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Wednesday, March 12, 2014

Dad looks uncomfortable in his wheelchair


Today we will begin a two  part series on pressure sores. We will begin by discussing what pressure sores are and how to spot them. Our next blog will be about how to prevent pressure sores in the future.

Burge Medical Supply Blog

An unfortunate fact of life for many wheelchair users is the potential for acquiring pressure sores, also called pressure ulcers. These sores are the criminal element of the wheeled world. The development of these sores can rob a victim of their health, independence, and quality of life. The contributing factors and circumstances can be varied and complex. In most cases it is impossible to single out one element and pronounce it as the primary source. More times than not, it is a multi-dimensional problem. The solution may also be multi-dimensional and should be approached that way.

Pressure ulcers result from long periods of uninterrupted pressure exerted on the skin, soft tissue, muscle and bone. They occur more frequently over a bony prominence such as the sacrum, the hip, or the heel. Two thirds of pressure ulcers occur in patients over the age of 70.

Pressure ulcers can lead to pain, disfigurement, and slow recovery from comorbid conditions. They interfere with daily living and are strongly associated with longer hospital stays and higher mortality rates. Frailty and chronic illness, both common among older adults, predisposes to pressure ulcers. At Burge Medical Supply many of our patients spend at least 5 to 8 hours a day confined to their wheelchair or power wheelchair. The combination of skin breakdown and constant pressure on the buttocks, shoulders, lower legs, ankles and heels, from sitting in a wheelchair seating system, exposes the patient to pressure ulcers.

Development Signs

Pressure sores have a way of sneaking up on you so you don’t know there is a problem until the damage is done. If you have determined that your loved one is at risk for developing sores, it’s important to check their skin daily for any signs that an ulcer has begun. When checking the skin for signs of a developing pressure ulcer, always compare the bony areas that are most commonly affected to the surrounding skin. Signs that a pressure ulcer is beginning to form may include:

  • Color changes – Skin over bony areas (lower back, hips, heels, elbows, etc.) may appear reddened and may or may not blanch white when pressed. Skin may also appear bruised, having a blue, purple, or black color. 

  • Temperature changes – Compared to skin surrounding the affected area, the beginning stage of a pressure ulcer may feel warm to the touch or cool. 

  • Changes in consistency of skin – The beginning stage of a pressure ulcer may make the affected skin feel firm to the touch or may make it feel boggy. Boggy skin can best be described as feeling as though it’s filled with fluid. 
  • Changes in sensation – Your loved one may start complaining about pain, tingling, or itching in affected areas. 

The Four Stages of Sores:

Stage 1 sores are not open wounds. The skin may be painful, but it has no breaks or tears. The skin appears reddened and does not blanch (lose color briefly when you press your finger on it and then remove your finger). In a dark-skinned person, the area may appear to be a different color than the surrounding skin, but it may not look red. Skin temperature is often warmer. And the stage 1 sore can feel either firmer or softer than the area around it.

At stage 2, the skin breaks open, wears away, or forms an ulcer, which is usually tender and painful. The sore expands into deeper layers of the skin. It can look like a scrape (abrasion), blister, or a shallow crater in the skin. Sometimes this stage looks like a blister filled with clear fluid. At this stage, some skin may be damaged beyond repair or may die.

During stage 3, the sore gets worse and extends into the tissue beneath the skin, forming a small crater. Fat may show in the sore, but not muscle, tendon, or bone.

At stage 4, the pressure sore is very deep, reaching into muscle and bone and causing extensive damage. Damage to deeper tissues, tendons, and joints may occur.







If you notice any of these early warning signs, alert your healthcare provider immediately.




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