A pressure sore (also referred to as a decubitus ulcer, pressure ulcer or bed sore) is any lesion caused by unrelieved pressure resulting in the damage of underlying tissue. It is a circumscribed area at which cutaneous tissue has been destroyed because of the restriction of blood flow to the area owing to excessive or prolonged pressure. The National Pressure Ulcer Advisory Panel defines a pressure ulcer as “localized injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.”
Though pressure sores may occur in many areas, the most common sites are over bony prominences, such as the coccyx (tailbone area), hip, elbow, heels, shoulder blade, knee, ankle, back of head, and ear. Pressure sores can develop between folds of the flesh, under breasts, buttocks and on the abdomen.
Pressure sores are characterized by “stages” of severity. In February 2007, the National Pressure Ulcer Advisory Panel (NPUAP) redefined the definition of a pressure ulcer and the stages of pressure ulcers, which includes the original four stages, plus two new stages on deep tissue injury and “unstageable” pressure ulcers.
The NPUAP describes the various Pressure Ulcer Stages as follows:
- Suspected Deep Tissue Injury. “Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.”
- Stage I: “Intact skin with non-blanchable redness of a localized area usually over a bony prominence. Darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.”
- Stage II: “Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough. May also present as an intact or open/ruptured serum-filled blister.”
- Stage III: “Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle are not exposed. Slough may be present but does not obscure the depth of tissue loss. May include undermining and tunneling.”
- Stage IV: “Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.”
- Unstageable: “Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.”
Who is at risk for developing pressure sores?
There are a variety of primary risk factors for pressure sore development, which, in addition to immobility, include some of the following clinical conditions: (1) continuous urinary incontinence or chronic voiding dysfunction, (2) severe peripheral vascular disease, (3) diabetes, (4) severe chronic obstructive pulmonary disease (COPD), (5) chronic bowel incontinence, (6) paraplegia, (7) quadriplegia, (8) sepsis, (9) terminal cancer, (10) chronic or end stage renal, liver, and/or heart disease, (11) disease or drug-related immunosuppression, or (12) full body cast.
What should nursing homes be doing to prevent pressure sores?
Adequate staffing of the facility is the key to success in the prevention and treatment of pressure sores in a nursing home. Without adequate staff, there is a substantial risk that pressure sores will develop in at-risk residents. Prevention is accomplished through relieving pressure (repositioning of the patient with impaired mobility at least every two hours is an absolute must), prompt incontinent care (urine and feces burn the skin and contribute to skin breakdown), proper nutrition and hydration (absolutely necessary to prevent skin breakdown and critical to the healing process once such breakdown has occurred), mobility (check client’s nursing home records to determine if his or her mobility was maintained on a daily basis), and proper hygiene (not only personal hygiene, but also environmental factors such as clean sheets and clothes).
If you believe a loved one has a pressure sore or decubitus ulcer because the nursing home failed to do its job, take action and contact the Kosieradzki • Smith Law Firm online or call us toll-free at (877) 552-2873 to set up a FREE CONSULTATION.