The Development Stages Of Pressure Sores
As we age, our skin becomes thin and dry and less elastic. This characteristic makes the elderly more susceptible to skin injuries such as pressure sores or decubitus ulcers. Pressure sores are areas of damaged skin and tissue that develop when unrelieved pressure cuts off blood flow to the skin. Without adequate blood flow, the affected tissue dies. Pressure sores are extremely painful and potentially fatal.
The National Pressure Ulcer Advisory Panel has five classifications of pressure sores which indicate the severity of the ulcer. They are as follows:
- Stage I: Initially, a pressure sore appears as a persistent area of red skin that may itch or hurt and feel warm and spongy or firm to the touch. In blacks, Hispanics and other people with darker skin, the mark may appear to have a blue or purple cast, or look flaky or ashen. Stage 1 wounds are superficial and go away after the pressure is relieved.
- Stage II: At this point, some skin loss has already occurred either in the epidermis, the outermost layer of the skin, in the dermis, the skins deepest layer, or in both. The wound is now an open sore that looks like a blister or abrasion, and the surrounding tissues may show red or purple discoloration. If treated promptly, stage II sores usually heal fairly quickly.
- Stage III: By the time a pressure ulcer reaches this stage, the damage has extended to the tissue below the skin, creating a deep, crater-like wound.
- Stage IV: In the most serious and advanced stage, a large-scale loss of skin occurs, along with damage to the muscle, bone, tendons, and/or joints. Stage IV wounds are extremely difficult to heal and can lead to lethal bone, blood, and skin infections.
- 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 – scabbing (tan, brown or black) in the wound bed. Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as the body’s natural (biological) cover and should not be removed.
Pressure sores are preventable. In fact, caregivers say bedsores are easier to prevent than to treat. The law requires that a nursing home must ensure that a resident does not develop pressure sores, unless the residents medical condition makes the pressure sore unavoidable.
It is also important to note that the law also requires the nursing home to prevent the progression of any bedsores the resident may have at, or during admission to the nursing home facility.
Upon admission, nursing homes are obligated to identify individuals at risk for pressure sores and form and implement a care plan to prevent pressure sores.
Repositioning & Cushioned Devices
One way nursing homes can prevent the formation of pressure sores is by frequently turning and repositioning residents to ensure the individual is not putting unrelieved pressure on any certain area of the body. Experts advise shifting position every 15 to 30 minutes the resident is in a wheelchair and at least every two hours, even during the night, while in bed. If a resident is unable to move independently, a caregiver must be available to help.
Utilizing cushioned devices, such as foam pillows or wedges, for support, alleviates pressure to areas where the resident is at risk. There are also pressure relieving devices such as special mattresses, beds, heel protectors and boots which can help alleviate pressure and prevent pressure sores. If there are any signs of pressure sores or neglect, alert the nursing staff, attending physician and nursing home director.
Nutrition & Hydration
Nutrition is crucial in preventing skin breakdown and aides in the healing process. Malnourished residents are very susceptible to pressure sores, making it essential for the resident to receive enough calories, protein, vitamins and minerals in their diet.
Protein-calorie malnutrition is associated with increased susceptibility to infections and a higher incidence of skin breakdown and delayed healing. Protein-calorie malnutrition is also associated with a higher death rate from co-existing illness.
Disorders of fluid/electrolyte balance also occur more frequently in the elderly population. These disorders may be caused by excessive water loss, inability to increase water intake, or failure to recognize the need to increase water intake. Dehydration is the most common fluid disorder of frail elders.
According to the Wisconsin Department of Health Services, 42% of nursing home residents had bladder incontinence frequently or all of the time. Daily skin inspections are necessary for early detection and prevention of pressure sores. Moisture from unchanged diapers, wet or soiled sheets, sweat, or draining wounds can aid in the development of pressure sores.
Pay special attention to your loved ones hips, spine and lower back, shoulder blades, elbows, heels, buttocks and tailbone and feet. If there are any signs of damage or infection (drainage, foul odor, increased tenderness, redness and warmth in surrounding skin) contact the caregiver immediately.
Who is at risk for pressure sores?
- Residents confined to a bed or wheelchair
- Immobile residents
- Inadequate dietary intake
- Impaired nutritional status
- Residents with dry skin
- Residents unable to reposition themselves
- Residents with an altered level of consciousness
- Residents who are underweight
- Residents who suffer from decreased mental status
- Residents who are incontinent
Hospitalization rates as a result of pressure sores have risen dramatically over the last 15 years, according to a report from the U.S. Agency for Healthcare Research and Quality. It is estimated that as many as one-fourth of nursing home residents fall victim to bedsores at some point during their stay.
Contact our Wisconsin Nursing Home Neglect Attorneys
If you or your loved one is the victim of any type of nursing home abuse or neglect, you must contact an experienced Wisconsin personal injury attorney, nursing home attorney to protect your rights and make sure you receive compensation for harm suffered at the nursing home.
Taking legal action against an abusive or negligent nursing home is one of the best ways one of the best ways to raise awareness, improve quality of care and effectively improve the life of your loved one and other victims of nursing home abuse/negligence.
At PKSD, we are dedicated to preventing negligence and abuse from occurring in nursing homes. Our Wisconsin nursing home negligence attorneys are experts in this complicated area of the law, and work relentlessly to hold nursing homes accountable.
Our team of Milwaukee personal injury attorneys, paralegals and nurses handles the most nursing home cases in Wisconsin. Our team helps clients and their families obtain financial restitution for their pain, suffering, financial loss and medical expenses. We provide each client with extensive resources, aggressive representation, personalized attention and compassionate legal care.