The factors leading to the formation of pressure ulcers are all but. Places of formation of bedsores

Pressure ulcers are damaged areas of tissue due to compression during prolonged continuous contact with the surface. For example, this applies to bedridden patients or people in a wheelchair. Pressure ulcers can be prevented by following certain preventive measures when caring for the sick.

At Yusupov Hospital, these processes are handled by experienced nurses and nurses with skills and knowledge that are successfully applied in practice.

The risk of developing pressure ulcers

The entire human body is intertwined with large and small blood vessels, due to which blood enters each cell, ensuring its saturation with oxygen and nutrients. If for some reason, in particular in the case of bedridden patients, the blood vessels are squeezed and blood does not enter certain tissue areas, cells without sufficient nutrition begin to die off and bedsores are formed.

Risk factors for pressure ulcers

The risk of developing bedsores exists in absolutely all bedridden patients. But the likelihood of their appearance is much higher in the following groups of patients:

overweight or, conversely, malnourished patients;
suffering from diabetes mellitus;
with cardiovascular diseases;
with head and spine injuries;
suffering from fecal and urinary incontinence.

The risks of developing pressure ulcers increase when the patient's personal hygiene rules are not followed.

It is necessary to ensure that the skin is not contaminated, special attention is paid to the hygiene of the perineum. All cosmetics and detergents must be hypoallergenic.

Bed linen and clothing should be made of natural soft fabrics. They should not have rough lines and buttons. The bed must be constantly straightened to avoid creases. Otherwise, there is a high probability of tissue trauma and the appearance of bedsores.

With proper patient care, the risks of pressure ulcers are minimized. It is better if the organization of proper care is handled by a specialist in a hospital inpatient setting or at home. In the Yusupov hospital, these responsibilities are assigned to nurses and nurses who have the necessary knowledge and skills to properly care for the patient.

Pressure ulcer risk areas

The most common areas of pressure ulcers are those parts of the body that have a bony ridge and are in close contact with the surface. In places of the bony protrusion under the skin, there is practically no adipose tissue, which reduces the pressure on the tissues.

In many ways, the risk zones for bedsores depend on the position of the body in which the bedridden patient is constantly located. If he is forced to lie on his back continuously, then bedsores can develop on the back of the head, elbows, heels, shoulder blades, ischial tubercles and the sacrum. If the patient regularly lies on his side, then cell death occurs in the ankles, hips and knees. When the patient lies on his stomach for a long time, bedsores can form on the pubis, abdomen, and cheekbones.

Preventing the formation of pressure ulcers

At the heart of the prevention of pressure ulcers is the task of preventing compression of tissues, and, consequently, disorders of normal blood circulation. This requires proper patient care, which is successfully organized by the nurses and nurses of the Yusupov hospital.

To prevent tissue squeezing, special mattresses are used. They can be made of foam rubber, at least 15 cm thick. In the Yusupov hospital, special medical anti-decubitus mattresses are used. They perform a light massage function and promote normal blood circulation.

It is important to turn the patient over at least once every two to three hours, including at night. This must be done very carefully, avoiding friction of skin areas on sheets, etc.

When changing bed linen, in no case should it be pulled out from under the person. The patient should be lifted and only after that the stale linen should be removed. Any mechanical damage to the skin, even the smallest, can eventually turn into bedsores.

It is also important to monitor the hygiene of the patient himself and the cleanliness of the room in which he is located. A supply of fresh air should be provided regularly. The room temperature should be comfortable, the air should not be excessively humid or dry.

With proper patient care and adherence to all preventive measures for pressure ulcers, the likelihood of their occurrence is minimized.

If it is not possible to stay with the patient around the clock or if certain skills are lacking, the best solution would be to use the services of specially trained medical personnel. The Yusupov hospital accepts even the most severe patients requiring special care. The condition of the patient in a hospital hospital is monitored by doctors and nurses around the clock. They are ready to provide any necessary assistance at any time.

You can get detailed information or make an appointment for a consultation by calling the Yusupov Hospital.

Bibliography

ICD-10 (International Classification of Diseases)
Yusupov hospital
Badalyan L.O. Neuropathology. - M .: Education, 1982 .-- S.307-308.
Bogolyubov, Medical rehabilitation (guide, in 3 volumes). // Moscow - Perm. - 1998.
Popov S.N.Physical rehabilitation. 2005 .-- S. 608.

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- these are areas of the skin that are damaged due to compression of tissues, due to prolonged contact with the surface. For example, being forced, as a result of an illness, to be in a wheelchair, a special splint for a fracture, or lying on a bed. The tissues in such cases receive a small amount of blood and die off.

