Bedsores

As you may already know, bedsores can be a serious problem in nursing homes. You might know some basic information regarding bedsores. However, if you believe that your loved one has developed a bedsore, you need additional information regarding the type of bedsore that your loved one faces and how it should be treated. Here, you can get all of the information that you need about the four bedsore stages.

Bedsores

One of the most common forms of injury that a person can sustain in a nursing home is a bedsore. This is also known as a pressure sore. A bedsore is an injury to skin and tissue underneath skin caused by extensive pressure on a part of the body. Bedsores generally develop when a person does not move for long periods of time. If nursing home employees neglect residents, bedsores are a common development. Bedsores commonly develop in areas such as:

• Ankles.
• Heels.
• Tailbone.
• Spine.
• Shoulder blades.
• Elbows.
• Hips.

These body parts are common areas where bedsores develop. This is because there isn’t a lot of fat or muscle to protect the bone from pressure.

How Bedsores Form

When the body experiences pressure with no relief, blood flow to tissue and skin is limited. When this happens, tissue and skin cells will become damaged and can eventually die. Friction can aggravate or worsen a bedsore. This may occur when your loved one tries to move or a care provider attempts to move your parent. Another factor in nursing homes that contribute to bedsores is known as shear. Shear is when two forces are moving in opposite directions. For example, in a hospital bed that is elevated, your loved one might begin slipping. Your loved one’s skin will start pulling in a downward direction, but the bones will stay put. This force can create a bedsore.

Some residents are at higher risk for bedsores than others. Individuals whose physical health limits their mobility and ability to change positions. Bedsores occur in several stages and are characterized based on their severity.

Stage One Bedsore

If you, your loved one, or a nursing home staff member catches a bedsore early on, it will likely be a stage one bedsore. The good news if your loved one is diagnosed with a stage one bedsore is that this is the mildest form of bedsore, and compared to the other stages, a stage one bedsore can be treated fairly easily.

A stage one bedsore is characterized by the fact that it is not an open wound. Your loved one will not have any tears in the skin around the bedsore if it is a stage one bedsore. Another good sign is that most stage one bedsores are not at risk for infection. While infection is possible with a stage one bedsore, it is not as common as with the more severe stages of bedsores.

Identifying a Stage One Bedsore

Even though a stage one bedsore is a mild form of a bedsore, or pressure sore, it can still be very painful to your loved one if developed. Your loved one may complain of an area of skin that is warm to the touch, tender, and of a different texture than the surrounding skin (softer or firmer).

Most stage one bedsores appear red in color, but not all bedsores have this characteristic. Some might be blue or purple in color. Any patch of skin that is a different color than the patient’s normal skin color could be a pressure sore. One discerning characteristic is that the bedsore does not “blanch.” This is a term for what happens to healthy skin when it is pinched or touched firmly. If you pinch your skin together and let it go, it should turn a whitish color. This is because you are cutting off circulation and preventing blood flow to the skin. When blood returns to the area, the skin will return to its normal color. A bedsore will not blanch, and will remain the same color when pressed or pinched.

Treating a Stage One Bedsore

The earlier that a bedsore is identified, the easier it can be treated. For this reason, it is important to discuss bedsores with your loved one during your frequent visits to the home. The following actions can be taken to treat a stage one bedsore:

• Relieve the pressure on the bedsore. This can be done by moving the patient consistently to ensure that one area is not receiving too much pressure. Pressure can also be relieved with the use of specially padded bedding, foam pillows, and other special cushions.
• Avoid friction by lightly powdering the patient’s skin or bedding. Special medical tools can also be used to avoid friction.
• Good nutrition is essential to helping bedsores heal. Make sure that your loved one is consuming a balanced diet to assist in this process.
• Clean the bedsore. Most stage one bedsores are first cleaned with a saltwater solution and then wrapped in special gauze made specifically for bedsores. Be sure that whoever is cleaning the bedsore is gentle, as this skin is very sensitive.
• Consult with a doctor. To make sure that a proper diagnosis is made and your loved one receives the best treatment possible, you should talk to a doctor.

This information should help you identify and treat a stage one bedsore if your loved one develops this issue. If a bedsore develops, be sure to consult with the nursing home staff and your loved one to determine if the sore could have been avoided.

Stage Two Bedsore

If a stage one bedsore does not receive treatment early on, it can turn into a stage two bedsore. One of the major differences between a stage one bedsore and a stage two bedsore is that a stage one bedsore is not an open wound, while a stage two bedsore is. A stage one bedsore will only affect the first few layers of skin, while a stage two bedsore extends deeply into the skin. While you can identify a stage one bedsore by an irritated or red patch of skin, a stage two bedsore will appear as a blister, a scrape, or an ulcer on the skin.

Furthermore, a crater can develop underneath the skin and the bedsore can fill up with puss or blood. This can damage your loved one’s skin and ultimately kill skin cells beyond recovery. The stage two bedsore will feel very painful for your loved one and if it does not get treated, it can develop into a stage three or even a stage four bedsore. This process can occur quickly, so it is important to identify and treat a stage two bedsore as soon as possible.

Examination

If you suspect that your loved one has developed a bedsore, a professional should look at the area in question. A doctor should examine your loved one and can make the final determination of the stage that the bedsore is in and the best treatment methods. A doctor should consider any allergies that the patient has, the level of skin breakdown, and the level of discomfort that the patient feels before proceeding with a diagnosis and treatment options.

