Description bedsores
Pressure ulcers are differently large wounds arising especially in long bedridden patients, due to the local pressure on the skin. Usually arise in areas with a small layer of fat or muscle tissue.
Even for advanced contemporary medicine bedsores are a serious problem because it is difficult to heal and may hinder the entry of infection into the body. Medical staff are trying to preemptively fight against bedsores regular positioning, the best hygiene, replacement of bedding and use of bedsores beds for patients at risk. Patients with pressure ulcers involves much greater physical and time burden. Mortality of decubitus patients is five times higher than in persons of the same age who do not suffer from bedsores.
Cause and risk factors of pressure ulcers
Causes of pressure sores are complementary. Pressure exerted between the skin and the support (bed), causing compression of the tissues. Tissue and blood flow and oxygenation are not, they lead to tissue death, called necrosis professionally. This necrosis was then added infection. The highest pressure occurs at the bony prominences such as hip joints, sacral projections sacrum or tailbone. Sometimes they appear on their heels, back of the head, shoulders, cheekbones, around the blades, ankles, knees on the side, at the toe or soles.
More important than the intensity of pressure for the formation of bedsores duration of action.They are formed very rapidly, between about 1 to 6 hours. For this reason, they are most at risk of long-term patients lying, unconscious people, people with dementia, people over 70 and people with spinal cord injuries.
For elderly are sores risky due to change of properties of the skin – decreases elasticity fibers worsens pain perception, increasing the permeability of the skin, there is no good conversion of the skin and reduces the amount of blood vessels.
Higher risk patients have malnutrition because they have reduced the natural ability to heal wounds.Therefore, it is necessary to pay attention to caloric diet, getting enough vitamins and minerals. Obesity is also associated with an increased incidence of pressure ulcers, because obese patients acts on the pad greater compressive force, and thus leads to greater oppression tissues.
Another risk factor is depression, decreased immunity, changes in blood flow, severe postoperative and posttraumatic conditions (such as fractures of the lower limbs). Unfortunately, they also includeneglected nursing work. Incontinence causes disruption of the surface of the skin and therefore less resistant to mechanical influences. The skin can cause shear forces and friction generated by the sliding on the mat, when moving the patient on the bed, caused by falls during inappropriately appended dressings or due shrnutému ložnímu garment. Blood vessels bend, stretch, narrow and damaging the surface layer of the skin due to friction. This results in expansion of an existing pressure ulcer.
Among the adverse effects also include anemia (anemia), dehydration, diabetes, liver disease, kidney failure, tumors, vascular diseases, disorders of brain function, drug intoxication, brain and spinal cord injuries.
The best proof is the topcoat layer of skin, muscles and less resistant to at least adipose tissue.Pressure damage proceeds always from the depths to the surface, and decubitus looks on the surface is always better than what it actually affected. Therefore, it is not at all easy to recognize emerging bedsores.
prevention of bedsores
Prevention in the fight against pressure sores is the most important step because treatment is six times more expensive and difficult than prevention.
In the case of suspected bedsores test is performed to evaluate the degree of risk by the Norton, Braden or evaluation is performed on the overall state according IGAP. Self-sufficiency patient can be verified through test ADL according to the Barthel. It is necessary to assess whether the patient belongs to a certain risk groups with a risk of bedsores that was eventually burdened by excessive care. These tests evaluate whether the patient without risk, low, medium or high risk.
Determining risk is performed at an interval of 2-24 hours after admission to the hospital for acute care and is repeated every 48 hours. For long-term care as LDN, the evaluation takes place immediately upon receipt of the patient and subsequently repeated weekly during the first month hospitalization, then monthly or quarterly.
Among the indispensable steps for prevention include positioning. Regularly changing the patient’s position in bed or in a wheelchair at certain time intervals. These can vary according to the assessed risk of developing pressure ulcers between 10 minutes to 4 hours. For each patient, the risk is prepared a written daily schedule, which is scheduled precisely changing positions. When the first symptoms of pressure ulcers must immediately intervals between changes of positions reduced.
Test the skin and the level of patient comfort. Therefore, it is desirable with every change in the position of wondering if the patient feels well.
In the event that the patient is able to move its position should change periodically every 10-15 minutes. If the patient is unable to rotate independently, it must be positioned healthcare provider or caregiver. Interval position change varies according to the specific condition of the patient (from 10 minutes to 4 hours). It is used most often lateral and oblique positions on the abdomen positions only rarely and never to present decubitus.
To alleviate pressure uses of foam or air mattress protections pat, various pads and positioning pillows. These pads and pillows should be used to prevent direct contact bed and bone spurs such as the knees, ankles and joints. The most preferred location appears oblique position because there is pressure distribution.
If the patient lies in bed, one should think of relief pat about 1 cm above the surface. If the feet but rose too, there would be a poor blood supply to the tissues.
