Bed Sores: Classification and Management

Bed Sores...

Bed Sores

• Decubitus ulcers or pressure ulcers

• It is an ulceration in the skin that is caused by prolonged pressure on a bony or weight bearing part of the body.

Most Common Areas

• Sacrum• Elbow• Knee • Ankle

Risk Factors

• Unrelieved pressure• Friction• Humidity• Shearing forces• Temperature• Age• Continence• Medication

“ A bed sore ca develop in as early as two to three hours. In its early stage, it usually appears as red blotch on the skin which is warm to touch...”(Johnson & Johnson et al)

Causes

Bedsores are accepted to be caused by three different tissue forces:

• PressureThere is compression of tissues. It leads to

decreased tissue perfusion, ischemia occurs leading to tissue necrosis if left untreated

Causes

• Shear forceThe force created when the skin of a patient

stays in one place as the deep fascia and skeletal muscle slide down with gravity. This can also lead to ischemia and tissue necrosis.

• FrictionIt causes shedding of layers of epidermis.

Aggravating Factors

• Excess moisture• Age• Nutrition• Vascular Diseases• Diabetes mellitus• Smoking• Temperature: cutaneous metabolic demand rises

by 13% for every 1°C rise in cutaneous temperature

National Pressure Ulcer Advisory Panel Classification

Stage 1• the most superficial,

indicated by non blanchable redness that does not subside after pressure is relieved.

• skin may be hotter or cooler than normal, have an odd texture, or perhaps be painful to the patient.

National Pressure Ulcer Advisory Panel Classification

Stage 2• Damage to the epidermis

extending into, but no deeper than, the dermis.

• In this stage, the ulcer may be referred to as a blister or abrasion.

National Pressure Ulcer Advisory Panel Classification

Stage 3• Damage to the epidermis

extending into, but no deeper than, the dermis.

• In this stage, the ulcer may be referred to as a blister or abrasion

National Pressure Ulcer Advisory Panel Classification

Stage 4• is the deepest,

extending into the muscle, tendon or even bone.

National Pressure Ulcer Advisory Panel Classification

Ustageable Pressure Ulcer• Are covered with dead

cells, or eschar and wound exudate, so the depth cannot be determined.

Braden Scale for Predicting Pressure Ulcer Risk

Six Criteria:• Sensory Perception• Moisture• Activity• Mobility• Nutrition• Friction and Shear

Braden Scale for Predicting Pressure Ulcer Risk

• Each category is rated on a scale of 1 to 4, excluding the 'friction and shear' category which is rated on a 1-3 scale.

• A score of 23 means there is no risk for developing a pressure ulcer while the lowest possible score of 6 points represents the severest risk for developing a pressure ulcer

Treatment

Proper Care:• The most important care for a patient with

bedsores is the relief of pressure.

• Once a bedsore is found, pressure should immediately be lifted from the area and the patient turned at least every two hours to avoid aggravating the wound.

Treatment

Debridement• Autolytic debridement - the use of moist

dressings to promote autolysis with the body's own enzymes.

• Biological debridement, or maggot debridement therapy, is the use of medical maggots to feed on necrotic tissue and therefore clean the wound of excess bacteria.

Treatment

• Chemical debridement, or enzymatic debridement- the use of prescribed enzymes that promote the removal of necrotic tissue.

• Mechanical debridement - the use of outside force to remove dead tissue.

Treatment

• Sharp debridement - the removal of necrotic tissue with a scalpel or similar instrument.

• Surgical debridement

• Ultrasound-assisted wound therapy- the use of ultrasound waves to separate necrotic and healthy tissue.

Treatment

• Nutrition

• Infection control

• Education of caregivers

• Wound intervention