Pressure ulcers are one of the most common complications that occur in bedridden patients. What is it?
Pressure ulcers are called changes in body tissues in a certain area (or several) caused by prolonged contact with a solid surface. Such changes are provoked by a violation of blood circulation, lymph circulation and innervation.
It is very important to understand what pressure sores are, their prevention and treatment.
Development features
Naturally, the appearance of pressure sores on the side of the body on which a person lies, in areas touching the surface. So, when the patient is on the back, bedsores in bedridden patients most often develop on the buttocks, in the sacrum, tailbone, heels, on the shoulder blades, at the level of the spinous processes of the spines. If a person lies on his stomach, pressure sores may appear at such points of contact with the surface: the knees, the front surface of the chest wall, the iliac crests. In a semi-sitting position, a typical lesion is the area of the ischial tubercles.
But lesions of sites not listed above are not excluded. For example, bedsores (a photo depicting this pathology can be found in the medical guide) sometimes develop on the occipital region and in the folds under the mammary glands. Perhaps a specific arrangement in the presence of plaster dressings in places of their tight fit of the material to the skin, using oilcloth fabrics, rubber tubes, catheters, prostheses. That is, localization is due to where exactly there are damaging factors.
Important is the condition of the patient's body. There is a high risk of the appearance and more rapid development of pressure sores with general exhaustion, the presence of congestion, which is often observed with heart failure, in patients who are of advanced age. In young, conscious people, on the contrary, the appearance of pressure sores is unlikely. And even if they appear, they rarely develop to the later stages. But at the same time, it should be remembered that due to the gradual development of damage in these patients, you can sometimes miss the first signs of pathology.
In almost all cases, the development of pressure sores occurs according to the same pattern; only the time of each stage is different. The beginning is always stagnation of blood as a result of compression, in the absence of treatment, the affected tissue is necrotic.
What is the danger of pressure sores?
The main danger is associated with their complications. Since in most cases bedsores in bedridden patients develop rapidly, and in a very short time a large area can suppurate and necrotic, it is often necessary to excise the affected tissue. This sometimes leads to disruption of the blood supply and innervation of nearby sites, which, in turn, leads to disruption of their functioning.
In some cases, the result of the development of pressure sores is the need to amputate a limb. In addition, the development of necrotic processes in the periosteum or bone tissue, gas gangrene or sepsis is possible.
It is also important that the processes that occur in the body during the development of bedsores, their treatment, require considerable energy expenditures, therefore they deplete the patient, thereby exacerbating the course of the underlying disease. Festering bedsores are especially dangerous.
Thus, it is very important to understand how to recognize bedsores. Etiology, pathogenesis, prevention, treatment of pressure ulcers of different localization are very similar.
Why do bedsores occur?
The reason for their development is a violation of blood circulation in a specific area of the skin. This can happen in several cases.
Most often, this phenomenon is observed when the vessels are squeezed, especially if the squeezing time exceeds two hours, which happens with a long stay in one position. Tissues that do not receive blood are necrotic, and this is already the development of a bedsore.
A possible cause is microdamage of small vessels located in the skin. This can occur when wet tissue, for example, a soiled sheet, is pulled out from under the patient. Sometimes injuries occur as a result of a person's attempts to independently change his posture or move. Therefore, any friction, minor damage to the skin and mucous membranes should be avoided, and if a person wants to turn around or do something, try to help him.
If you know the causes causing pressure sores, prevention, treatment of such a pathology is carried out more correctly and efficiently.
What increases the risk of bedsores?
In order to understand what pressure sores are, what are their reasons, what are prevention and treatment, it is very important to know what affects the risk of their occurrence. There are many such factors. Some of them are associated with the characteristics of the patient's condition, others with the organization of proper care for the bedridden patient.
Of the first group of factors, the most significant are the following features:
- Age - increased risk of development in elderly patients.
- Weight - here the danger is both overweight and underweight. The more weight, the greater the pressure on the fulcrum of the body. But insufficient weight often indicates an exhaustion of the body, and this is also a predisposing factor not only for the appearance, but also for the more rapid development of necrotic processes.
- Diseases of the heart and vascular system - with pathologies of this type, stagnation in the circulatory system develops faster, blood vessels are more easily damaged, any effect provoking a violation of their integrity is more significant.