The causes of bedsores.

The entire human body is intertwined with blood vessels and capillaries. Thanks to them, oxygenation and tissue nutrition occurs. The smallest capillaries enter every centimeter of the skin. If for some reason there is a prolonged squeezing of the vessels, then the enriched blood does not enter this place. As a result, tissues lack nutrition and die. that is why bedsores are formed.

Sometimes in bedridden patients, the upper skin is displaced, which also leads to the formation of pressure ulcers. When caring for such patients, it is often necessary to change the wet bedding and simply pull it out from under the bed. Or they pull a heavy patient on the bed trying to move. All this can lead to injury to the skin and bedsores.

The risk of developing pressure ulcers.

All bedridden patients are at risk of developing bedsores. But the likelihood of their occurrence in people who are overweight, or vice versa, severely malnourished, diabetic patients, prone to heavy sweating, is much higher than in others. Patients with cardiovascular diseases, spinal cord and head injuries, as well as those who have problems with fecal and urinary incontinence are at risk. Unfavorable conditions of detention and inadequate care of such patients can also cause pressure sores. If the skin is dirty, and there are bumps, folds, foreign small objects and crumbs in the bed, or there is an allergic reaction to care products, all this increases the chances of bedsores.

Places of formation of bedsores.

Parts of the body that are in close contact with the surface and have a bony protrusion are the most common places for pressure ulcers to form. In the place where there is a bony protrusion, there is almost no fatty tissue under the skin, which reduces pressure on the tissues.

The formation of bedsores largely depends on the position of the patient's body when lying down.

So if the patient is forced to lie on his back a lot, bedsores will appear on the ischial tubercles, shoulder blades, sacrum, back of the head, as well as elbows and heels.

If the patient is constantly lying on his side, bedsores develop on the thighs, ankles and knees. If necessary, lie on your stomach, bedsores are formed on the cheekbones and pubis.

The severity of the pressure sores.

Medicine distinguishes six stages of pressure ulcers, according to their severity.

Pressure ulcers - stage 1 is characterized only by reddening of areas of the skin, which is compressed for a long time.

Pressure ulcers - stage 2 - there is swelling of the skin, blisters appear, and necrosis of the upper skin begins.

Pressure ulcers - stage 3 - ulcers appear at the site of the blisters.

Pressure ulcers - stage 4 - ulcers become deeper and affect the skin, as well as muscles.

Pressure ulcers - stage 5 - the affected muscles also die off.

Pressure ulcers - stage 6 - the degree of damage is very strong, the ulcer penetrates to the bone. The bone is also damaged and infected.

Treatment of pressure sores.

Pressure ulcers are easier to prevent than to treat them later. There is no magic remedy that can help you cope with this disease. It is only necessary to perform a number of measures to restore blood circulation and eliminate tissue compression in the place where the bedsores appeared. By performing preventive measures, you can stop the development of pressure ulcers. For healing already appeared bedsores, it is good to use Iruksol ointment, as well as dressings made of gauze cloth impregnated with petroleum jelly. Also in the pharmacy network there are specialized hydrocolloid dressings that promote rapid healing. Their significant drawback is the price. The choice of various healing ointments is great. Sea buckthorn oil helps well. In the case of a bacterial infection, it is important to use antibacterial drugs.

Large areas of pressure ulcers that are difficult to heal are treated with surgery, namely tissue grafting.

Prevention of bedsores.

The main goal of preventive measures is to prevent tissue compression and impairment of their blood circulation.

First of all, good care of the bedridden patient is required. It’s good if it’s a patronage specialist. In order to prevent tissue squeezing, a soft but sufficiently elastic mattress should be placed on the bed. Today on sale there are special mattresses for bedsores. They perform the function of massage and help to improve blood flow in tissues. A good effect is given by the use of a foam mattress, if it is not possible to purchase a special one. The position of the body of the recumbent should be changed as often as possible. But this should be done carefully so as not to injure the skin. It is necessary to carefully monitor the cleanliness of the bed, which should be flat, not crumpled, without crumbs, clean and dry. Those parts of the body that are more susceptible to the formation of pressure ulcers must be raised by placing rollers or pieces of foam rubber under them. A rubber ring can be placed under the sacrum. All these designs contribute to an increase in the area that is in contact with the bed. As a result, blood flow in the tissues improves and the likelihood of developing a pressure ulcer is reduced.

A lying patient should be moved with care on the bed in order to prevent injury to soft tissues. If it is impossible to move or turn the patient on your own, get someone to help you. If it is necessary to change the bedding, first lift the patient and then pull out the sheet. All patient care operations must be performed with care and attention.

