900 per person per month.
Bedsores are most apt to develop on the:*Ankles *Knees*Back of the head *Lower back*Heels *Shoulder blades*Hips *Spine.People over the age of 60 are more likelythan younger people to develop bedsores.
•Atherosclerosis (hardening of arteries)•Diabetes or other conditions that makeskin more susceptible to infection•Diminished sensation or lack of feeling•Heart problems•Incontinence (inability to control bladderor bowel movements)•Malnutrition•Obesity ,Paralysis or immobility•Poor circulation•Prolonged bed rest especially inunsanitary conditions with wet or wrinkledsheets•Spinal cord injury
Causes & symptoms:Bedsores most often develop whenconstant pressure pinches tiny bloodvessels that deliver Oxygen and nutrientsto the skin. When skin is deprived ofoxygen and nutrients for as little As anhour, areas of tissue can die and bedsorescan form. Slight rubbing or friction againstthe skin can cause minor pressure ulcers.They can also Develop when a patientstretches or bends blood vessels by slippinginto a different position In a bed or chair.Urine, faeces, or other moisture increasesthe risk of skin infection.
People who are unable to move orrecognize internal cues to shift positionhave a greater than average risk ofdeveloping bedsores. Other risk factorsinclude.•Malnutrition•Anaemia (lack of red blood cells)•Disuse atrophy (muscle loss or weaknessfrom lack of use)•Infection.
Diagnosis:Physical examination, medicalhistory, and patient and care giver observationsare the basis of diagnosis. Special attention mustbe paid to physical or mental problems, likeincontinence or confusion, that could complicatea patients recoveryBedsores usually follow six stages:Redness of skinSwelling, and possible peeling of outer layer ofskinDead skin, draining wound, & exposed fat layertissue death through skin and fat, to muscle.Destruction of bone, bone infection, fracture,and blood infection
Treatment:Prompt medical attention can preventsurface pressure sores from deepening intomore serious infections. For mild bedsores,treatment involves relieving pressure,keeping the wound clean and moist, andkeeping the area around the ulcer cleanand dry. Antiseptics, harsh soaps, andother skin cleansers can damage newtissue, so a saline solution should be usedto cleanse the wound whenever a freshnon-stick dressing is applied.
The patients doctor may prescribeinfection-fighting antibiotics, specialdressings or drying agents, or lotions orointments to be applied to the wound in athin film 3/4 times a day.Warm whirlpool treatments are sometimesrecommended for sores on the arm, hand,foot, or leg. In a procedure called deriding,a scalpel may be used to remove deadtissue or other debris from the woundDeep, ulcerated sores that dont respond toother therapy may require skin grafts orplastic surgery
A doctor should be notified whenever aperson:*Will be bedridden or immobilized for anextended time*Is very weak or unable to move*Develops bedsoresImmediate medical attention isrequired whenever:*Skin turns black or becomes inflamed,tender, swollen, or warm to the touch*The patient develops a fever duringtreatment*The sore contains pus or has a foul-smelling discharge.
With proper treatment, bedsores shouldbegin to heal two to four weeks aftertreatment beginsAlternative treatment:Zinc and vitamins A, C, E, and B complexhelp skin repair injuries and stay healthy,but large doses of vitamins or mineralsshould never be used without a doctorsapproval.A poultice made of equal parts ofpowdered slippery elm (Ulmus fulva)marshmallow (Althaea officinalis), and Echinacea(Echinacea sp.) blended with a smallamount of hot water can relieve minor
An infection-fighting rinse can be made bydiluting two drops of essential tea tree oil(Melaleuca sp..) in eight ounces of water.An herbal tea made from the calendula(Calendula officinalis) can act as an antiseptic and wound healing agent. Calendulacream can also be used.Contrasting hot and cold local applicationscan increase circulation to the area andhelp flush out waste products, speeding thehealing process. The temperatures shouldbe extreme (hot and ice cold), yet tolerableto the skin.
Hot compresses should be applied for threeminutes, followed by 30 seconds of coldcompress application, repeating the cyclethree times. The cycle should always endwith the cold compress.Prevention:It is usually possible to prevent bedsoresfrom developing or worsening. The patientshould be inspected regularly; shouldbathe or shower every day, using warmwater and mild soap; and should avoid coldor dry air. A bedridden patient should berepositioned at least once every two hourswhile awake.
A person who uses a wheelchair shouldshift his weight every 10 or 15 minutes, orbe helped to reposition himself at leastonce an hour. It is important to lift, ratherthan drag, a person being repositioned.Bony parts of the body should not bemassaged. Even slight friction can removethe top layer of skin and damage bloodvessels beneath it.
If the patient is bedridden, sensitivebody parts can be protected by:*Sheepskin pads*Special cushions placed on top of amattress*A water-filled mattress*A variable-pressure mattress whosesections can be individually inflated ordeflated to redistribute pressure.Pillows or foam wedges can prevent abedridden patients ankles from irritatingeach other, and pillows placed under thelegs from mid-calf to ankle can raise theheels off the bed.
Raising the head of the bed slightly andbriefly can provide relief, but raising thehead of the bed more than 30 degrees cancause the patient to slide, thereby causingdamage to skin and tiny blood vessels.Aperson who uses a wheelchair should beencouraged to sit up as straight aspossible. Pillows behind the head andbetween the legs can help preventbedsores, as can a special cushion placedon the chair seat. Donut-shaped cushionsshould not be used because they restrictblood flow and cause tissues to swell.
Prognosis:Bedsores can usually be cured, butabout 60,000 deaths a year are attributed tocomplications Caused by bedsores. Bedsores canbe slow to heal. Without proper treatment, theycan lead to•Gangrene (tissue death)•Osteomyelitis (infection of the bone beneath thebedsore)•Sepsis (tissue-destroying bacterial infection)•Other localized or systemic infections that slowthe healing process, increase the cost oftreatment, lengthen hospital or nursing home
Further Reading following Books helpThe Medical Advisor: TheComplete Guide to Alternative andConventional Treatments, editedby Time-Life Books. Alexandria,VA: Time-Life, Inc., 1996.Alternative therapies like Ayurvedaare having effective remedy forthis depressing stigmatas andpainful life threatening for theambulatory.
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