What Is a Pressure Sore?

Bed sores are also called pressure ulcers, which are mainly caused by the long-term compression of local tissues of patients, followed by ischemia and hypoxia due to insufficient blood supply. Common problems in the process of clinical rehabilitation treatment and nursing work. For elderly patients lying in bed for a long time, because their physical functions are generally in a state of decline, autoimmune resistance gradually declines or even completely loses, so bedsores are more likely to occur, and a series of pressure ulcer complications are caused, which endangers patients life safety.

Bed sores are also called pressure ulcers, which are mainly caused by the long-term compression of local tissues of patients, followed by ischemia and hypoxia due to insufficient blood supply. Common problems in the process of clinical rehabilitation treatment and nursing work. For elderly patients lying in bed for a long time, because their physical functions are generally in a state of decline, autoimmune resistance gradually declines or even completely loses, so bedsores are more likely to occur, and a series of pressure ulcer complications are caused, which endangers patients life safety.

Chinese name

Senile bedsores

Foreign name

Aged bedsore

Bedsores in the elderly 1. Causes and corresponding diseases

Decubitus ulcers refer to local tissue ulceration and necrosis due to long-term compression of local tissues, which causes blood circulation disorders, and continuous ischemia, hypoxia, and malnutrition. Elderly patients are more likely to occur due to their poor nutritional status and low physical fitness. In the care of patients with decubitus ulcers, the causes of decubitus ulcers should be understood, and corresponding nursing measures should be taken according to the causes, in order to treat the symptoms. The main reasons are as follows:

1.Local factors

(1) Vertical pressure

This pressure is due to its own gravity and force attached to the body, and is the most important pathogenic factor. Studies have shown that the capillary pressure measured by plethysmograph is 2.1 ~ 4.3kPa. If the pressure exceeds this limit, the perfusion of the capillary to the tissue can be blocked, and the blood flow in the skin will be stopped. Waste is prone to tissue degeneration and tissue ischemic necrosis.

(2) Friction

Friction is the mechanical force acting on epithelial tissue, mainly from the skin's resistance to friction with the surface of clothing, pants or sheets. It can remove the outer protective keratinized skin and increase the skin's sensitivity to bedsores. The bed has wrinkles, scum, or dragging, dragging, pulling, or pulling the patient when moving. In addition, it can raise local skin temperature, increase the temperature by 1 ° C, accelerate tissue metabolism and increase oxygen consumption by 10%, and increase the susceptibility to bed sores.

(3) Shear force

Shear force is caused by the progressive relative displacement of two objects when sliding between adjacent surfaces, and is closely related to body position. For example, when lying on the back, when the head of the bed is raised, when the seat is tilted, or when a wheelchair user leans back, the crotch is subjected to increased shear force. Shear force acts on the deep layer, causing relative displacement of the tissue, which can cut off the supply of small blood vessels in larger areas, resulting in a decrease in tissue oxygen tension, so it is more harmful than vertical pressure.

(4) Local skin temperature and humidity

A 1 ° C increase in body temperature and a 10% increase in metabolic rate can reduce the tolerance of ischemic tissues. Animal experiments have also shown that the degree of tissue damage is related to an increase in temperature. When the skin becomes excessively wet, the tissue becomes soft and fragile. Moisture irritation caused by incontinence and sweating leads to impregnated and soft skin, which is easily injured by shearing and friction. Fecal incontinence is more dangerous than urinary incontinence due to the presence of more bacteria and toxins. The infection caused by the impregnation of this pollutant makes the condition worse.

2.Systemic factors

Elderly patients are prone to bed sores with systemic nutritional disorders, negative nitrogen balance, dry skin, poor elasticity, sensory or dyskinesia, poor blood circulation, and weight loss. Infusion of large amounts of fluid causes a drop in body temperature and increases the chance of pressure sores forming in the pressured area. In addition, research shows that there is a clear relationship between bed time and age and the occurrence of bedsores, which is positively correlated, that is, the longer the bed time, the older the bed decubitus is more likely to occur. Set the bedtime warning value to> 21.40d and the age warning value to> 54.44 years. In addition, severe malnutrition, heart failure or other diseases cause body edema, advanced cancer, decreased skin resistance caused by various end-stage diseases, reduced subcutaneous lipid prevention, stress, depression, depression, lack of self-care ideas, etc. Risk factors.

3. Improper care

In addition to many factors mentioned above, inadequate understanding of the risk factors for bedsores by nursing staff, patients and family members and the inadequate care caused by them are the main obstacles to prevention of bedsores.

