No matter how carefully they care for bedridden and sedentary patients, still sometimes you can not do without pressure sores. The classification of soft tissue and skin necrosis, presented below, will help those who care for patients to determine the degree of damage and find solutions to the problem. In order to make everything clear, we first find out what pressure sores are.
Terminology
Pressure ulcers are a process that leads to necrosis (necrosis) not only of the skin, but, in the case of a progressive stage of damage, of deep-seated tissues. Sores are also called minor skin disorders, which can be eliminated with proper care. Deep ulcers on the body should also be attributed to necrosis.
Necrosis develops due to constant prolonged pressure on a part of the body. The tissues seem to be pinched between the protrusions of the bones and a hard surface. Usually in these places, the subcutaneous fat layer is completely absent. Nothing softens the pressure on the fabric. There is a violation of blood circulation, innervation.
If a person lies on his back for a long time, then wounds form on the sciatic tubercles, sacrum, nape, shoulder blades, elbows and heels.
If on the side, then the hips (big spit), knees, ankles suffer.
Long lying on the stomach leads to the formation of pressure sores on the cheekbones and pubis.
The most susceptible to the occurrence of pressure sores are people:
- overweight;
- exhausted;
- consuming little water and food;
- with diabetes and heart disease;
- injured head and spinal cord;
- with urinary and fecal incontinence.
Seams, folds, the presence of crumbs and small objects on the bed provoke the appearance of necrosis. Allergies should not be ruled out. Skin care products can cause it.
Causes of necrosis
Before we move on to talking about the classification of bedsores, we will learn more about the causes that cause them:
- Tissue squeezing. Every cell in the body lives thanks to oxygen and nutrients. They come to her with blood through the capillaries. In the lymphatic and blood vessels, the products of their vital activity are removed from the cells. If a person is in one position for a long time, bone tissue comes into contact with a solid surface, capillaries and nerves are pinched. Nutrients and oxygen do not enter cells, and processed substances are not removed from them. They accumulate and adversely affect healthy cells, which leads to their death. If you do not provide timely assistance to the patient, the process becomes irreversible.
- Tissue shift. In a hospital for patients all conditions are created. There are special beds with which the upper body is raised. This relieves stress on the cervical spine. But in order to prevent the appearance of pressure sores, it is necessary to monitor the patient's legs. They must be supported. Otherwise, the body will begin to slide. Tissues that lie deep will move relative to the motionless skin. There is an inflection of blood vessels, blood clots form, which can burst. Pinching of the nerve endings provokes a decrease in sensitivity in places of necrosis. Therefore, it is difficult to diagnose the onset of complications.
- Friction. Coarse clothes, creases on the bed, etc. can cause friction. The protective skin layer is erased, which causes damage to the skin. Such damage may also occur if the linen is changed incorrectly. Do not pull sheets from under a still person.
- Skin moisture. Constant wetting causes a process such as maceration. It provokes a break in communication between surface cells, and then deeper.
Strong body moisture increases skin friction on the surface. This, in turn, leads to the appearance of microtraumas. The skin begins to thin and peel.
In order to understand what criteria lie in determining the classification of bedsores, it is important to understand the causes of this complication and developmental features. That's why we talked about the factors that cause necrosis.
Severity
There are four stages of necrosis development and two additional categories. If there is no proper treatment, the first stage quickly turns into the last. So, the classification of pressure sores by severity is as follows:
- First stage. Sustained redness appears on the surface of the skin. It does not disappear even after the exclusion of pressure. Affected integuments differ from healthy ones in color. A swelling may appear.
- Second stage. Necrosis affects not only the epidermis, but also the dermis. An open wound appears on the skin. Its bottom is pinkish or red. Scabs or fibrous plaque may appear.
- Third stage. All skin layers are damaged. Necrotic tissue changes are visible. Pockets with pus and fistulous passages may form.
- The fourth stage - the deep layers of tissue are affected: muscle, bone, tendons. The surface of the bedsore is covered with black necrotic tissue. Blood supply is disturbed, deep fistulous passages are filled with pus. Intoxication and sepsis are possible. Bone damage can cause osteomyelitis.
The classification of pressure ulcers according to severity includes two additional categories:
- First one. Tissue necrosis spreading deeply. The bottom of the wound is covered with a plaque from light yellow to black. Scabs may appear along the edges of the wound. The degree of damage cannot be determined until necrotic formations and plaque are removed.
- The second one. The focus of the affected tissue is localized. It has clear boundaries. A hematoma may appear. The color of the bedsore is maroon. It varies greatly with healthy skin.
How to help a patient
We turn to the treatment of pressure sores. Classification of the disease, or rather, knowledge of this, is very useful. First, we learn about the basic principles of getting rid of an illness, there are three of them:
- restoration of normal blood circulation;
- cleansing the damaged area from wound exudate, pus, dead cells;
- measures aimed at the speedy healing of wounds.
Here's how to treat:
- First stage. Affected areas of the skin are wiped several times a day with camphor alcohol. You can prepare a mixture of vodka and baby soap (in equal parts). An anti-decubitus mattress or rubber circle is recommended. The patient should be turned over every three hours. Red spots should be ground, and then lubricated with preparations containing zinc oxide (Tsindol ointment, Menalind cream). Do not lay the patient on the side where the smeared area is. After washing, you can use a powder. This will prevent diaper rash.
- Second stage. Wounds are treated with a 3% solution of hydrogen peroxide, 1% solution of chlorhexidine. Immediately after treatment, the wound should not be covered with a bandage. Let it dry and ventilate. If possible, the damaged area can be treated with quartz lamp rays for ten minutes. This procedure will prevent infection and dry the edges of the wound.
