Concept.
Due to injury or illness, the patient stays in a bed-ridden position for a long time and cannot turn over casually, resulting in prolonged pressure on the local skin tissues of the body, which slows down the blood circulation in the pressurized tissues, causes ischemia and hypoxia in the subcutaneous tissues of the skin, and then results in continuous redness, cyanosis, blistering, ulceration, and necrosis, which is called “bedsore”.
Clinical manifestations.
The clinical manifestations of decubitus ulcers can be seen as a series of skin activities. The depth of color changes from red to white with no tissue loss, and the depth of destruction extends to muscles, joint capsules, and bones.
Early changes in the skin, leukoerythroderma, are characterized by strong erythema changes from pink to bright red.
The pigmentation reflects the severity of the change in vascular status, the heavier the color, the more dramatic the skin change, which can change from black-red to greenish-purple.
A further deteriorating reaction in the tissues of the pigmented area is compression dermatitis. Rupture of the epidermis, as well as blisters appear under the epidermis. Large blisters, crusts and scales may appear. With appropriate treatment. 2 to 4 weeks may heal without persistent pathological changes. Lack of awareness and untimely management of pressure dermatitis leads to the formation of true decubitus ulcers.
Clinical presentation More than 95% of decubitus ulcers occur on the bony ridge of the lower body 67% of ulcers occur around the hip and buttocks and 29% occur in the lower extremities. These anatomical areas are the most at risk for decubitus ulcers when the patient does not change position frequently.
The clinical manifestations of decubitus ulcers can be seen as a series of skin events with changes in color depth ranging from red to white with no tissue loss and deep destruction extending to the muscles, joint capsule, and bones.
Preventive measures.
Decubitus ulcers not only increase the nutritional consumption of the patient’s body and cause serious systemic infections, but also increase the economic burden and the mental and nursing burden of the patient and his or her family, especially in paraplegic patients who, once preventive care is neglected, experience recurrent decubitus ulcers, which are more serious than once. Therefore, the prevention of bedsores is especially important.
1. Fully understand the location of bedsores and the external and internal factors
Decubitus ulcers are usually found in the bony bulges that are under pressure and lack the protection of fatty tissue, without muscle wrapping or thin muscle layers, and are more likely to occur in the scapula, ribs, vertebral body bulges, elbow joints, iliac crest, greater trochanter of the femur, sacrococcygeal, knee joints, internal and external ankles, heels, etc. They can also occur in the anterior superior iliac spine, knee joints, and prominences along the ribs when lying prone. Extrinsic factors that can cause bedsores are moisture, friction, burns, frostbite and abrasions; intrinsic factors that can cause bedsores are loss of consciousness in paraplegia, old age, frailty, anemia, malnutrition, protein deficiency, urinary and fecal incontinence, fever, diabetes and infection.
2.Get the skin color, texture (soft and hard) and observe the temperature
Reddening of the skin: i.e. the skin becomes red and fades when pressed;
Cyanosis of the skin: the part of the skin that is cyanotic (purple) and does not fade when pressed;
Skin blistering: i.e. the part of the skin that is blistered, indicating the necrosis under the superficial layer of tissue. The temperature and texture of the skin can be felt by gently touching the skin. For every 1°C increase in body temperature, the oxygen requirement of tissue metabolism increases by 13%. When sustained pressure causes tissue ischemia, the increase in temperature will increase the susceptibility of decubitus ulcers.
3. Turning regularly
Effective turning to intermittently relieve local pressure is the most effective and critical measure to prevent bedsores. Generally, bedridden patients should turn over once every 1-2 hours, and if the skin turns red, they should turn over once every hour, alternating between left and right side, flat and prone positions, and using soft pillows, air pillows, water pillows, air washers, sponge rings and other pads on the protruding parts of the bone, which can play a role in local suspension and reducing pressure. Patients in wheelchairs can put a sponge pad on the bottom of the foot, soft pillow (pad) or sponge pad under the hip, change the center of gravity once every 15-20 minutes, should prevent the patient from sitting in a wheelchair for a long time (more than 2 hours), where possible, let the patient stand and walk for 10 minutes.
4.The correct implementation of massage
When lying down, put your hand under the hip, palm downward and upward can be. Fully feel the skin temperature and pressure situation, and up massage the skin for 5 minutes, repeat every 20 minutes. When lying on the left or right side, side to side in place, half flat half side (oblique side) application of soft pillows to support the waist and back, the skin color, temperature, texture of normal pressure parts available 50% saffron alcohol poured into the palm, both sides from light → heavy → light massage 5-10 minutes; found that the skin becomes red, it is not suitable for skin massage, can be suspended pressure red parts, generally lift the pressure 30 -40 minutes after the skin color can return to normal. The skin continues to redden, cyanosis, more should not massage, so as not to aggravate the injury.
