- posted: Nov. 13, 2023
Bed sores. Pressure ulcers. Decubitus ulcers. All synonymous for areas where someone has been immobile for
an extended period of time. Such ulcers, unfortunately, are not uncommon. Whether on a nursing home
resident or a diabetic living at home, these ulcers occur when too much pressure rests on an area of the body,
such as the heels, buttocks, shoulder blades, back of the head, and backs and sides of the knees. This is why
shifting positions is so imperative to offload pressure from sensitive areas. Certain medical conditions such as
diabetes, circulation problems and malnutrition put some individuals at higher risk of ulcers.
These wounds are referred to as Stage 1, 2, 3 and 4 based on the damage present, such as depth, severity and
characteristics of the skin and tissue surrounding the wound. This staging helps physicians determine the best
treatment for recovery. If sores are properly treated, and if caught very early, they can heal in a matter of days.
However, if neglected or not adequately treated, severe bedsores may take many months of painful care to
A stage 1 ulcer has redness on the skin that does not disappear once the pressure is relieved. The area may feel
itchy, burning or simply hurt.
Stage 2 is a superficial or shallow wound, affecting the outer surface of the skin, the epidermis, and the layer
below it, the dermis. As the wound heals, there is no scar tissue formation, and the damaged tissues involved
Stage 3 wounds are much worse and deeper, with full thickness tissue loss. It involves damage down to the
subcutaneous tissue. The sore looks like a crater and may be malodorous. Signs of infection may be present
like red edges, pus, heat and/or drainage.
With a stage 4 wound, the skin is severely damaged, surrounding tissue begins to die (necrosis), and muscle,
tendon or bone may also be damaged and/or exposed. A life-threatening infection may result from this stage of
Treatments include cleansing, application of ointments, bandages when appropriate, using pressure reducing
devices such as booties to off-load the heels, special chairs, pressure reducing mattresses and the
turn/repositioning program, as well as enhanced nutrition. Severe sores may require debridement or surgery,
known as flap surgery. Debridement is the removal of necrotic tissue from the wound in an effort to assist the
wound in healing and lowering the risk of any further possible infection. Flap surgery may be necessary in a
wound that refuses to heal. This surgery involves a pad of one’s muscle, skin, or other tissue being used to
cover the wound and cushion the affected bone.
Once a pressure sore is “staged” it can progress to a higher stage but it can never be “back-staged” or “down
staged.” Scar tissue that develops from treating a bed sore is never as strong as healthy tissue and is therefore
more likely to break down again. This is why vigilance is so important to keep your loved one healthy with
mobility, repositioning and providing good nutrition.
Pressure sores can be very painful consequently prevention is of utmost importance. Nursing facilities and
hospitals have turn and reposition charts to document this task. This prevents bed sores from developing, or
once developed, prevents them from worsening. The patient’s families can also assist in the prevention of these
ulcers with observation. Visit your loved one frequently, at differing times of the day, and various days of the
week if possible. Interact with the staff, ask questions as to the care your loved one is receiving, ask to see the
care being provided, and pay close attention to the care being given to your family member. Wounds, if
noticed and caught early, can heal fully. But like anything damaged, the longer it goes, the worse it gets.
If you are concerned that a loved one has been neglected, abused, or simply has not received proper care, you can contact Romaguera Law Group today for a FREE consultation, and complete review of records.