The largest organ in the human body is the skin. The enemies of the skin are pressure, moisture, and sheering forces. As skin ages it becomes less elastic and on the cellular level, less sturdy. Skin tears, abrasions and decubitus ulcers (bedsores) and other breaks in the skin expose your loved one to dangerous and often life threatening infections. Caregivers need to always be aware of openings in the skin as a portal for potential infection. They must monitor weekly your loved one’s skin integrity and be quick to identify risk factors for skin breakdown. For ease of reference I have listed the four stages of a decubitus ulcer:
Stage I: This stage is characterized by a surface reddening of the skin. The skin is unbroken and the wound is superficial. Generally when pressure is relieved off of this area the skin integrity is returned to baseline.
Stage II: This stage is characterized by a blister either broken or unbroken. A partial layer of the skin is now injured. Involvement is no longer superficial.
Stage III: The wound extends through all of the layers of the skin. It is a primary site for a serious infection to occur.
Stage IV: A Stage IV wound extends through the skin and involves underlying muscle, tendons and bone. The diameter of the wound is not as important as the depth. This is very serious and can produce a life threatening infection, especially if not aggressively treated. All of the goals of protecting, cleaning and alleviation of pressure on the area still apply. Nutrition and hydration is now critical. Without adequate nutrition, this wound will not heal.
Pressure ulcers generally develop over an area of bony prominence subjected to extended periods of applied pressure. Accordingly, during weekly skin integrity inspections caregivers must generally looking at elbows, the back of the head, heels, and buttocks or tailbone areas. This is not the time to be shy. Caregivers cannot ignore the sacral (backside) inspection since it is a primary site of life threatening skin breakdown due to excessive moisture (particularly if you loved one is incontinent and in a diaper) and constant pressure when sitting or laying down.
The standard of care for preventing progression of decubitus ulcers is to turn and reposition residents who are unable to do so themselves at a minimum of every two hours. Furthermore, since we understand that moisture is the enemy of the skin, they must ensure that diaper and linen changes are routine and timely. Air mattresses, pressure relieving devices, ointments, dressings and the like are all part of an overall skin integrity program. Since caregivers must be doing weekly skin integrity inspections, bedsores should not generally be discovered in the late stages and once identified one must be vigilant in their pursuit of appropriate interventions to prevent the progression of a sore from one stage to the next aware that with each successive stage the danger to your resident increases and the likelihood of healing diminishes drastically. Finally, like all the organs of the body, the skin is healed, promoted or maintained by adequate nutrition and hydration.
If your loved one developed bedsores/pressure ulcers inside a nursing home, an assisted living facility, or hospital, call us today. Because as you can see, with proper care, there is absolutely no excuse for it to progress.
