Bedsores or Decubitus Ulcers Are Always Preventable If Proper Care is Given
As a former Registerd Nurse (RN), attorney Robert J. Reeves used to treat patients in the Intensive Care Unit who were clinging to life from a Stage IV decubitus ulcer, or bedsore. This is a critical care situation where there is massive tissue, muscle,and even bone loss. After a bedsore begins, immediate and aggressive treatment must be undertaken to prevent more damage from blocked circulation and resulting infection. If the infection gets into the person’s bloodstream, they become “septic” and will die if the infection cannot be controlled and then reversed. The body suffers extremely high fevers, and the immune system is overwhelmed by infection. Blood cultures are drawn repeatedly, and massive doses of antibiotics are given to try and save the patient’s life. So how does such a life threatening condition begin? It starts when an immobile or bedridden person is not given proper hydration and nutrition and is not turned properly to prevent bedsores from forming.
In most situations, we see nursing home residents and patients with head injury or paraplegia cases. In elderly patients, inattentive care by staff can allow residents to become malnourished and dehydrated which sets up a perfect scenario for bedsores to start. They tend to become less mobile and even bedridden. If not encouraged to ambulate or left in bed or a wheelchair for several hours, skin breakdown can occur. If not detected promptly or skin care measures not employed, decubitus ulcers can quickly deteriorate, often within days. At that point, aggressive inpatient medical treatment will be required in an already immunosuppressed patient. If sepsis develops, many elderly patients simply cannot overcome the infection and will pass.
With head injury cases, these patients are being care for in hospitals and by specially trained professional staffs. They have specifically designed beds that constantly “move” in an attempt to prevent decubitus formation. The staff monitor fluid intake, usually by IV, and nutrition is supplied through a tube directly into the stomach. Many of these patients are on ventilators to breathe and are fighting to recover from a traumatic brain injury. If properly monitored and turned regularly, bedsores never get a chance to start. On reddened areas, skin integrity must be maintained by applying lotions and regular massaging to maintain proper circulation to the area.
Paraplegia and quadraplegia patients are, of course, the most vulnerable to bedsore formation and must be protected by hypervigilant care. Special care must be given at all times but especially during transport by ambulance for procedures and followup care. I have a recent case where a paraplegic patient was left on a hard stretcher for several hours waiting for an MRI scan. During that relatively brief period, the patient was not turned or repositioned. Several “reddened areas” in the usual “pressure points” were not detected, and skin breakdown started in just a few hours. People who are paralyzed already suffer from decreased circulation and are chronically under nourished and borderline dehydrated. As a result, bedsores quickly deteriorate without immediate and aggressive medical intervention. In this case, the patient died in her thirties after just a few days. How can this happen so fast? It is the deadly combination of inadequate hydration, nutrition, systemic circulation issues, and lowered immune response. No matter what the excuse given, bedsores are completely preventable in all cases. The more frail and vulnerable the patient; the more care is required. When proper care is not given, deadly results can occur quickly.