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Risk and stage of development of pressure sores than to treat?

Contents:

The development of pressure sores on the body complicates the treatment of patients in intensive care, geriatric, and rehabilitation at home, after heart attacks, strokes, for spinal paralysis, complicated fractures of limbs, spinal injury, comatose States, other pathologies, forced human presence in repetitive posture.


What are bedsores?

Bedsores is a pathological change in the skin, subcutaneous tissue, muscle, bone, and other tissues of the body, developing type neurotrophic disorder, which causes – the violation of the innervation, blood and lymph circulation of local body area, long-term contact with a solid surface.

Brief characteristics of pathological changes on the body:

  • develop on the side of the body adjacent to the solid surface;
  • characterized by the stages of pathogenesis, begin with the stagnation of blood circulation, in the absence of treatment, end of neurotrophic necrosis of the wet or dry type, sepsis, or gas gangrene;

  • most quickly, within days, develop in malnourished patients with stagnant heart failure;
  • localized on the protruding areas of the body most commonly affected areas:
  • when the position of the patient on the back, the affected region (sacrum and coccyx, the buttocks, the spinous processes of the spine, shoulder blades, heels);
  • when the position of the patient on the abdomen, affected area (knee joints, the crests of the iliac bones, protruding surface of the breast);

  • position patient on side or semi-sitting, the affected region (the point of the buttock);
  • rarely localized on the neck and the folds of the breast.

Specific localization of pressure sores on the skin under the plaster bandages in places snug for moisture non-penetrating material (oilcloth diaper, rubber tubes), pleatslinens, bandages, etc.

Specific localization of ulcers on the mucous membranes: under dentures, long-term drainage of urethra – the urethra, prolonged catheterization of blood vessels on the lining of blood vessels.

Pressure ulcers rarely develop in individuals at a young age, in consciousness, without history, are burdened with chronic diseases. Usually this category of patients, if bed sores are developing gradually, it is likely to miss the impending pathology.


The first signs of pressure sores

  • The subjective sensations that the patient may report her carers, while in the consciousness and stored pain sensitivity areas of the body:
  • a tingling sensation on the skin in places likely of developing pressure sores due to the stagnation of body fluids (blood, lymph) nourishing the nerve endings;
  • loss of sensation (numbness), about 2-3 hours in this area of the body.
  • Visible signs of incipient bedsore who are required to know those caring for patients:
  • stagnation of peripheral blood and lymph, first in the form of venous erythema bluish-red color, without clear borders, with its localization in the place of contact between bone, muscle ridges of the body with a bed bed, the intensity of staining of the skin: from subtle to intense;

  • desquamation of the epidermis of the skin with preliminary formation of purulent bubbles or without them.
  • These are signs of the beginning of a bedsore. It is necessary to take urgent measures to prevent further deterioration of the disease.

    What to do to eliminate the first symptoms of bedsores?

    To do this:

    • to change the posture of the patient every two hours, if no contraindications, it is recommended to use a special pillow to change the position of the limbs and body relative to the bed surface, forming the gaps between the skin and the bed;
    • to monitor the level of head of patient's bed, the head must be below or flush with it;
    • to adjust the humidity in the patient's skin cosmetics (cleansing cream, foam, solution, spray, warm bath (never use hot water), doing these procedures two times a day, with uncontrolled bowel movements to remove the contamination as quickly as possible;
    • to remove excess moisture from the skin and skin folds (water, residuesliquid food, urine, wound exudate, sweat) using special absorbent pads, diapers, napkins, towels, films;
    • regularly to turn the bed or to change linens at least once a day;
    • not to make intensive massage, slight stroking of the skin with signs of stagnation, do this gently, without rubbing, especially on sites with close proximity of the bones;
    • use anti-bedsore mattresses or wire mesh balloon type, equipped with special silent compressors for the maintenance and change of stiffness of the base, with adjustable and programmable inflating different parts.
    • use for patients in wheelchairs, pillows filled with gel foam and air, to monitor the change of body position in the chair at least once an hour.

    What is the danger of bedsores?

