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Bedsores, Pressure Sores, Decubitus Ulcers

A bedsore or pressure ulcer is an area of skin that breaks down when a person stays in one position for too long without shifting their weight. This often happens to individuals utilizing wheelchairs or who are bedbound even for a short period of time. The constant pressure against the skin reduces the blood supply in that area, and the affected tissue dies. A pressure sore or decubitus ulcer starts as a reddened area of skin that can get progressively worse, forming a blister, then an open sore, and then finally a crater. The most common places for pressure ulcers to develop are either bony prominences (bones close to the skin) like the elbow, heels, hips, ankle, shoulders, back and the back of the head.

Are bedsores preventable?

Absolutely! Caretakers or nursing home staff must assess each patient individually as to the risk of development for pressure ulcers. Any individuals who are bedridden, have fragile skin, chronic medical conditions such as diabetes or vascular disease, malnourishment, mental disabilities such as Alzheimer’s disease or urinary incontinence are more prone to the development of pressure sores. Therefore, competent and regular turning and repositioning of the sick or elderly resident will prevent the development of bedsores. Turning prevents the buildup of pressure on the skin that can result in the development of bedsores. Turning is universally considered to be the most important factor in bedsore prevention. Yet, despite its universal acceptance, many facilities, including hospitals and nursing homes, fail to properly turn and reposition their residents. It can be labor intensive work because the patient needs to be turned at regular intervals. Turning of patients at least every two hours is usually considered to be the minimally accepted standard of care. In bed-bound residents, the staff should turn the patient to their side. If a resident spends most of their time in wheelchairs, the staff needs to lift the residents out of their chairs and reposition them for preventative purposes.

What are the stages of bedsores?

Bedsores or pressure sores are characterized by severity: From Stage I (the earlier sign) to Stage IV (the worst):

  • Stage I: A reddened area on the skin that, when pressed, is “non-bleachable” (does not turn white). This indicates that a pressure sore is starting to develop.
  • Stage II: The skin blisters or forms an open sore. The area around the sore may be red and irritated.
  • Stage III: The skin break down now looks like a crater or there was damage to the tissue below the skin.
  • Stage IV: The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes tendons and joints.

On rare occasions, references will be made to a bedsore that is "unstageable". An unstageable bedsore is usually an indication that a bedsore has advanced so far that a large area of skin, tissue and bone is involved.

Bedsores are a wide spread problem in nursing homes and hospitals. The development of bedsores is an indication of poor nursing care. Often times Nursing Homes tell the family of residents that bedsores cannot be prevented or are just a part of the ageing process. This is simply not true.

With careful assessment and bedsore prevention plans such as pressure relieving mattresses and turning and repositioning programs, bedsores can be avoided. However, the most important part of bedsore prevention treatment ultimately rests with the skill and dedication of the staff.

If you believe that a family member or a loved one has developed a preventable bedsore, contact us at Fenster & Cohen, P.A. and let us assist you.