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Medical Issues in Nursing Homes
Pressure ulcers
Pressure ulcers are also referred to as pressure sores, bedsores, and decubitus ulcers. A pressure ulcer can range from a very mild pink coloration to the skin which disappears in a few hours after the pressure is relieved, to a very deep wound extending to and sometimes through a bone into internal organs.
All pressure ulcers have a course of injury similar to a burn wound. This can be a mild redness of the skin and/or blistering such as a first degree burn to a deep open wound with a lot of blackened tissue in it such as a third or fourth degree burn. This black tissue is called eschar.
The primary cause of pressure ulcers is unrelieved pressure. It can also occur from friction by rubbing against something such as a bed sheet, cast, brace, etc. or from prolonged exposure to cold. Any area of tissue that lies just over a bone is more likely to form a pressure ulcer. These areas include the spine, coccyx or "tailbone", hips, heels, and elbows. Other contributing factors to the development of pressure ulcers is poor nutrition, weight loss, diabetes, poor hygiene, and dehydration.
Prevention is the most important component of pressure ulcer management. Removing all pressure from the involved areas to prevent further decay of tissue and promote healing is the primary method of treatment. Frequent turning is mandatory to alleviate pressure on the wound and to promote healing. The individual must have increased nutrition to allow for proper healing of the wounds.
Another key aspect of treatment is keeping the area clean and removing dead or necrotic tissue which can form a breeding ground for infection. Some deep wounds require surgical removal, called debridement, of dead tissue.
Without all of these elements being in place the wounds will not heal properly and will very likely worsen.
Pressure ulcers may indicate potential problems with the care being delivered to the nursing home resident. Even in good nursing homes, small wounds may develop, but with quick attention, these wounds will heal and not progress to massive wounds. According to federal law, in most situations there is no medically valid reason for a pressure ulcer to progress to a Stage IV situation (a massive deep open wound).
Click on any of the links to the right to find out more information about other medical issues that can occur in nursing homes.
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