    Bedsores are pathological, the treatment of which should be avoided. If it failed to do, when the formation of pockets of maceration of the skin, the pathogenesis is developing very quickly, with the formation of foci of tissue necrosis and is characterized by prolonged treatment of purulent wounds. Dangerous outcomes of pressure ulcers. In some cases, the ulcers are the cause:

    • extensive excision of soft tissues and the formation of defects with the violation of innervation and circulation underlying parts of the body
    • amputations of the lower extremities;
    • necrotizing lesions of the periosteum and bone tissue in osteomyelitis, periostitis;

    • exhaustion of protective forces of the body, complicating treatment of the underlying disease;

    With the development of pressure ulcers by type of moist necrosis is infection of the wound, with the development of purulent process (abscess, sepsis, gas gangrene).

    With the development of pressure ulcers by type of dry necrosis develops protracted pathogenesis with long periods of healing of the defect.


    The causes of bedsores

    The cause of bedsores is as follows. Our body is completely permeated with small blood vessels. On these vessels – capillaries – blood to the various organs of the body. If there is compression or squashing of the blood vessels, the blood supply to the tissues, resulting in tissue umertvljajut.

    If the person is instationary for two hours, his blood vessels are squeezed and blood ceases to flow in some parts of the tissues of the body. So formed bedsores. Remember that it is very dangerous to sit or lie still.

    Also the sores form if the sick person often pull a wet sheet. Thus there is a rupture of blood vessels. It is quite invisible to the human eye. But after the rupture of blood vessels to the tissues stops blood. Formed bedsores.

    Also, blood vessels can tear, if the person cannot, for example, to walk and kept myself slipping, to accept another position.


    Risk factors for development of pressure ulcers

    It is noticed that the pressure sores developing in bedridden patients at different times. In medical institutions, to systematize the assessment of risk factors for development of pressure ulcers, use of Norton scale, the waterlow or Linwood. At home they do not matter. Based on the criteria formulated by the risk factors associated with errors in care and the individual characteristics of the patient, suitable for home use.


    1. Factors associated with errors organization of patient care:

    • unkempt bed're redoing the less than once a day;
    • a rare change of underwear dry and clean;
    • neglect of hygienic procedures (treatment of the body with special solutions, obsushivaniya, massage areas of the body where possible without the additional trauma of bedsores);
    • hard, uneven surface of the bed.

    2. Factors associated with individual characteristics of the patient:

  • old age;
  • depletion or Vice versa, the obesity of the patient;
  • cardiovascular disease;
  • diseases associated with the violation of innervation of the body (including strokes);
  • disorders associated with changes in metabolic processes in the body (diabetes mellitus, impaired water-salt metabolism or the common limitation in the drink);

  • an unbalanced diet or a deficiency in the diet of protein foods, protein dystrophy (disorders of protein metabolism);
  • the patient's condition (coma, dementia, etc.) in which he has no control over defecation, urination.
  • In addition to the factors causing the occurrence of pressure ulcers, include Smoking, diabetes, lack of water and little foodexcessive or, on the contrary, very light weight, incontinence of urine and feces, dirty skin, crumbs and small objects in bed, allergic reaction to care products for the skin, folds, seams, buttons on underwear, as well as injuries and diseases of the spinal cord and cerebrum, sweating under high temperature.


    The stage and degree of pressure ulcers

    The pathogenesis of pressure ulcers is characterized by phasic development. There are four stages of pathogenesis.

    Stage I bedsores

    Visually determined venous erythema at the site of adhesion of the skin to the outside surface. Venous erythema is the result of obstructed outflow of blood from the local area.

    How to distinguish venous from arterial erythema redness and bruising?

    • Contrast to arterial hyperemia:
    • color venous erythema – red-cyanotic, the color of blood erythema – bright red;
    • the local temperature of the venous erythema corresponds to the skin temperature or slightly below, the local temperature arterial hyperemia is a warm area of the skin in the place of determining the temperature.
    • The contrast of the bruise:
    • red-bluish skin color in the place of finger pressure not changing (bruise)
    • the same skin color in the place of pressure pales (venous hyperemia).

    Venous hyperemia (erythema) of exposed bone areas of the human body adjacent to external surfaces, without compromising the integrity of the skin is the most important feature of bedsore first stage.

    Stage II of pressure ulcers

    Visually defined by the thinning of the epidermis – the top layer of the skin, followed by desquamation, formation of bubbles. Pathogenesis develops as follows: venous stasis causes a disruption in the nutrition of tissues, the innervation area of the body, excess fluid in the skin, causing swelling (maceration) and rupture of the epidermal cells.