Healing agents are used to restore the skin: ointment "Argosulfan", spray "Panthenol" and others. After this, the wound is closed with a gauze napkin. Processing in this way is carried out twice a day.
More complicated cases
We continue to talk about the treatment of necrosis, depending on the classification of pressure sores:
- Stage Three. The wound is cleaned with 3% hydrogen peroxide. Pressure sores are processed directly from the bottle; the wound surface cannot be touched with your hands or a napkin. After that, biological damage treatment agents are used. A protective dressing is applied, impregnated with "Multiferm", means "Pam-T", solution or gel "Curiosin" and others, a sterile napkin is placed on top and fixed with a plaster. This procedure is carried out once a day.
- Stage Four. In this case, only surgical intervention is required. First, all dead tissue is removed, and then measures are used to heal the wound.
As you can see, the method for solving the problem depends on the classification of bedsores. Treating necrosis is a long and painstaking job requiring patience.
Prevailing Division
We move on to the following type of bedsores classification - exogenous and endogenous. Let's talk about them in more detail.
The exogenous factor is characterized by prolonged strong and constant pressure on the soft tissues. The human body during the disease is weakened. And this is one of the reasons that creates the conditions for extensive, and most importantly, rapid skin damage. The classification of exogenous pressure ulcers is as follows:
- External - soft tissue is squeezed between the bone and another object (splint, gypsum, mattress).
- Internal - appear in the internal organs, vessels. The reason that causes them is the constant and prolonged pressure of catheters, drainage tubes, tampons.
The appearance of endogenous bedsores provokes a weakening of the body, a violation of vital functions. Emerging wounds can be mixed and neurotrophic:
- Mixed. They are found in malnourished people with diabetes and spending most of their life in bed.
- Neurotrophic. Appear with damage to large nerve trunks, hemorrhages in the spinal cord and its injuries.
Size division
We examined the classification of bedsores according to the degree of damage, according to the prevailing factor. Let's talk a little about such a characteristic as the size of necrosis.
The disease is divided into four types:
- a lesion of up to five centimeters in diameter is considered small;
- if the diameter of the wound is in the range of five to ten centimeters, this is a bedsore of medium size;
- from ten centimeters to fifteen - large necrosis;
- bedsore more than fifteen centimeters is called giant.
Separately, it is worth considering the fistulous form of the lesion. A large cavity appears in the soft tissues, which connects to the external environment through a small hole in the skin. Weeding is sometimes located at a great distance from the wound. But still, all the discharge passes through the fistula, which is often curved, tortuous. The fistulous form of a bedsore is often accompanied by osteomyelitis of the underlying bone.
Risk factors
Classification of bedsores is carried out on this factor.
The main stage of the prevention of pressure sores is the identification of patients belonging to the high-risk group. Risk factors are divided into reversible and irreversible, as well as internal and external.
According to these parameters, types of bedsores are classified as follows:
- Internal reversible risk factors. Limited immobility, exhaustion, poor nutrition, insufficient intake of ascorbic acid, anemia. Also, they should include fecal and urinary incontinence, disorders of the nervous system, hypotension, dehydration. Confused consciousness, coma, peripheral circulation disturbance, thinned skin, anxiety - the continuation of this list.
- The next group in the classification of pressure ulcers by risk factors is external reversible factors. These include inadequate hygiene, folds on clothes and bedding, patient fixation tools, and bed handrails. This group also includes injuries of the spine, abdominal cavity, pelvic bones, damage to the spinal cord, improper technique for moving the patient, the use of glucocorticoid hormones and cytostatic drugs. Extensive surgery lasting more than two hours should also be attributed to this group.
A variety of scales are used to determine the risk of pressure sores. One of them is the J. Waterlow scale. Assessment of the degree of risk in bedridden patients is carried out daily. When high risk occurs, anti-decubitus measures are immediately prescribed.
All points are summed up, according to the final results, the degree of risk is determined:
- from one to nine points - no risk;
- ten to fourteen - there is a risk;
- fifteen to nineteen - high risk;
- more than twenty - a very high degree of risk.
Necrosis prophylaxis
With the definition of bedsores, their classification you have already met. Of course, it is better if you do not have to deal with this problem.
In order to avoid it, observe these rules:
- Every day, check the condition of the skin of the patient. Pay special attention to the area where the protrusions of the bones are in contact with the surface.
- If possible, change the supine position every three hours.
- Use special tools: inflatable circles, mattresses.
- Bedding should be soft. Clothing should not contain coarse and synthetic fibers. No fasteners and buttons on it.
- Be sure to control the air temperature in the room where the patient is located. It should be comfortable so that the patient does not freeze and does not overheat. Sweating causes diaper rash, which leads to pressure sores.
- Carefully care for the patient’s skin. In a lying person, it becomes thinner and drier. Do not use creams and lotions containing alcohol.
- Use diapers, disposable diapers, pads if the patient is suffering from urinary or fecal incontinence. After every act of defecation or urination, change hygiene products. Rinse and dry well.
- Change bed sheets carefully. Do not pull it from under the patient. Perform all manipulations carefully.
- If possible, make the patient move at least a little. If possible.
- Watch out for food. It should be high-quality, balanced and low-calorie.
Conclusion
Understood a little in the classification of bedsores, the causes that cause them. Learned how to help people and how to prevent this problem.
It is better, of course, to avoid the occurrence of an ailment, but if you failed, then do not delay the start of treatment. Complications of pressure sores can greatly aggravate the plight of patients. The prognosis can be disappointing, and the outcome can be fatal. The complications that causes necrosis include:
- erosive bleeding;
- osteomyelitis of the underlying bone;
- phlegmon;
- purulent arthritis;
- sepsis and others.
Try not to bring your relatives to such a state. Give them timely help.