All linen should be soft to avoid irritation to the skin. All means for caring for the patient's skin must be hypoallergenic. Toilet of intimate areas should be performed frequently, because urine and feces are the main skin irritants. It is also necessary to monitor the temperature in the room and dress the patient accordingly in order to prevent overheating and the appearance of diaper rash.

Thus, the prevention of pressure ulcers depends on the quality of care. Today, there are a lot of cosmetics on the market designed to facilitate the care of such patients. If necessary, use diapers, various creams and powders, special drying ointments. The skin should be kept clean and dry, and it should not be overmoistened. All care devices should be as soft as possible and not injure the skin.

Bedsores are damaged areas of the skin that occur as a result of compression of tissues during prolonged contact with a hard surface (bed, wheelchair, splint, etc.) Bedsores appear as a result of exsanguination and tissue necrosis at the site of compression of the skin.

Causes of bedsores

As you know, nutrition and oxygenation of the skin occurs due to the presence of blood vessels in it. The smallest of them, called capillaries, penetrate every centimeter of the skin and nourish it. With prolonged squeezing, the vessels are compressed, and blood does not flow. This leads to the fact that certain areas of the skin are exsanguinated, and tissue necrosis occurs.

Another reason for the formation of pressure ulcers is the displacement of the upper layers of the skin. This happens when the patient is pulled on the bed, or a boat or wet underwear is pulled under him. All this can lead to disruption of blood supply, resulting in the formation of pressure sores.

Pressure ulcer risk factors

The most susceptible to the occurrence of bedsores are people who are overweight or, conversely, exhaustion, eat poorly and drink little, have a history of diabetes mellitus or heart disease, sweat a lot, have brain and spinal cord injuries, and suffer from urinary and fecal incontinence. Dirty skin, folds and seams on the bed, the presence of crumbs and small objects, and allergies to skin care products are also considered unfavorable factors.

Places of formation of bedsores

Areas of the body above the bony ridges that come into contact with a hard surface are most prone to pressure ulcers. This is due to the almost complete absence of subcutaneous fat in these places, which can reduce the pressure on the tissues.

If a person lies on his back for a long time, then bedsores are formed on the sacrum, ischial tubercles, shoulder blades, back of the head, heels and elbows.

When lying on its side, bedsores form on the thighs in the region of the greater trochanter, on the knees and ankles.

Prolonged position on the stomach leads to the formation of necrosis on the pubis and cheekbones.

The severity of the pressure sores

Depending on the severity of the pressure sores, they are divided into six stages:

Stage I - reddening of the squeezed areas of the skin occurs;

Stage II - the skin swells, becomes covered with blisters, necrosis (death) of the upper layer of the skin begins;

Stage III - ulcers appear on the skin;

Stage IV - ulcers grow and penetrate the muscle layer;

Stage V - muscle necrosis and destruction occurs;

Stage VI - the most severe stage, the ulcer reaches the bone, which can be damaged and infected.

Prevention of bedsores

Prevention of pressure sores includes a number of measures aimed at reducing tissue compression and maintaining normal blood circulation in the skin.

For bedridden patients, careful care is essential. To reduce tissue compression in bedridden patients, it is necessary to purchase a soft and resilient mattress. There is a special anti-bedsore mattress on sale, which has a massage effect, improving blood circulation in certain areas of the skin. You can also use a foam mattress if you are unable to purchase a pressure sore mattress. It is necessary to change the position of the patient's body as often as possible, and this must be done carefully enough to avoid friction and displacement of soft tissues. The patient's bed should be flat and clean, free of crumbs and foreign objects. Under the areas of the body, where bedsores usually occur, it is necessary to put rollers or soft foam pads. A special rubber circle can be placed under the sacrum. All these devices (rollers, bedsore mattress) increase the area of the body that comes into contact with the surface on which the patient is located. This significantly improves blood circulation in the tissues and reduces the risk of pressure ulcers.

Prevention of pressure ulcers also includes proper and gentle turning of the patient, with minimal risk of damage and friction of soft tissues. If you cannot cope alone, look for yourself an assistant. Do not pull and pull wet linen and sheets from under the patient; first, it is necessary to lift it. All manipulations on skin care and bedding should be carried out with care and gentleness.

To reduce skin irritation, use soft linen (the more washes, the softer the bed) without seams, patches or buttons. For toilet skin, use mild, low-allergenic cosmetics. Clean the genitals and perineum more often, as urine and feces tend to irritate the skin. Provide the optimal temperature regime in the room, cover and dress the patient depending on the temperature, avoiding overheating. Sweat irritates the skin and increases the risk of ulcers.