    Surface damage of skin thinning and peeling of the epidermis, compromising the integrity, maceration (moisture) is the most important symptom of the second stage of a bedsore.

    Stage III bedsores

    Visual is defined as a wound with an abscess (contamination microflora) or without suppuration.

    Involvement in the pathogenesis of deep tissue layers of the skin, subcutaneous tissue, muscles with suppurative type of inflammation and begins the process of necrosis (tissue death) is the most important symptom of the third stage of bedsores.

    Stage IV bedsores

    Visual is defined as a local cavity or a defect formed as a result of the decay (necrosis),the edges of the cavity is made by the walls of the defect which continued purulent inflammation.

    Nekrotizirovanne cavity and its extension due to inflammation of the walls is the most important symptom of stage IV bedsore.

    In different parts of the body, there can be different stages of bedsores.

    Festering bedsores

    Suppuration plot bedsore begins with the second stage, develops in the third and fourth, after contamination of wounds by Staphylococcus, Streptococcus, other pyogenic microorganisms of the plot.

    Often the path of development of festering bedsore is erysipelas and cellulitis. In severe cases, the sore passes into sepsis or gas gangrene.

    1. The development of septic bedsores by type of erysipelas

    Mug– local purulent inflammation at a localized area of the skin. The causative agent of hemolytic Staphylococcus aureus and other pyogenic organisms. Erysipelas occurs in persons with a weakened immune system, older age groups, is accompanied by toxemia, hyperthermia.

    The symptoms of erysipelas in bedsores:

    • the skin at the site of the bedsore bright red dense cold with a noticeable swelling is the main symptom;
    • the increase in body temperature to 39 degrees;
    • headache, weakness, nausea;

    • evolving purulent wound;
    • the exudate from the wound, no treatment enters the bloodstream.

    2. The development of septic bedsores on the type of phlegmonous inflammation

    Cellulitis is a diffuse purulent inflammation without clear boundaries. The pathogen Staphylococcus aureus and other pyogenic microorganisms, E. coli. Abscess can be localized for: skin, fascia, intermuscular space.

    The symptoms of phlegmonous inflammation in bedsores:

    • shiny swelling without clear boundaries red, hot to the touch is the main symptom of the beginning of phlegmonous inflammation ;
    • body temperature to 40 degrees;
    • the rapid development of the fistula with purulent or putrid contents.

    3. The development of pressure sores on the type of septic inflammation

    Sepsis or purulent infection of the blood – sequel to the erysipelatous or phlegmonous inflammation. An extreme stage of sepsis is septic shock, often downloaded with the death of the patient.

    Symptomssuppurative septic inflammation in bedsores

    It is possible to allocate such symptoms as:

    • atypical – a variety of symptoms, the absence of primary (pathognomonic).
    • high temperature at the beginning of the process and low at the completion;
    • the rapid development process.

    With symptoms of sepsis begin to fight in the early stages of bedsores with antibiotics. Currently bringing the patient to septic conditions happens rarely, maybe with immunodeficient status of the patient, insensitivity to antibiotics.

    4. The development of pressure sores, by type of gas gangrene

    Gas gangrene is a severe purulent, putrid pathology. The causative agent Clostridium microorganism, most often perfringens Clostridium (soil microorganism). Infection occurs by ingestion of contaminated soil maseribane on the surface of the bedsore.

    Symptoms of gas gangrene in bedsores:

    • sounds crepitate (crunch) in the conduct on the affected area of the skin – pathognomonic symptom.
    • rapid development for six to seven hours;
    • skin color is gray-blue;
    • wound dry;
    • a strong putrid smell.

    Skin treatment for bedsores

    There are three areas of skin treatment for bedsores.
    • Hygienic treatment of the skin to maintain the physiological properties of the skin (moisture, skin pH, softening of the skin, increase elasticity), deletion of the physiological body fluids (sweat, sebum, flakes of epidermis), aggressive environments, excreta (urine and feces) and deodorization of the skin;
    • Preventive treatment of the skin, to stimulate the local blood circulation, recovery of sensitivity, prevent cracking of the skin.
    • Medical treatment, the use of drugs in formulations (ointment, cream, solution, gel, spray, powder, powder, topical solution, etc.),

    Solution for the treatment of pressure ulcers

    In modern surgery application solutions in the treatment of bedsores lost some of its former importance. Meanwhile, simple solutions are successfully used for many decades in military surgery to treat wounds and their complications.