5.The requirements of mattress and bed sheet
The mattress of bedridden patients should be breathable, soft and hard, good water absorption, available air mattress (oval-shaped is good), high-density sponge mattress, the bed sheet should be pure cotton, in addition to the sheet can be laid on a cotton bath towel, easy to replace. Sheets to keep flat, dry, clean, no wrinkles, no crumbs, no debris; air mattress inflatable soft and hard to moderate, over-inflation can increase the pressure on the skin. For the patient to replace the sheets should prevent dragging, pulling, dragging, to prevent damage to the skin.
6, keep the skin clean and dry and intact
There are various ways to prevent bedsores, but the method we usually use is to scrub with warm water 1-2 times a day, not using irritating cleansers when scrubbing, and not scrubbing hard to prevent damage to the skin. For the sweaty armpits and abdominal grooves, a small towel can be used to wipe them at any time. In order to prevent skin damage can be puffed in the local “Johnson and Johnson” baby buttocks powder or prickly heat powder. For those who are incontinent, wash the skin around the anus in time, apply Johnson & Johnson baby buttock powder or buttock cream, it can effectively prevent the perianal and perineal tie up and eczema; those who are incontinent can use bt type high neck breathable urinary receiver; apply hot water bag for hot compress, the water temperature should be at 50℃, and wrap it with towel, the time of hot compress is 30 minutes, the skin condition of the hot compress part should be observed frequently, it can’t be hot compress in one part for a long time to prevent scalding.
When cooling with ice bags, ice bags should be placed on both sides of the neck, armpits, groin. Ice time to 10-30 minutes is appropriate, not placed too long to prevent frostbite.
7.Strengthen nutrition
①Give high protein, legumes.
②consume more vegetable oils, such as peanut oil, sesame oil, soybean oil, canola oil, etc., which have laxative effect and are conducive to relieving constipation.
③ Use foods rich in plant fiber, such as coarse grains, vegetables, fruits, beans, etc.
④Eat foods rich in vitamin B1, such as coarse grains, beans, lean meat, animal offal, fresh vegetables, etc.
⑤ Eat more fruit juices, fresh fruits, jams, honey, etc. to stimulate intestinal motility.
⑥Drink more water and drinks to avoid dry stools.
(7) Eat less and more meals if necessary to facilitate digestion and absorption.
(8) Any patient with dyspepsia, enteritis, diarrhea and constipation should consume more yogurt.
8. Early detection and early treatment
The skin of decubitus ulcers is red in the early stage and can improve after taking measures such as turning and decompression. When superficial skin ulcers, ulcers and exudate are present, you should go to the hospital for treatment.
Care for bedsores.
1. Avoid long-term local pressure: Bedridden patients should be encouraged and assisted to change positions frequently, generally turning every 2 to 3 hours, up to 4 hours, and every hour if necessary. In the easily pressurized parts, air ring, sponge cushion or soft pillow should be padded.
2. Regularly check and massage the pressurized parts. Daily morning and evening with warm water bath or massage once. If you find that the skin of the pressure site is red, after turning over with saffron alcohol (saffron 15 grams plus 75% alcohol 500 ml soaked for a week) pour a little in the palm of your hand, with the palm of the large fissure area centripetal massage local skin 10 to 15 minutes. You can also use only 70% alcohol or white wine, prickly heat powder massage. For those who are allergic to alcohol, use hot towels to massage with lubricant after applying.
3, keep the patient’s clothes, bed linen and bedding clean, soft, flat and dry. After urination and defecation should be promptly rinsed and dried, can be coated with oil or prickly heat powder and other moisture absorption and reduce friction, summer need to be used with caution.
4, increase the patient’s nutrition, give high protein, high vitamin, easy to digest food.
5.When there is a blister, under aseptic operation, puncture the blister or aspirate the liquid in the blister, apply purple potion and put on sterile gauze.
6, the broken surface is larger, use 0.2% potassium permanganate solution to rinse, cut off the necrotic tissue. Keep the traumatic surface dry, promote local blood circulation, generally with 50-100 watt light bulb baking, distance of about a foot, each baking about 20 minutes, 1 to 2 times a day. You can also apply a layer of edible white sugar to the broken area and wrap it with sterile gauze, which can increase local nutrition and promote wound healing.