I’m Ed Smith, a Sacramento nursing home negligence attorney. One of the more common, and preventable, injuries that people suffer from while in nursing homes is decubitus ulcers. Also known as pressure sores or bed sores. Bed sores are painful and can be very serious. Proper care by nursing home staff can help eliminate the occurrence of bed sores. Steps to reduce the occurence of bed sores generally includes repositioning the bedridden resident every two hours as per accepted nursing home procedures. However, there are many nursing homes which are understaffed, and some residents are left for long periods of time in the same position. When this happens, decubitus ulcers are often the result.
Cause of Decubitus Ulcers
The cause of bed sores or decubitus ulcers is typically because of constant pressure on the skin. As a result, blood flow is cut off to the skin in that area. Skin then begins to deteriorate and eventually becomes necrotic.
Other Factors Contributing to Decubitus Ulcers
- Moisture: Wetness from urine, feces or perspiration increases the vulnerability of the skin’s surface. Therefore, patients suffering from incontinence are at an even higher risk of getting decubitus ulcers.
- Friction and Shearing: Rubbing of the affected area causes irritation. This increases the skin’s vulnerability. One of the more common causes of shearing is when a member of the nursing staff drags a patient across the bed instead of lifting them. Dragging the resident increases irritation and friction to the heels and elbows. Additionally, elevating the head portion of the bed any more than 30 degrees typically increases the shearing forces at the tail bone, low back and buttocks, the other frequent spots for decubitus ulcers.
- Lack of Nutrition: Decubitus ulcers occur more frequently in nursing home residents who suffer poor nutrition. This is most common in cases of deficiencies of Vitamin C, Vitamin E, calcium, zince and albumin (a protein). Also, anemia is commonly associated with an increased risk for occurrence of decubitus ulcers.
- Decrease in Sensation: If a nursing home resident is unable to feel an injury, then a bed sore might not be caught and treated in its early stages. It is important, therefore, for people with spinal cord injuries or diabetes to be closely monitored by nursing staff and family members because they may be injured without knowing it.
- Advanced Age: As we grow older, our skin becomes thinner, making it more susceptible to breakdowns which can lead to decubitus ulcers.
- Circulatory Issues: Residents with circulatory issues already have problems with blood circulation. Therefore, they are at greater risk for skin breakdowns like decubitus ulcers. It is important to remember that people with diabetes or artherosclerosis are at increased risk for this condition.
- Limited Movement: Clearly, residents who are not able to move on their own without assistance are at the highest risk of developing a decubitus ulcer. It doesn’t matter if the decreased movement results from a temporary injury or a long term condition. The lack of movement is what allows for the pressure to stay fixed on one area of the skin, cutting off the supply of blood. Nursing home residents who are able to turn on their own or shift their weight are at a decreased risk for developing decubitus ulcers.
Decubitus Ulcer Staging
Decubitus ulcers have four stages. The higher the stage the more severe the wound.
- Stage I: The skin is red, but unbroken, and may be a little warm to the touch. This is considered a superficial wound which quickly fades as soon as the pressure is removed. At this stage, a decubitus ulcer is a warning sign. It indicates a signal that further intervention is required. This indicates more frequent repositioning, improved nutrition and cushioning is required.
- Stage II: At this stage the skin looks like a blister. It may either be broken or unbroken. The wound is no longer merely superficial but now includes a partial layer of skin which has been injured. The treatment for Stage II decubitus ulcers focuses on keeping the area clean, protected and covered, in addition to repositioning, improved nutrition and cushioning.
- Stage III: The wound now is present throughout all layers of the skin. It has become a primary site for infection. This stage of the wound requires immediate medical attention to prevent infection and promote healing. Left without attention, a Stage III decubitus ulcer will deteriorate very rapidly.
- Stage IV: This stage is the worst of decubitus ulcers. The wound at this point extends throughout the skin and into muscle tissue also. This kind of wound requires immediate treatment by a skilled wound care medical professional. Oftentimes, surgery is needed to debride necrotic tissue. In serious cases, amputation becomes necessary to save someone’s life. This is because the risk of infection is extremely high and can become life threatening.
Preventing Decubitus Ulcers
The incidence of nursing home negligence and abuse in our state is a growing problem. It is the job of the nursing home to prevent decubitus ulcers in residents. Clearly, that does not always happen. There are things that loved ones can do to help prevent decubitus ulcers from happening in a nursing home setting.
The primary thing to do is check your loved one’s skin. If he or she is always covered by sheets or blankets, look for signs of skin breakdown. Pay special attention to the lower back, tailbone, heels, hips and elbows. Watch for redness, breaks in the skin, abrasions, rashes and blisters. Bony areas are most prone to decubitus ulcers. If you discover any of these conditions, report it to the nursing home staff at once.
The staff at the nursing home or a physician can typically diagnose a decubitus ulcer by simply examining your loved one’s skin. Further diagnostic tests are usually not needed unless the wound has become infected. If an infection is present, blood tests, x-rays and cultures may be required to see if complications have developed such as osteomyelitis or sepsis. These and other complications are serious and life threatening conditions. This is why decubitus uclers must be taken so seriously. It is important to note that the nursing home resident usually doesn’t die of the decubitus ulcers but rather from the infections that develop from the wound. If you discover decubitus ulcers on your loved one tell a medical professional at once.
Related resources and articles by Ed Smith:
- Nursing Home Negligence
- Geriatric Fall Patterns
- New Law Protects Nursing Home Residents
- Punitive Damages for Instutional Elder Abuse
Sacramento Nursing Home Negligence Attorneys
I’m Ed Smith, a Sacramento nursing home negligence attorney. If you or a loved one has suffered from nursing home negligence, please call me at (916) 921-6400 or toll free at (800) 404-5400 for free, friendly advice.
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