Header graphic for print
Nursing Homes Abuse Blog By Jonathan Rosenfeld

Understanding Pressure Sores In Nursing Homes & Other Medical Facilities

Posted in Bed Sores, Pressure Sores, Decubitus Ulcers & Pressure Ulcers, Osteomyelitis, Sepsis, Stages of Bed Sores

A study by Gosnell and VanEtten finds that pressure ulcers affect approximately 1 million Americans each year. The overwhelming majority of these patients are residents in a care facility, especially elders in a nursing home. Knowing and recognizing the signs of pressure ulcers is your loved ones’ best defense against the neglect that leads to these painful injuries. The Mayo Clinic reports that medical professionals divide pressure sores into four distinct categories of severity:

Stage I Bed Sores appear as a red patch on intact skin. These are the first sign of circulation loss due to a patient remaining in one position for long.

Signs of Stage I Sores include:

  • Skin texture, color or temperature markedly different from that around the sore.
  • Failure to blanch – become lighter in color – when pressed.
  • Pain when touched or pressed.

Though themselves not terribly serious, pressure ulcers at this stage can be painful. Potential complications include infection and becoming a higher-stage pressure ulcer.

Stage II Bed Sores are an open wound. The skin has died from lack of blood, and deteriorated to expose the tissue beneath. These sores only happen when a Stage I sore has gone unnoticed and/or untreated by a patient’s care providers.

Signs of Stage II Sores include:

  • Damage and peeling of the epidermis – the top layer of skin.
  • Exposed, visible, and possibly damaged dermis.
  • Either an open, bowl-shaped hole in the skin or an intact blister over the wound.
  • A layer of dead, yellow tissue or pus within the wound.

Infection is a serious problem for pressure ulcers at this stage, including both infection at the wound site and the generalized infection called sepsis. Sepsis occurs in 26 percent of cases of unhealed pressure sores, according to resources published at Medscape.com.

Stage III Bed Sores occur as lower-stage sores continue to fester untreated. The skin dies and the wound continues to deepen.

Signs of Stage III Sores include:

  • Extreme pain at the infection site, enough to interfere with appetite and sleep.
  • Fat exposed at the bottom of the wound.
  • A layer of dead black, red or yellow tissue coating the bottom of the wound, which resembles an open crater.

At this point, gangrene becomes a serious risk as tissue is dying at the site of the wound. Ostyomylelitis, arthritis and even cancer are other risks of untreated Stage III sores – other systems becoming affected once the condition has penetrated beneath the skin.

Stage IV Bed Sores are the most severe, with the tissue death and infection reaching beyond the skin and fit and to internal tissues.

Signs of Stage IV Sores include:

  • Bone, muscle and connective tissue visible at the bottom of the wound.
  • Red, black and yellow dead tissue covering parts of the open wound.
  • Tissue death in the dermis and fatty layers beneath the epidermis.
  • Infection and sepsis due to exposure of internal organs to the open air.

National Institutes for Health statistics report over two-thirds of patients with stage four bedsores dying within 6 months.

It is the responsibility of all care facilities to take proper precautions to prevent pressure ulcers, and to treat any that do occur quickly and effectively. Facilities that don’t – whether due to understaffing, poorly trained staff, or employee irresponsibility – frequently pay damages to the individuals and families their negligence has harmed.

Resources relating to pressure sores:
http://www.ncbi.nlm.nih.gov/pubmed/14652420.1
http://www.mayoclinic.com/health/bedsores/ds00570/dsection=treatments-and-drugs
http://emedicine.medscape.com/article/319284-overview

Nursing Homes Abuse Blog