Senile bedsores 2. Differential diagnosis

The clinical diagnosis of senile bedsores is divided into the following phases: degree (congestion and ruddy period): the epidermis is not damaged, but the skin is red. But the redness over 30min has not improved. Degree II (inflammatory infiltration phase): redness of the epidermis, mild ulcers, erosions, blisters, and tissue defects, but less than the dermis, and the wound infiltration was pink with pain and no necrotic tissue. Grade (superficial ulcer stage): The ulcer extends from the dermis to the subcutaneous and is a scab-like tissue defect with exudate and infection and necrotic tissue, but it does not involve nearby tissues and joints. Degree IV (necrotic ulcer stage): The entire skin is extensively damaged, necrotic and involves tendons, bones and their supporting tissues, which can be accompanied by fistulas, and if there is nerve damage, it is accompanied by severe pain.

Bedsores in the elderly

Stages I and II bedsores

The management principle is to protect wounds and prevent wound infections. If the epidermis is not ulcerated, give a non-invasive massage first. For small blister that is not ulcerated, try to reduce the local friction and let it absorb itself. For large blister, puncture and suck the exudate with a syringe under sterile conditions. Afterwards, cover the sterile dressing. Treatment of ulcerated wounds: Disinfect the skin around the wounds, clean the wounds, and then use a sterile dressing to cover them according to whether the wounds are infected.

Stage III and IV bedsores

The treatment principle of stage bedsore is to clean the wound, remove necrotic tissue and promote the growth of granulation tissue. The basic measures are debridement, external application, and sterile dressing. Thorough debridement can be performed by using a surgical scalpel or scissors to remove the rotten flesh and necrotic tissue at the edges and bottom of the bedsore until a fresh bleeding surface appears to facilitate the repair and generation of healthy tissue.

Some studies believe that hyperbaric oxygen is the best treatment for bedsores, but it is too expensive and difficult to promote. However, plastic bags can be used to cover the wound and send pure oxygen to the bag. When the pressure in the bag reaches 3.99 ~ 6.67kPa, it can make necrotic fat and The liquefaction of protein tissues makes the vital tissues red and helps the healing of bedsores.

Bedsores in the elderly

1.Psychological nursing

Bed sores often occur in the elderly who have been bedridden for a long time or those who cannot take care of themselves such as spinal cord injury and limb paralysis. They often feel pain due to the prolonged course of the disease. confidence. Nursing staff should adopt various communication skills to communicate with patients, patiently comfort and actively guide, improve patients' psychological tolerance, eliminate bad moods, and promote early physical recovery.

2. Health education

Provide relevant knowledge and education to patients and their families, introduce the general knowledge of the occurrence, development and treatment of bedsores, get the understanding and cooperation of their families, and teach their families some preventive measures for bedsores, so that patients and their families can actively participate in self-care and consciously cooperate with medical care Treatment to promote the recovery of the body's immune mechanism.

3. Effective prevention

Decompression: Intermittent stress relief is the key to effective prevention of bedsores. Decompression is the first precautionary measure. Turning around regularly, changing positions, and applying decompression equipment appropriately are the most basic ways to prevent local tissue from being compressed. The patient can turn on his back in the order of supine, left, prone, and right, once every 2 hours.

When obese and critically ill patients are not suitable to turn over, they can raise the foot of the bed about 30 °, and use a soft pad every 1h to 2h to alternate between left and right, increase local air permeability, reduce pressure on the pressured part, and make soft tissue Alternately under pressure.

For those who have difficulty turning over, 30 ° rollover is an effective prevention. Soft pillows can be used on the left and right sides. For patients with limited mobility and fractures, continuous supine decompression can be used to prevent bedsores.

Friction and shear force are risk factors for bedsores. Shear force will occur when the head of the bed is raised above 30 °. For patients in a semi-recumbent position, the head of the bed is shaken below 30 °, hips are bent 30 °, Pillow or inclined sideways, a soft pillow on the side to reduce the body down, resulting in shearing force at the tail.

The bed should be clean, flat, and dry, and the patient should be lifted when turned over without dragging to prevent friction. Wipe the bath regularly with warm water and massage the local tissues to promote blood circulation.

Maintain the skin tissue's tolerance to pressure and damage, keep the skin clean and moist, and prevent the skin from being wet, but care should be taken not to use the baking lamp excessively.

Patients with incontinence should pay attention to avoid infiltration of urine directly into the skin. When caring for patients with fecal incontinence, wash the anus and its surroundings after each defecation, and apply a skin protective film to the anus to form a protective film to isolate the feces from the skin. Of stimulation.

Strengthening nutrition: According to the nutritional status of patients, nutritional supply should be targeted, and high protein, sufficient calories and high vitamin diets should be given to increase the body's resistance and tissue repair capacity.