Proper skin care is one of the ways to prevent pressure sores. Do not let your skin get too wet or dry, keep it clean. Use moisturizers and nourishing creams, powders, drying ointments. Do not rub the skin when washing and drying the patient, but blot easily. Sponges and washcloths should be soft. For urinary incontinence, use diapers or urine bags (for men).

Decubitus ulcer treatment

No amount of pressure sore remedy will help completely eliminate the problem until the compression of the tissues is eliminated. The main treatment for pressure ulcers should be aimed at restoring blood circulation in damaged tissues. To do this, use all the measures to prevent pressure ulcers.

For the rejection of dead tissue, various means for bedsores are used. Iruksol ointment has a good effect. For faster wound healing, it is necessary to use gauze dressings soaked in petroleum jelly. You can apply special hydrocolloid dressings if you can afford them (they are quite expensive). There are also special healing agents for bedsores, in the form of various ointments. You can use sea buckthorn oil. With the development of a secondary infection, which often happens when pressure sores occur, antibacterial agents should be used.

Decubitus ulcers, which are large and difficult to heal, can only be treated with surgery (tissue grafting).

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If the lateral surface is squeezed, then bedsores occur on the shoulders, elbows, lateral surfaces of the thighs and pelvis.

Factors affecting the formation of pressure ulcers

Pressure ulcers are a very dangerous complication in an already seriously ill patient, which worsens the process of treating the underlying disease and requires separate long-term treatment, especially in the latter stages.

Phlegmon

Acute inflammation of the cellular space is accompanied, treatment is difficult due to the fuzzy border of the inflammatory process. The causative agent is staphylococcus aureus, Escherichia coli. The main signs are pain, swelling, redness,. Treatment is carried out by opening the focus and using broad-spectrum antibiotics.

Gangrene

This complication is accompanied by rapid tissue necrosis. On palpation, a specific crunch is heard, the color of the epidermis is predominantly dark, a putrid odor emanates from the wound. Intramuscular injections of penicillin give good results, but mainly to avoid damage to adjacent tissues. The affected part of the body, usually a limb, is subject to amputation. This complication accompanies, with insufficient or ineffective treatment, pressure ulcers at 4 stages of development.

Sepsis

The fight against this complication is effective only in the early stages. Since this is a systemic inflammatory process that affects the weight of the body as a whole, the further development of the infection is fatal. Detoxification of the body, anti-inflammatory treatment with the use of glucocorticoids is carried out. Septic infection of the body can accompany treatment for 3 and 4 degrees of pressure ulcers.

Preventive actions

Analyze the history and ensure that the causes leading to the formation of a pressure ulcer are excluded as much as possible.
Using a functional bed for immobile patients, with an anti-decubitus mattress and made from natural fabrics, is a fairly effective way to prevent the development of pressure ulcers.
Activation of the patient - carrying out breathing exercises, physiotherapy exercises, taking into account the patient's physical capabilities,.
Permanent and correct skin hygiene, especially in places of friction and pressure, using products that do not cause an allergic reaction.
Organization of the daily routine and, taking into account the patient's condition.
The diet should be optimally balanced in terms of vitamin and mineral composition in order to maximize the proper functioning of organs and systems, without overeating. This is especially important for a bedridden patient; excess weight interferes with a full-fledged rehabilitation process.
Regular examination and expert advice.

Pressure ulcers, like any other disease, are easier to prevent than. Moreover, long-term treatment requires costs, both material and moral, especially in home care for bedridden patients.

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Bedsores are areas of necrosis (necrosis) of the skin and tissues adjacent to them, which occur under constant pressure on tissues with impaired cellular nutrition.

Metabolism and nutrition in all tissues of the body is provided by its circulatory system with the help of the smallest blood vessels - capillaries. The walls of the capillaries are very elastic. When they are squeezed, blood flow in the tissues slows down or stops completely. This squeezing occurs when a person is sitting or lying down. When circulatory disorders last more than two hours, malnutrition (ischemia) of tissues develops, which leads to their necrosis (necrosis). A healthy person is usually not in this position for such a long time. Pressure ulcers develop in bedridden or sedentary patients with impaired movement functions.

Causes Leading to the Formation of Pressure Ulcers

The main cause of pressure ulcers is the compression of skin tissue between the bone and the hard surface.

This compression, leading to pressure ulcers, can be caused by certain reasons.

