Bedsore/Decubitus-What is a bedsore?
Bedsores (decubitus), also known as pressure ulcers (pressure sores).Bedsores due to the late results of nutritional blood supply to the body tissues and blood disorders. For the correct nomenclature of tissue necrosis remains controversial. The current nomenclature used interchangeably more, such as pressure ulcers, but more bedsores named. Because bedsores name comes from the Latin, meaning show a long period of inactivity caused by ulcers. In fact, many bedsores occurred in parts of the long-term transformation and oppressed. The correct use of the name should include the pathology is not only a special position. The bedsores naming reflects the understanding of the excessive pressure on pathology, and its pathological changes in long-term oppression caused tissue necrosis, and finally leading to tissue ulceration.
Bedsore/Decubitus - epidemiology
More common in a coma and paralyzed patients, bedridden patients with debilitating fractures of the long-term fixed or bedridden patients.
Bed sores - the cause of
Prolonged pressure on the the bedsores Department of body parts the blood circulation, blocked, and the skin and subcutaneous tissue ischemia caused by the occurrence of blisters, ulcers or gangrene in general, prolonged bed rest, physical weakness, emancipated inconvenience and limb dysesthesia were susceptible to bedsores, clinical more common in patients with the following three categories:
(1) coma and paralyzed patients
Bedridden patients with debilitating.
3 fractures after long-term fixed or bedridden patients.
Bedsore - pathogenesis
The bedsores long years of oppression and concentrated in certain parts of the body enough to make the local blood circulation obstruction leading to tissue hypoxia, causing tissue damage and necrosis. If you continue to pressure the defect will lead to full-thickness skin necrosis. Ulcers produced easily lead to bacterial infection of ulcers at the base and the edge of the capillary and venous congestion, coupled with the gradual formation of a large number of granulation tissue, ulcers or gangrene area allows it to expand within a few days up to 3 ~ 6cm in diameter in the subcutaneous rapid Farfetched, Chuanzao range can be away from the edge of the 8 ~ 10cm, can affect the development of the deep to the periosteum and even bone caused by focal periostitis or osteomyelitis.
Bedsore/ Decubitus- pathophysiology
The results of the local tissue pressure, capillary blood flow oppressed tissue ischemia and hypoxia (oxygen deficiency). Lift the oppression of blood flow into the tissue compression region becomes congestion, a phenomenon called reactive hyperemia. The reason is that prominent, local redness and body to the ischemic tissue oxygen. Protection of local vasodilator mechanism is short-term ischemia of natural compensatory response. Reached a critical limit if the lifting of repression and after reactive hyperemia, can resume the cycle of damage was suffered. Tissue pressure is greater than 4.25kpa pressure in the capillaries in a long time, and blood vessels happened to collapse and the formation of blood clots. Continued oppression of blocking blood flow, interfere with lymph circulation, tissue loss of oxygen (o2), nutrients and metabolic disruption. Cells to produce toxic metabolites leading to tissue acidosis, increase in capillary permeability, resulting in edema, while the last cell death, and then repair has become impossible. Normal body, through the sensory system in the detection of persistent local pressure to produce ischemia. A person has the integrity of the nervous system play a compensatory role in the partial pressure, and sit, stand, or even sleep often change the gravity. Motor nerve activity through feedback mechanisms to change the body position and lift the pressure on top of the promontory. The sleeping of the movement of studies have shown that healthy people every 15 minutes often a change of position. exton-smith and sherwin investigated the relationship between the independent movement of the body and the incidence of bedsores, concluded that very little nightly movement of more than 20 times less than the number of activities the possibility of pressure sores. barbenel et al. also reduced motility is an important factor in the bedsore development, measured count on the night movement of patients over the age of 40 that generated the risk of pressure sores, the results showed that patients admitted to hospital three days after the night, the body's movement The number gradually reduced. The logic is inactive or not the movement of the patient, not to lift the oppression will cause tissue ulceration.
The bedsores pathogenic Another factor is the pressure tolerance of the tissues. Different organizations have different sensitivity to oppression, muscle tissue is the most sensitive skin compression is more durable. Reported in the literature that the external pressure is applied to the skin 2 hours after the muscle below will produce ischemic changes. The same pressure acting on the skin six hours the muscle completely denatured. Bedridden patients a lot of skin damage is caused due to compression of muscle ischemia, tissue necrosis results. The the husain determination by the degree of tolerance of oppression. Decline in severe ischemic vascular damage. Remain under pressure, although the occurrence of bedsores, but most of the patients the possibility of secondary recurrent ischemic damage.
