Decubitis Ulcer (Pressure/Bed Sore) Claudia Mormino Anatomy & Physiology P. 4

Causes A pressure sore is caused by pressure on an area of the skin that interferes with circulation. They can develop on areas of the body that rub together and moisture collects (under breasts, buttocks and thighs). Pressure sores are mainly caused in three ways: friction (rubbing together), shearing (skin stays in place and muscles continue to move in the opposite direction), and prolonged pressure (staying in the same place for a long period of time), which interferes with the circulation of that certain area.

Areas prone to pressure sores

Signs and Symptoms The first sign of a pressure sore is a change in skin color, which usually turns to a red color. Pressure sores occur in four main stages.

Stage One The skin is red, darkened or non blanchable (red skin that does turn white when pressure is applied), that is still present thirty minutes after pressure is relieved. One should position off area and report it. Do not, by any means, try to massage this area. Observe every two hours and report any changes.

Stage Two Blister like lesions may begin to appear, and the skin may be broken. Keep the area positioned off and report the need for dressing changes. Report any odors, drainage and change in size.

Stage Three The skin tissue is destroyed and fatty tissue may be involved. Infection and eschar (scab) may result. Continue to position off and report any changes whatsoever.

Stage Four Skin, and fatty tissue are destroyed and muscle and bone may be involved. Continue to position off and report changes. In stage four, signs of systemic infection may appear. Be sure to report any of the following changes: wound odor, pain, elevated temperature, and confusion.

Illustrated Stages of Pressure Sores Stage Four Stage Three Stage Two Stage One

More Illustrations

Preventions Use these methods to prevent bedsores: make sure skin is clean and dry; reposition every two hours; keep the linen dry, wrinkle free, and clear of any objects that cause pressure; clean urine and feces from skin ASAP; make sure clothing and shoes do not bind or constrict; encourage the person to drink and have proper nutrition; massage pressure points (prior to stage one). Some preventative devices include: bed cradles, heel and elbow protectors, flotation devices, pillows, waterbeds, pressure mattresses, and egg crate mattresses. The BEST way to prevent a bed sore is look for and REPORT any changes in skin!!

Works Cited http://www.mayoclinic.com/health/bedsores/DS00570/DSECTION=causes Dugan , Diana. Successful Nursing Assistant Care. Second. Albuquerque, New Mexico: Hartman Publishing, Inc., 2008. 320-337. Print. (NOTES) http://gardenrain.files.wordpress.com/2009/05/sitting-pressure_sores04-e1.jpg http://www.nursinghomesabuseblog.com/images/Screen%20shot%202010-10-22%20at%202.53.02%20PM.png http://www.nursinghomesabuseblog.com/bedsores-pressure-sores-decubi/hospital-bed-sores/ http://1.bp.blogspot.com/_MjVQ-cqUpVs/TPH9rriTvzI/AAAAAAAAAaY/UqhhsM1i3nk/s1600/Pressure%2Bulcer.jpg http://hamill-law.com/bedsore4.jpg http://tidsskriftet.no/lts-img/2011/L11-ENG-09-1472-01-Over.jpg http://www.wjes.org/content/2/1/10/figure/F17 http://www.visualphotos.com/photo/1x9083430/Pressure_Sore_on_Heel_AB681A.jpg http://www.sciencephoto.com/image/263094/530wm/M2800097-Close_up_of_pressure_sore_ulcer_on_heel-SPL.jpg http://www.medical-definitions.com/images/decubitus.jpg http://seattletimes.nwsource.com/ABPub/2010/09/09/2012855576.jpg