Bed sores

November 12, 2012

Bed sores

Bed sores may often be seen as a relatively trivial skin condition which is the result of sitting or lying in the same position for too long. However the reality is very different, whist it is true to say that bed sores are easily treatable this is only when they are discovered and treated in the early stages of development – if left without treatment then they can, in fact, be fatal. It is also not the case that these pressure ulcers, as they are also known, are the result of sub-standard care or neglect – bed sores are hard to prevent especially in those known to be at risk.

Pressure sores may develop when the skin becomes damaged and tend to occur in patients who, for various reasons, are immobile. Because of the sustained pressure in areas such as buttocks, hips and heels when a patient is immobile circulation may well be cut off to these places and this will cause tissue death – the beginning of a pressure ulcer. If not dealt with quickly then progression will be rapid and treatment problematic.

Because bed sores are known to occur in a specific group of patients it should be good practice to have a preventative regime in place. Vulnerable groups would include -

  • Patients who are immobile for any reason – sedation or medically induced coma, injury, illness. Steps should be taken from the very early stages of immobilisation in order to prevent development of skin lesions.

  • Those with long term spinal cord injuries – because nerve damage associated with these types of injuries is usually permanent then the compression of skin and tissue in these patients is constant. Lack of sensation triggers means spinal injury patients are unaware of their need to change position and may not feel the developing bed sore. They are also vulnerable to damaged skin and poor circulation both of which can exacerbate the risk of developing pressure sores.

  • The elderly – elderly patients who may be underweight or even malnourished are at a greater risk of bed sore development, they may also have difficulty with mobility, and the thinning of the skin – which is part of the natural aging process – is another risk factor in this patient group.

  • Nursing home residents – possibly due to the frailty of these patients the incidence of bed sores is somewhat higher.

  • Coma patients – coma patients are not only unable to move unaided but also may be unaware of the pain associated with developing pressure sores.

  • Some conditions may mean that a patient does not feel pain sensations – this means they will not instinctively take protective measures against bed sores such as changing position – or asking to be moved.

  • Patients who have lost weight or are not eating a healthy diet may be at increased risk of developing pressure sores.

In all of these patient groups pressure sores may develop as the result of continuous pressure, friction or shear – which occurs when skin moves in one direction and the bone below moves in another, the tailbone is particularly vulnerable to shearing.

Taking steps to prevent the development of bed sores should be a priority of patient health care and there are a number of things which can be implemented without too much difficulty -

  • Good diet

  • Stop smoking

  • Increase exercise – obviously the patient may well need assistance in this area.

  • Frequent changes of position – this is the single most important preventative measure where pressure sores are concerned. A bed sore can begin to develop very quickly, therefore wheelchair users should move position at least every 15 minutes and the bedridden patient every two hours.

  • Good positioning – a physical therapist will be able to advise on the best positions for patients.

  • Use of pressure reducing equipment in bed and in wheelchairs if appropriate.

  • Inspect the skin daily – especially around the hips, spine, shoulder blades, elbows, lower back, buttocks, coccyx, heels etc.

In the case of bed sores prevention is much better than cure – treatment may be unpleasant and lengthy, the use of preventative measures in at risk groups is essential in order to avoid development of pressure sores.

Category: Articles