    • To prevent the development of pressure ulcers recommended: 2% solution of camphor alcohol, 0.5% solution of ammonia, 1-2% solution of tannin in alcohol, 1% salicylic alcohol 2-3 timesa day.
    • For the treatment of pressure ulcers recommended:
    • exterior solutions – 25% solution of MgSO4, 10% hypertonic NaCl solution with chymotrypsin, 05% aqueous solution of chlorhexidine digluconate;
    • parenterals: intravenous, drip 0.5% solution of metronidazole.
    • Not recommended for the prevention and treatment solutions in all concentrations: iodine, KMnO4 – potassium permanganate, brilliant green, hydrogen peroxide.

    It is important to follow the diet of the patient. The diet should include foods that have zinc, iron and other useful minerals. Bedsores are often formed from a lack of iron. It is abundant in dairy products, fish, poultry, eggs. The patient should eat more green vegetables and fresh fruits. For those patients, digestive system which copes poorly with meat, alternatively, a suitable broth.

    Topic: pressure ulcer Prevention


    Bedsores on the heels, buttocks and coccyx

    The usual position of the patient lying on the back. The most vulnerable sites for the development of pressure sores – buttocks, coccyx, heels, and sometimes the area of the blades. So first of all with hygiene procedures, the patient should pay attention to specified areas of the body.

    Bed sores on heels

    Unusual, at first glance, localization, however, is common. There are several diseases of the heels, which while not associated with the sores, but are proof of the vulnerability of this area of the body, namely, necrosis of the heel (Haglund's disease – Since), bursitis, epiphysitis heels and so on.

    Causes of pressure sores on the heel:

    • the load when lying on the back;
    • thick skin, difficult to detect incipient pathology;
    • cracked skin heels, the risk of microbial contamination;
    • congestion of the lower extremities is a frequent companion of the elderly occurs in some diseases (diabetes, etc.).

    Symptoms of pressure sores on the heels

    Many sources indicated the absence of signs of bedsores on the heels. The appearance of bedsores may be preceded by a white spot, tingling, loss of sensation in the heels.

    Preventive measures

    Prevention of pressure sores on the heels include:

    • use unloading devices for heels (wedge pillow, ovchinki, specialmattresses);
    • stimulate circulation (light massage of the calf of the legs), RUB 2% camphor alcohol, change your foot position every two hours;
    • protect the heels of my feet against the ingress of microflora, such as by using colloidal bandages-butterfly (Compil Plus), lends a moist sterile chamber. Materials from which is made of bandage, a sealing compound to leave the dressing on the wound for two to five days.

    Treatment of pressure ulcers on the heels

    Tools and methods for the treatment of pressure ulcers on the heels are no different from the treatment of leg ulcers in other parts of the body. Take into account the anatomical localization of bedsores.

    Bedsores on buttocks

    Bedsores on buttocks dangerous consequences. This plot is located close to important organs (colon, hip joint, pelvic organs, nerve centers and blood vessels Innervate the lower limb), disruption of which significantly affects the quality of life, and in some cases life-saving.

    Glutes are powerful muscles, which must resist the formation of bedsores. However, persistent contamination of the skin with urine, feces, without proper hygienic treatment, stimulates the development of pressure sores. In the formation of the necrotic lesion, the formation of extensive soft tissue defects are difficult to treat. Precursors and symptoms of pressure sores on the buttocks is typical.

    Preventive measures:

    Prevention of bedsores on the buttocks include:

    • conduct regular hygiene procedures of the buttocks and perineum using washing creams, liquids, sprays, to facilitate use special gloves with latex coating, which protect the hands of the person caring for patients, does not injure the damaged areas of the skin of the patient;
    • to prevent chafing of the skin of the buttocks and perineum, use absorbent underwear, bed sheets, diapers, diapers, neutral absorbent powder;
    • Regularly, every two hours change position of the patient, use anti-bedsore mattresses with a programmed change in the stiffness of the bed and its different parts, use pillows, cushions and other devices to prevent pressure sores on the buttocks.

    The treatment of pressure sores on the buttocks

    In the early stages recommended swipe multifarm Russian production or their analogues. The use of MultiTerm shown in purulent processes with weak–moderate exudation. The exposure time and the magnification rate indicated on the package.

    Treatment of neglected forms of pressure sores on the buttocks takes into account anatomic features of this area of the body, similar to the treatment of purulentRussian Academy of Sciences.