- Concomitant diseases - a special place here is occupied by diseases that lead to impaired innervation (for example, previous strokes), as well as those in which metabolic processes are disturbed (for example, diabetes mellitus).
- Food and drink - dangerously inadequate intake of fluid and food, it is especially important to monitor the amount of protein in the diet.
- The inability to independently control urination and defecation is observed if the patient is unconscious, paralyzed or unable to control his behavior and condition due to dementia.
- Severe sweating - may be due to metabolic or endocrine disorders, as well as the result of a fever.
- Features of the perception of drugs - the emergence of allergic reactions to drugs used for skin care in places where pressure sores develop can be an adverse factor. Prevention, treatment of pressure sores implies the need to take into account all the features of the patient's body.
The second group of factors includes the features of care. A rare change of bed and underwear, the absence or improper implementation of hygiene procedures, unevenness and excessive hardness of the surface on which the patient is lying, the presence of crumbs, small items increase the likelihood of bedsores.
Pressure ulcers: how to recognize them?
If the patient is conscious and has sensitivity, he can talk about subjective feelings to those who care for him. Signs of the onset of pressure sores include complaints of a tingling sensation. It occurs as a result of stagnation of blood and lymph in a place where there is a high probability of the appearance of pathological processes leading to the formation of a bedsore, if necessary measures are not taken. As a result of such stagnation, the nerve endings do not receive the necessary nutrition, and subjectively it feels like a tingling sensation. After a few hours, a loss of sensitivity, the occurrence of a feeling of numbness in areas of the skin to which blood does not flow, is possible.
After some time, visible signs appear. In places where the protruding parts of the body come into contact with hard surfaces, bluish-red spots occur - venous erythema. They do not have clearly defined edges. Their color can be both saturated and barely noticeable.
If such signs were noticed, measures must immediately be taken to prevent the further development of pathological processes in the affected areas. Care must be taken to recognize bedsores. Prevention, treatment of pressure sores is all the more effective the earlier the first signs were noticed and actions were taken to eliminate them.
Help with the first signs of pressure sores
For prevention and treatment at the initial stage of their development, measures should be taken to more carefully care for the patient, to ensure that he is able to be in a comfortable and proper position.
Use special mattresses that help those who have pressure sores. Prevention and treatment of these formations is the direct goal with which they are made. Such anti-decubitus mattresses are of two types: cellular and balloon. They are equipped with compressors that operate silently and maintain the necessary hardness of the surface on which the patient lies. For patients who are in wheelchairs for a long time , special pillows filled with air, foam or gel can be used.
If the person is in a supine position, it is desirable that the head of the bed be slightly lowered or on the same level with the body.
Another important factor is the regular change in body position. If there are no contraindications, this should be done at least once every 2 hours. In this case, it is advisable to use specially made pillows. They help to change the position of individual parts of the body relative to the surface on which a person lies. Due to this, space remains between separate skin areas and the bed for some time, there is no squeezing of blood vessels, and the likelihood of pressure sores development and progression decreases. Patients in a wheelchair need a change in body position every hour. The bed on which the patient lies must be rebuilt at least once a day. At the same time, it is important to monitor the condition of bedding and underwear - it is dangerous to form folds, crumbs or other small objects that can cause skin irritation and microdamage on the laundry.
Of great importance is the hygiene of the skin. Particular attention should be paid to their humidity. To control this characteristic and prevent excessive moisture use special powders, creams, solutions, sprays, taking a warm (but not hot) bath. These hygiene procedures should be carried out at least twice a day. In addition, when urinating and defecating, it is necessary to remove dirt from the skin and linen as quickly as possible. For this purpose, as well as in order to remove sweat, food debris, wounds, use diapers, towels, napkins, diapers, absorbent pads.
It is permissible to stroke areas of the skin where there are signs of congestion, but you can not rub these places, do intensive massage. Such actions can provoke an acceleration of the process.
Pathogenesis
Four stages of development are distinguished in the pathogenesis of pressure sores. During stage I, venous erythema develops at the site of skin contact with the foreign surface. The reason for the development of erythema is a violation of the outflow of blood. Outwardly, erythema looks like a bluish-red spot, when pressed, the skin on the affected area turns pale. The temperature in the erythema is the same as the rest of the skin or slightly lower. The most common place for development is bone protrusions. The skin remains intact, there is no violation of its integrity.