Should not be used too often washers under head above a level higher than 30 degrees, because then there is a shear, ie the slip. They should be used, for example only when administered food.The patient should have head lifted a pillow or a pillow around 15 degrees.
In a seated patient, it is necessary to use anti-decubitus pads. They should never sit on the existing pressure ulcer. In the case of pressure ulcers on the buttocks should use the bed to the weight distribution. Wheelchair should sit up straight and should not slide down from the truck.
The base is a dry bed, so it is essential for problems with incontinence panties or wear disposable diapers. It should not be ignored either skin care – keep it clean, dry, use gentle detergents and prevent it from drying out.
A very important part of a good diet. Although it seems that it seemingly unrelated wounds, the opposite is true – keeps the skin elastic and supple, provides enough nutrients, vitamins, minerals and trace elements, increases immunity against infection and shortens the healing of existing wounds. Proper diet belongs in the hands of an expert (such as nutritional sisters), which assesses the risk of malnutrition and lack of individual food components. For sick general rule 15-20% protein, 25-35% fat, 45-65% carbohydrates. The diet should consist of sufficient protein (meat, eggs, fish, legumes), fruits and vegetables, milk and cereals. It is also used many dietary supplements for supplementing the vitamins, minerals, and in the case of eating disorders.
Rehabilitation seeks to promote mobility and self-care. It is best to start as soon as possible. The intensity and the method is selected according to the specific needs of an individual.
symptoms of bedsores
Due to improved health care are pressure sores divided into four levels according to the severity. It is very important to know that bedsores proceed from the depths to the surface. Even minor marks on the skin surface and may be a sign of extensive damage underneath the surface layer.
first grade
At the point of applied pressure there is a slight swelling (edema) and redness of the skin. The skin is intact, but the depth of now there is a process leading to the formation of bedsores. These symptoms are completely reversible, so when you change the position of the patient, the swelling disappears. But pressure can cause permanent changes in the skin.
If the caregiver is not skin redness sure there is a simple test – when pressed leather for a brief moment nezbělá but remains red. In people with darker skin, such as blacks, African Americans, Asians or romové not easy to find redness at first instance bedsores.
Upon detection of the first signs is an urgency to act – a slight reddening can quickly turn into more serious level.
II. degree
In the affected areas formed blisters and sometimes can be surface-exposed top layer of skin. The skin is swollen, bluish and hard.
Here the test is similar – after pressing the skin affected area turns white but stays below the white, since no recovery circulation. Subcutaneous blood vessels are damaged and leads to death of the tissues.
To restore the skin may occur, but it is a long process because of damage to the skin.
III. degree
In the third step leads to necrosis (death) of the tissues between the washer and the bone. This looks like a crater since damaging all layers of the skin. Area bedsores may cover dry black crust or melting necrotic flesh.
It is recommended to carry out swab for bacteriological examination, because the plague is a gateway for bacteria. Any inflammation can spread into the bloodstream and cause this death.
Also here can decubitus spontaneously heal, but healing takes several months to years. After healing of atrophic scar is formed adjacent to the bone, which may, even after a small load fall apart and give rise to chronic pressure ulcers.
IV. degree
To the fourth stage covers the most serious cases of bedsores, which date back to the bone. May lead to infectious inflammation of bones and joints. The bacteriological swab is therefore essential.
These cases never heal spontaneously, so it is always necessary surgery.
treatment of bedsores
The treatment of pressure ulcers is very difficult. Comprising the steps of: elimination of pressure, removal of necrosis, guard against infection, pain elimination, promotion of granulation and support epitalizace.
For proper treatment of pressure ulcers it is necessary to ensure a moist wound environment,which prevents the entry of bacteria from the wound area and keeps it at a constant temperature.Moisture wounds and defend against infection, for example, provide coverage of hydrocolloid, hydrogel coverage, alginate coverage means charcoal, polyacrylate pads, protection of network material or transparent polyurethane cover. On the market there are plenty of products, in large part paid by the insurance company.
The wound was cleaned with saline solution each time the dressing. For the patient, this cleaning extremely painful, therefore requires gentle care and sometimes use of painkillers.
Necrotic tissue in a wound must be removed as soon as possible because the bacterium promotes and prolongs healing. Removal of necrosis can be done mechanically or by using enzymatic autolytically substances.
The hardest stage pressure ulcers must be addressed surgically. Uses of skin transplants or skin grafts. This operation is not, however, suitable for all patients because it takes up to 3 hours, and blood loss is up to 1.5 liters.
complications of bedsores
It is almost always present infection that occurs from near – urine, feces, sweat, blood or infection from a nearby pressure ulcer. , Risk of bacterial penetration deeper into the wound where they can cause the so-called. Wound infection. Therefore, in the most severe type of pressure ulcers (serious II., III. And IV. Grade) was performed bacteriological smear of depth and the edges of wounds. The wound is most often staphylococcus, streptococcus, pseudomonas, and Escherichia coli.
In extreme cases, can cause sepsis (blood poisoning).
