Prevention & Care of Decubitus Ulcer (Bedsores)
Decubitus ulcers, or bed and pressure sores. occur where the skin has broken because of pressure. Both external and internal factors affect the skin's breakdown. External factors may be abrasions, scratches, burns, or chemicals. Internal factors may be swelling, abscesses, or allergic reactions. Disease may also cause skin breakdown. An elderly or ill client may have poor circulation as part of his disease process, which leads easily to decubitus formation. The pressure can also come from the weight of the body lying in one position too long or from splints, casts or bandages. Even wrinkles in the bed linen can cause a decubitus ulcer. Heat, moisture, continued pressure and lack of cleanliness often makes Decubiti worse. Substances on the skin, such as urine, perspiration, feces, wound drainage, or even soap, tend to make decubiti worse. If a decubitus ulcer is not treated, it will quickly become larger, very painful, and even infected.
A decubitus ulcer is the responsibility of the entire health team. Therefore, as the homemaker/home health aide, you have to know how to recognize decubiti when they occur. Report the first sign of decubiti to your supervisor so that steps can be taken to prevent further damage.
SIGNS OF DECUBITI
The signs of a decubitus are a warm area of the skin, redness, tenderness, discomfort, and a feeling of burning. After this, the skin often becomes gray in color. This means that the blood supply to the area is greatly decreased. If the condition is allowed to continue, a blister will form, and finally the skin will actually break and a wound will appear. If you notice any one of these signs, alert your supervisor and remove the pressure to the area. By doing this, you may well prevent further skin breakdown. When the skin is broken, a decubitus ulcer has formed.
CARE OF A DECUBITUS ULCER
Specific treatment for a decubitus is prescribed by a doctor. The wound, however, must be kept clean and the rules of asepsis followed. The client must be positioned so that pressure is removed from the decubitus. If care is a simple, nonsterile dressing, you may be assigned to clean the area and cover it. Be sure you understand the procedure. Ask your supervisor to advise you of the way to fasten the dressing. If tape is used, alternate the site so the tape doesn't cause irritation. Be gentle when removing the tape.
If the client is incontent, so that the urine and feces continue to drain into the wound, discuss alternatives with your supervisor. The client's care plan may have to be changed so that the decubitus remains dry and can heal.
Encourage all the practices of good basic skin care to prevent further skin deterioration and improve the healing climate. Often, even with good practices, clients suffer from skin breakdown. It is important for you to feel that you have done all you could to prevent this. But do not feel guilty if he client, despite your efforts, forms a bedsore. Sometimes, other contributing factors occur over which you have no control.
Once in a while, a decubitus ulcer does not heal with conservative care and the client must be placed on medication and even hospitalized. It is the goal of your good care to prevent this from happening.
CARE OF CLIENT BY THE FAMILY
A decubitus will have to be cared for 24 hours each day. Your supervisor will establish a plan of care. You, as the homemaker/home health aide, will perform the care while you are in the house. The client's family will assume the care the rest of the time. It is important to the healing of the decubitus that the care be done on regular basis. If the care is not carried out throughout the day, healing will either be delayed or not take place at all.
You may notice that no healing is occurring. If you believe the client's family is unable to care for the wound in your absence, or you find out the family is definitely not caring for the decubitus, report this. Skin care is a 24-hour concern and must be shared by all caregivers.