Treating a Stage Two Bedsore

While stage one bedsores are relatively easy to treat, stage two bedsores become more complicated. However, the good news is that the stage two bedsore is not as difficult to treat as the stage three or four bedsore, and with proper treatment, your loved one should heal well. A stage two bedsore will need more attention than a stage one bedsore. Dressings should be changed regularly, and medication could help to reduce puss, prevent infection, or treat infection. At this stage, surgery is generally not required, but it can be an option if the bedsore is not healing or if it continues to worsen. If you think that your loved one’s stage two bedsore might turn into a stage three bedsore, please proceed to our blog post on stage three bedsores for more information.

Stage Three Bedsore

A stage two bedsore can heal before it progresses to the third stage if the proper precautions are taken. Some ways to prevent this type of bedsore include:

• Rotating a patient every few hours to prevent pressure on certain parts of the body.
• Physical therapy to increase mobility.
• Promoting a healthy lifestyle, such as eating a balanced diet, maintaining proper hygiene, and staying hydrated.
• Using powder and foam to alleviate pressure in bed.
• Properly cleaning and dressing the wound.

What is a Stage Three Bedsore?

Bedsores will not heal on their own, so a mild bedsore will continue to progress until it does severe damage to a patient. A bedsore in the third stage indicates that something has gone wrong in your loved one’s care. To allow a stage three bedsore to occur, the nursing home staff has not properly prevented a bedsore from forming or treated a bedsore that has been identified.

A stage three bedsore will appear as a more severe form of the stage two bedsore. A stage two bedsore will wear away skin, and a third stage bedsore will then reveal dead or dying skin. The outer area of the bedsore might be black because the skin is rotting away. This skin will be damaged beyond repair. Because the wound will be so deep in a stage three bedsore, fat tissue might be visible. However, one discerning factor between this stage and stage four bedsore is that in a stage three bedsore, bone, and tendon will not be exposed. While this will be a terrible sight to see, your loved one’s pain level might actually be reduced due to the nerve damage characterized by this stage.

Treating a Stage Three Bedsore

A stage three bedsore will likely do permanent damage to your loved one. It is important to take immediate action to minimize this damage and heal the wound. Proper steps to take include:

• Alleviating pressure by alternating the patient between sitting and laying positions frequently.
• Using the right types of cushions to alleviate pressure. Never use a ring shaped cushion.
• Making sure that the bedsore remains dry. Sweat, saliva, unclean sheets, or other liquids will aggravate the bedsore and increase the likelihood of infection.
• Leaving the area alone. The bedsore should be properly dressed and this dressing should be changed, but the skin should not be massaged or touched more than necessary.
• Prescribing medication for infections.
• Considering surgery as an option to remove dead tissue that might promote the growth of bacteria.
• Consulting a doctor to determine the best treatment methods for your loved one.

Stopping a bedsore at the third stage is the best way to help your loved one at this time. If you suspect a stage three bedsore, you should contact a professional as soon as possible.

Stage Four Bedsore

A stage three bedsore can become a stage four bedsore if it is not treated properly. One of the major differences between these types of bedsores is that a stage four bedsore shows exposed bone, tendon, and ligament, while a stage three bedsore will only show exposed tissue. This distinction makes the fourth stage bedsore deeper than the third stage bedsore. Oftentimes, more skin is damaged as a result of a stage four bedsore, and dead or rotten skin is more prevalent. Dead or dying skin can also extend farther than the bedsore wound itself if a bedsore reaches the fourth stage. Skin might be dying under surrounding areas of the bedsore, even if it appears to be healthy on the surface.

Stage Four Bedsore Treatment

Unfortunately, most elderly patients are not healthy enough to fully recover from stage four bedsores. For this reason, stage four bedsores are generally managed, but not necessarily healed. The damage is oftentimes too severe at this stage for a patient to make a full recovery. However, efforts can be made to preserve or improve a patient’s quality of life and prevent any life threatening issues related to the bedsore. A few common ways to minimize pain and damage include:

• Properly dressing the wound and keeping it dry.
• Moving the patient to ensure that pressure does not increase on one area of the skin.
• Using cushions to alleviate aggravation.
• Getting surgery to remove dead tissue or skin so as to avoid infection. Other options for removing dead skin tissue include biological debriding procedures, natural enzymes, manmade enzymes, ultrasounds, special dressings, and more.
• Utilizing negative pressure therapy. While negative pressure therapy works better for some patients than for others, this is an option that you might want to consider. Negative pressure therapy removes all dead tissue to help new, healthy tissue form.
• Prescribing medication. Medication can be used to prevent or cure infection and relieve your loved one’s pain.
• Using air fluidized therapy. Air fluidized beds can help to prevent bedsores and alleviate pressure on deep bedsores.

Bedsore Causes

Bedsores are common in nursing homes. This is sometimes due to the inattention of nurses and other staff members. If residents are not consistently cared for, bedsores can develop. Residents should be moved, stretched out, and allowed to walk to prevent this issue. The consequences of this ailment can be minor or severe. They range from discomfort and pain, to something as serious as death. This is because bedsores that are left untreated for long periods of time can become infected. This can weaken your loved one’s immune system. Ulcer infections and bone infections can be serious. You should be constantly checking in on your loved one to make sure that bedsores don’t develop. If bedsores do develop, you need to find out immediately. This will prevent them from worsening and impacting your loved one’s health.

Getting Help

If your loved one is the victim of a stage four bedsore, the first order of business is finding a way to manage this injury to avoid serious, life threatening complications. Once your loved one is receiving treatment, you need to consider how a stage four bedsore occurred. Stage four bedsores are most likely the result of carelessness or negligence on the part of staff members. You might consider taking legal action if this is the case.