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A bedsore is an ulceration of the skin and underlying tissue that occurs typically in debilitated patients confined to bed and remaining in one position so long that pressure on the skin areas that bear the patient’s weight deprives them of their normal blood supply. It is a special type of ulcer caused by impaired blood supply and tissue nutrition resulting from prolonged pressure over bony or cartilaginous prominence. The skin overlying the sacrum and hips is most commonly involved, but bedsores may also be seen over the ears, elbows, heels and ankles. They occur most readily in aged, paralyzed, debilitated, and unconscious patients. Low-grade infection may occur as a complication. Gradually an involved area becomes dark in color, the skin breaks down, and ulcer results. Prevention is much to be preferred, for cure is tedious and difficult.

Prevention

Good nursing care, good nutrition, and maintenance of skin hygiene are important preventive measures. The skin and the bed linens should be kept clean and dry. Bedfast, paralyzed, moribund, listless or incontinent patients who are candidates for the development of decubiti must be turned frequently (at least every hour) and must be examined at pressure points for the appearance of small areas of redness and tenderness. Written schedules can be very helpful. Water-filled mattresses, rubber pillows, alternating-pressure mattresses, and thick papillated foam pads are useful in prevention and in the treatment of lesions. “Donut” devices should not be used.

What to Do

1. Turn the patient frequently from one position to another.
2. Use padding or inflated rubber rings to diffuse the pressure of body weight, particularly over the bony prominence.
3. If the patient has edema (swollen tissues), seek to relieve swelling.
4. Maintain strict cleanliness of the skin.
5. After bathing the skin, use mild stimulation, such as gentle message with lubricant cream, or an alcohol rub, to increase blood circulation.
6. Use talcum powder and proper clothing to protect the skin from friction against bed sheets.


Treatment once a bedsore has developed.

The doctor in charge of the case should give detailed instruction. This is a suggestion:

1. Use a special air mattress designed for this purpose, in which adjacent areas are alternately inflated and deflated automatically by mechanical means.
2. Clean and dress the ulcer daily, using sterile saline solution and sterile dressings.
3. Antibiotic ointments may sometimes hasten healing.
4. Make sure that the patient is receiving a balanced and adequate diet.
5. Early lesions should be treated with topical antibiotic powders and adhesive absorbent bandage (Gelfoam).
6. Deep infections are commonly present in pressure sores, often requiring systemic antibiotics.