Dorothy FarrarDecubitus (pressure ulcer)
With our aging population and the increase in the number of people in need of care, the word decubitus ( pressure sore ) is used again and again. The majority of the population has an idea of what is meant by that. However, how such a pressure sore is properly treated or how it can be prevented is often not known.
What is a decubitus (pressure sore)?
A decubitus ulcer is a pressure sore that occurs primarily in people who are bedridden or have restricted mobility. It occurs when pressure is applied to any part of the body over a long period of time until there is a deficiency of blood supply to the tissue.
In bedridden people, decubitus ulcers occur mainly on the buttocks, but also on the shoulders or heels, i.e. wherever there are central contact points of the joints or other bones.
causes
In addition to being confined to bed, such decubitus (pressure ulcers) can be caused by any form of restricted mobility, for example in people who are wheelchair bound due to paralysis or walking difficulties and have to sit for a long time.
Being underweight, but also severely overweight , can promote decubitus ulcers, but factors such as protein deficiency can also play a role. People with wound healing disorders or a reduced immune system are also at risk. If there is prolonged pressure on a certain part of the body in this risk group, pressure ulcers can occur.
Strictly speaking, healthy adults can also suffer from decubitus, because a blister on the heel that comes from a shoe that is too tight is a small decubitus.
When to the doctor?
Pressure ulcers usually develop in bedridden patients and caregivers who are sometimes unable to communicate and point out pain themselves. It is therefore necessary for caring relatives to be able to correctly interpret endangered pressure points.
The finger test is very helpful for early detection. If the redness persists and does not fade when pressure is applied to the affected area, a first-degree ulcer is already present. Medical advice must be obtained as soon as possible, since the success of the treatment is much better in the initial stages than in later phases. If the redness subsides after a short time, it is either a harmless skin defect or the beginning of decubitus. In this case, ointments and medicines will help. However, the affected area must be constantly monitored in order to be able to identify changes as quickly as possible.
Sometimes it happens that the patient has a pressure sore in the form of an open wound after only a short time in bed. If the affected person simultaneously feels unwell, vomits or has a loss of consciousness , these are indications of an infection caused by bacteria and viruses. There is an acute danger to life from blood poisoning (sepsis)! The emergency doctor must be alerted immediately!
Due to the rapid progression of the disease, decubitus should generally be treated by a doctor in the early stages. Only the doctor can stop the healing of the wound and prevent long-term effects through early treatment.
diagnosis and course
Even if the doctor makes the diagnosis, trained nursing staff can and must recognize a decubitus in all known stages. The decubitus is divided into four stages:
1st stage: slight reddening, reversible when the pressure is relieved
2nd stage: non-reversible reddening, blistering
3rd stage: Loss of all skin layers, tissue dies (necrosis)
4th stage: Loss of all skin layers, tissue dies, “pocket formation” occurs
If a decubitus is recognized in the first stage, pressure relief can effectively prevent the pressure sore. If pressure is continued to be exerted for many hours (e.g. lying down at night when the person cannot roll over themselves), massive skin damage can already occur. Severe decubitus ulcers do not form in a few hours. In most cases, however, there is no improvement at an early stage because the person is in poor general and nutritional condition and is still restricted to a wheelchair or bed because of their limited mobility. Even trained nursing staff cannot always prevent or treat pressure ulcers effectively.
complications
In the case of a decubitus pressure sore, which often occurs in bedridden and seriously ill people, there can often even be serious complications. A decubitus is not only a severely painful wound, but in an emergency it can even become inflamed and cause other health problems.
Especially with decubitus in the area of the buttocks, there is always a risk of bacteria migrating through stool and urine and causing an infection. An infection represents a further risk for people who are usually already seriously ill. It can also happen, for example, that surgical intervention may even be necessary. Necrotic areas, ie dead tissue and layers of skin, often have to be removed. It becomes particularly complicated when the decubitus has reached a higher stage. If, for example, bones such as the coccyx are already exposed, there is also a risk of periosteum inflammation .
In addition, a decubitus also has a legal side. In most cases, this complication is a nursing error or it arises from improper care and positioning of a patient. Under certain circumstances, a patient with bedsores or their relatives can even take legal action against the hospital, nursing staff and doctors and sue for damages or compensation for pain and suffering.
treatment and therapy
The treatment of decubitus basically depends on the circumstances and the underlying diseases of the patient. The first measure will always be to relieve the pressure. For bedridden people, this means regular repositioning. For wheelchair users who have to sit for a long time, special seat cushions can relieve decubitus, similar to alternating pressure mattresses for bedridden people.
Special wound dressings are extremely important, a normal, dry wound dressing (similar to a plaster) is usually not sufficient. Special multifunctional wound dressings cushion the area, do not stick to the wound, absorb wound exudate and release substances that accelerate healing.
Wound dressings with a silver coating achieve convincing results depending on the wound. Depending on the wound, it may even be the case that this bandage does not have to be changed every day because the wound dressing “works”. Of course, the hygienic conditions play an important role here, if the decubitus is on the rump of an incontinent bedridden person, the bandage must of course be changed more often.
outlook and prognosis
The prognosis for a decubitus depends on the degree of the same. Grade 1, 2 and often grade 3 pressure sores can usually be reversed with conservative therapy – i.e. regularly repositioning the affected person and appropriate food and, if necessary, wound treatment.
The ability of a pressure ulcer to heal depends on many factors. Obesity, severe underweight , lack of mobility and malnutrition slow down wound healing. Conversely, sufficient hydration in combination with exercise and a rich diet ensures a better healing process. In general, lying on the pressure point should be avoided as much as possible in order to have a positive prognosis.
The localization of the decubitus also has a significant share in the healing rate. The more subcutaneous fatty tissue or muscle mass there is, the more superficial the tissue damage is.
A fourth-degree pressure sore, on the other hand, will hardly be able to heal itself through the body’s self-healing measures. Surgical intervention is almost always necessary and, depending on the localization, carries hardly any risks.
A decubitus can arise again and again and affect different parts of the body. Paraplegic and bedridden patients are particularly at risk.
However, mild first-degree pressure ulcers can be effectively contained if they are detected early.
prevention
Prevention can be useful if you are overweight or underweight by changing your diet or taking dietary supplements. If a person is very thin and has therefore suffered a decubitus, special supplements in the diet (protein) can support the healing process of the wound. Sufficient fluid intake also helps the healing process. Today there are also wound managers who monitor the wounds of those in need of care and coordinate between nursing staff, relatives and the doctors treating them.
Hello and welcome to my Health Guide & Encyclopedia! My name is Dorothy Farrar, and I'm the founder and main author of this platform.
My passion for health and wellness started at a young age when I became interested in the connection between the food we eat and the way we feel. This fascination led me to study nutrition and dietetics in college, where I learned about the importance of a balanced diet and the impact of various nutrients on the body.