    Bedsores on the tailbone

    This area of the body a few sticks and when lying down, tightly in contact the bones of the coccyx bed bed. Bedsores on the tailbone is dangerous in small muscular layer and the presence of important nervous plexuses. The melting of the tissue when necrosis damages the nerve endings and causes a disruption in the innervation of the lower body.

    The symptoms of decubitus ulcer of the coccyx

    Precursors and symptoms of decubitus ulcer of the coccyx correspond to the classic conception of the development of its pathogenesis. In view of the anatomical proximity of the buttocks and tailbone prevention and treatment of early stages identical to the events on the buttocks.


    How to treat bedsores?

    Treatment of pressure ulcers the second, especially the third and fourth stages must comply with the treatment of purulent wounds. Festering wounds are difficult to treat, but over the years surgery developed a standard treatment algorithm. Of course additions and improvements in treatment are regularly paid, however, the purpose and objectives of the treatment remained unchanged.

    I. In the first phase of the pathogenesis

    In the first phase, when the wound of pus-filled bedsore and nekrotizirovannye fabrics should:

    • to provide outflow of pus from the wound;
    • to remove swelling;

    • to suppress microbial colonization of the wound.

    Revision of the wound, cleaning the edges of necrotic tissue is performed in a surgical Department. To drain pus make drains and to keep them reiseroute.

    Topic: a list of home remedies from the sores

    Passive drainage may be arranged in the home:

    1. To do this, the wound is filled with special wipes impregnated with compounds that promote drainage of pus. Periodically swipe change. As napkins you can use regular bandages, the edges of which do not fall into a filament. For the impregnation of wipes use solutions and ointments.

    2. Outdated drugs: hypertonic solutions of 10% sodium chloride, 3-5% solution of boric acid and others. At present, the use of such solutions is limited due to low suction power from 4 to 8 hours.

      Hydrophobic ointments (liniments, emulsions) on the basis of vaseline (liniment on Wisniewski, sintomitsinovoy emulsion, tetracycline, neomitsinovoy and others). Their disadvantage is that they do not absorb the pus, antibiotics in their composition do not apply in full force.

      Moderndrug: hydrophilic (water soluble ointment) – nasal spray, Levosin and other water-soluble compounds. They are well removed from the wound pus, for approximately 20-24 hours. Attention! Hydrophilic ointments only be used when the presence of pus in the wound, in another situation (pus absent) these ointments are not effective.

    3. Enzyme therapy - the following method of surgical treatment of purulent wounds (therapy removes pus enzymes).

    4. Proteolytic enzymes (trypsin, chymotrypsin, and others). To enhance their actions using a combination of these or other enzymes ointments, such as the combination of enzymes and ointments Iruxol.

    5. Antiseptic solutions topical use. furatsilin, hydrogen peroxide, boric acid (currently restricted). Shown to application of modern formulations – 0.5% solution yodopiron of 1% solution dioksidina.

    6. Physical methods of treatment. Use traditional methods (UHF, ultrasonic cavitation, oxygenation, vibrionaceae, laser therapy and other similar methods)

    II. In the second phase

    In the second phase, after cleaning the bedsore from pus to achieve the appearance of healthy tissue. Healthy scab is a thin layer of the dried granulation. Purulent eschar is a thick crust consisting of dried pus. Recovery festering under the scab, it is impossible!

    With the appearance of healthy granulation tissue treatment:

    • relieves inflammation;
    • protect healthy granulation tissue (healthy tissue) from accidental damage;
    • stimulating the processes of tissue repair.

    Of inflammation use:

  • ointment (hydrophobic ointment – methyluracyl, troxevazina, hydrophilic ointment – bepanthen and others);
  • herbal preparations – the juice of aloe, Kalanchoe, oil (sea buckthorn, dog rose);

  • laser therapy the therapeutic effect of stimulation of epithelialization of the tissues.
  • III. In the third phase

    In the third phase, to achieve the regeneration and cicatrisation of the wound healing process. Use modern drugs stimulating epithelization and scarring of tissues, for example: EDAS-201M, vitamins, Immunostimulants. In all phases of pathogenesis allowed the use of antibacterial agents, the recommended intravenous drip of a solutionmetrogel, antibiotics.

    The resulting defects and the consequences of pressure sores treated in a hospital.