Constant pressure. This type of pressure occurs when the skin and subcutaneous tissue remains trapped between bone and a hard surface for a long time. At the same time, the pressure significantly exceeds the pressure of the blood flow in the capillaries, which deliver nutrients and oxygen to the tissues. Energy starvation occurs in the cells, and they are damaged. In this case, bedsores are most often formed in places that do not have sufficient muscle mass - in the area of the shoulder blades, sacrum, spine, elbows, knees, hips.
Friction. This movement occurs when a person changes posture or is moved by other people. The skin is rubbed against a surface, usually a sheet. If the skin is damp, the friction will be stronger. The skin is constantly damaged and bedsores develop.
Slip. Occurs when two planes move in different directions. This usually happens when the head of the bed is lifted. In this case, the sick person slides down, which leads to damage to tissues and blood vessels. This increases the risk of pressure ulcers.

There are many factors that significantly increase the risk of pressure ulcers:

old age of the patient;
significant weight loss;
decreased sensitivity;
insufficient fluid intake and poor nutrition;
excessively dry or damp skin;
incontinence of urine and feces;
diseases in which blood circulation deteriorates;
frequent muscle cramps;
violation of the patient's consciousness;
smoking.

The degree of development of the disease

There are four degrees of pressure ulcer development.

First degree. Redness appears on the squeezed areas of the skin, but the skin is still intact. Hyperemia (redness) does not go away even after the cessation of squeezing.

The second degree of development of bedsores. A shallow violation of the skin surface occurs, which often extends to the subcutaneous tissue. Partial exfoliation of the upper layer of the skin is observed.

Third degree. There is a destruction of the skin, the formation of ulcers. Growing, ulcers penetrate the muscle layer. Liquid discharge flows from the affected areas.

The fourth degree of development of bedsores, the most severe. All soft tissues are affected. A cavity is formed that exposes the tendons, and sometimes the bones.

Prevention of pressure ulcers is mandatory for people with complete or partial immobility. The main measures to prevent pressure ulcers can be identified.

Reducing compression, friction and tissue displacement. It is necessary to ensure that the surface of the patient's bed is flat, without depressions and bumps. To minimize the load on the skin, it is necessary to change the position of the patient's body every 2-3 hours. It is good to put pads with a feather or foam rubber under the bone protrusions. For the prevention of pressure ulcers on the extremities, special bags with millet or other large grain are used.

The most effective remedy for bedsores is a special mattress. An anti-bedsore mattress eliminates the main cause of their formation - squeezing skin areas. It can consist of air cylinders or cells. Air cylinders or bedsore mattress cells are connected by tubes to a compressor. With its help, different parts of the mattress are automatically pumped up and deflated every 6-8 minutes. Thanks to the effect of constant massage, the pressure is evenly distributed over the entire surface of the patient's body. With the help of a bedsore mattress, a person's blood circulation, respiration and tissue nutrition are normalized.

In addition, there are other remedies for pressure ulcers. For patients who have been in a wheelchair or wheelchair for a long time, special anti-decubitus pillows are used. They are made from resilient foam, latex, foam rubber or inflatable cells. A rubber ring can be placed under the skin that is exposed to pressure, which also prevents pressure ulcers.

Careful personal hygiene of the patient and procedures that reduce skin irritation. To prevent pressure ulcers, it is very important to regularly cleanse the patient. For washing, it is best to use baby soap, a sponge, or a cotton washcloth. After washing, the skin should be blotted, not wiped off. Air baths should be done regularly for areas of the body where there is a risk of pressure ulcers. After washing, use special powders, creams, ointments. Such remedies for bedsores as Miramistin, Agrosulfan, Dermazin, Levomekol, Vulnuzan have proven themselves well. In any case, it is better if such drugs are selected for the patient by the attending physician.

Treatment of affected areas

Treatment of pressure ulcers of I and II degrees is conservative and usually lasts several weeks. Pressure ulcers of III and IV degrees are often treated using surgical methods, while complete cure is not always possible.

At the beginning of treatment for pressure ulcers, the pressure that caused them is reduced. For this, the position of the patient is changed, supporting devices are used.

After that, all damaged, dead and infected tissues are removed. At this stage of treatment of pressure ulcers, the following methods are used:

washing the wound, using special baths and dressings;
the use of chemical enzymes that destroy dead tissue;
surgical removal of damaged tissue.

The treated wounds are periodically washed with saline and a fresh bandage is applied.

When pressure ulcers become infected, local or general antibiotic therapy is necessary. For anesthesia, anti-inflammatory nonsteroidal drugs are used.

With the ineffectiveness of conservative therapy, surgical treatment of pressure ulcers is performed. The type of surgery depends on the location of the affected area, its size and severity.