At stage II of the development of pressure sores, thinning of the epithelium occurs, the skin peels off, and bubbles form on it. This is all a consequence of tissue malnutrition, which occurs due to stagnation of blood. It leads to a violation of innervation. In addition, fluid accumulates in the skin, epidermal cells swell, and eventually rupture and die. Thus, at this stage there are already visible skin lesions, maceration can be observed in the affected areas.
Stage III bedsores are characterized by the appearance of a wound. If pathogenic microflora gets into it, suppuration may develop. It is at this stage that the deep layers of the skin, subcutaneous tissue, muscles are involved in the pathological process, necrotic processes begin. Necrosis and the likelihood of purulent inflammation pose a huge threat to the patient's health.
At stage IV, a significant tissue defect in the form of a cavity is already present, on the walls of which purulent inflammation is visible. The cause of the appearance and enlargement of the cavity is tissue necrotization.
One person in different parts of the body may have pressure sores at different stages of development.
Possible complications
Most complications arising from the development of pressure sores are associated with the entry of pathogenic bacteria onto the damaged area. Most often it is staphylococcus or streptococcus, but cases of seeding with other pyogenic microorganisms are quite possible.
Most often, suppurative processes in a bedsore develop as erysipelas or phlegmon. In cases of general depletion of the body, weak immunity or improper organization of hygiene measures, inadequate treatment of pressure sores, life-threatening complications, for example, sepsis or gas gangrene, may develop.
Pressure ulcers in patients can begin to suppurate in the second or third stages, when a site of damaged epithelium or an open wound appears, subsequently, further development of purulent processes occurs.
Therefore, if pressure sores are present, prevention and treatment need not only them, strict monitoring of the general condition of the body is also important. Alertness should cause an increase in body temperature, an increase in weakness, headache, the appearance of swelling around the bedsore, a change in the color of the skin around it to a grayish, putrid odor from the wound, and other changes.
Typical localization of pressure sores
Depending on the position of the patient, where bedsores occur, their prevention and treatment may differ slightly.
Particular attention should be paid to options for their possible localization when the person is standing on his back. In this case, pressure sores most often occur on the heels, buttocks, tailbone, in the area of the shoulder blades.
The occurrence of pressure sores on the heels is often. Since the elderly often have stagnation in the legs, as a result of pressure on the heels, such processes are only exacerbated. In addition, the skin is usually denser in these areas of the body, so it is more difficult to notice the first signs of pathology. For the same reason, with this localization, bedsores (treatment of them) require a long and especially careful attention.
Pressure ulcers on the buttocks are dangerous in that this area of the body is close to important organs. The defeat of these organs not only requires careful treatment, but can also greatly affect the general condition and functioning of the body, even shorten life. Therefore, special efforts should be made to prevent such pressure sores. Prevention and treatment (photos depicting the appearance of this type of pressure sores are available in specialized journals) of such injuries should be carried out in accordance with all the rules. Otherwise, there remains a high probability that the process will lead to undesirable consequences.
Pressure ulcers: treatment and prevention
In addition to knowing what pressure sores are, where they can be located and how they look, knowledge is needed on how to treat them and how to prevent their occurrence. Treatment of pressure sores in a patient includes treating the skin for hygienic, prophylactic and therapeutic purposes. Such treatment should be carried out regularly.
It is important to understand what causes pressure sores. Prevention, treatment of pressure sores should also be mastered. Hygienic treatment of the skin is carried out to maintain at a safe level its basic properties and characteristics: acidity, moisture, elasticity. To do this, you need to eliminate pollution in time.
Preventive treatment involves actions that improve blood circulation and the renewal of the sensitivity of the skin and underlying tissues. Do not forget that damaged skin is more prone to the occurrence of pressure sores and suppurative processes, therefore, it is necessary to prevent its overdrying and the appearance of cracks on it.
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Of considerable importance is the nutrition of the patient. Vitamins, minerals, especially zinc and iron, proteins, must be present in the diet in the required amount, the use of vegetables and fruits is necessary. It is recommended to include dairy products, fish, chicken eggs, meat (preferably poultry) in the diet. If it is difficult for a person to eat meat, it can be replaced with broth.