Bed sores - classificationBedsores 1 bedsores according to the pathological process is divided into four, one - skin is not white red or acupressure; 2 - epidermal or dermal damage, but not yet penetrate the dermal layer;; 3 - epidermal all damaged or dermal penetration of subcutaneous tissue, but not yet penetrate the fascia and muscle layer;; 4 - cortex damage; involving muscles, bones.2, according to the color of the wound bed sores healing process of development is divided into cells :: ① red wound: the wound base for healthy red granulation tissue, cleaning or healing wound fall into this category; ② The Yellow wound: the bottom of the wound base off and death of bacteria, generally yellow wound refers to infection of the wound;; ③ black wound: wound black necrotic tissue and black scab, such as diabetic foot dry gangrene, necrosis of the deep bedsores surface crusts; ④ pink wound: the newborn epithelial tissue coverage.
3, clinical grading
Ⅰ degree: the skin without injury, only reddening of the skin, but to lift oppression redness no improvements by more than 30 minutes, the reaction of acute inflammation.Ⅱ: skin redness, erosions, blisters, tissue defects no time to dermal wound moist was pink, accompanied by pain, no necrotic tissue.Ⅲ degree: the true Pi Dapi for the organization of the crater-shaped defect with exudate and infection, but almost no pain, and necrotic tissue.Ⅳ degree: deep tendon and bone, exudate and infection, necrotic tissue, if nerve damage is accompanied by severe pain.
Bedsore/Decubitus - CheckLaboratory tests:
There are currently no related content description.
Other laboratory examinations:
There are currently no related content description.
Relevant inspection: Zinc
Bedsore - clinical performanceThe performance of more than 95% of pressure ulcers in the bone protuberance on the lower body. 67% of ulcers occur around the hip and buttocks, 29% occurred in the lower limbs. Typical of bedsores location of the sacrum, greater trochanter, ischial tuberosity, heel and lateral malleolus. These anatomical parts is that patients often do not change position when the most dangerous parts of the bedsore.
The clinical manifestations of pressure sores can be regarded as the skin, a series of activities. The range of color depth changes from red to white, tissue loss, the depth of destruction extending into the muscle, joint capsule and bone. The early changes of the skin, White erythema is characterized by strong erythema changes from pink to bright red. White with digital compression, release your finger quickly after reproduction erythema. Red region of the temperature increase is often accompanied by a slight edema of the skin, if the perception is normal, you can have pain. Relieve the pressure within 24 hours after the skin returned to normal without sequelae. Stain reflect the severity of the vascular status change color the heavier, more dramatic changes in the skin may be black and red changes in the black and blue. Which is characterized by finger pressure, no color changes, skin temperature decreased performance, lesions of the stove may feel soft or hardened. Some stains can be reversed, early prevention and be dealt with in a timely manner, and 1 to 3 weeks to completely disappear. Stain parts of the organization of the further deterioration of the response is compressed dermatitis. Epidermal rupture, and a blister under the skin. Large blisters, crusting, scaling can occur. After proper treatment. 2 to 4 weeks may be healing, persistent pathological changes. Such as a lack of understanding and dealing with the oppression dermatitis is not timely, which led to the real formation of bedsores. Early pressure sores, dermatitis, erosion of the stain or oppression, and epidermal tissue damage, blisters rupture, or of being erased, so that dermal exposure. Early ulcers are unclear, the bottom of the reflective surface boundary, often surrounded by erythema area of the non-white. Without surgical treatment, and further develop into chronic bedsores is inevitable. White change of chronic pressure sores were erythema around with digital compression, the adjacent skin tissue to harden and was warm or become spent porphyritic. Average ulcer base measuring less than 5 ~ 12cm diameter, dark red or dark red, touch of easy bleeding. Ulcers can be seen part of it is easy to confuse, small beneath the surface of the skin can have a large necrotic cavity. According to the degree of tissue destruction, ulcers classified as stage and grade. Bedsores reported in the literature reveals the ulcer classification system has three to six bedsores. Some Category 0, while others are classified from 1. Some classification performance of the graphic or at different stages of visibility description. A classification method is the use of letters instead of numerals.
Bedsore - diagnosis is based on1, more common in paraplegia, chronic wasting disease, a large area burns and deep coma bedridden patients.2, multiple Di bone, ischial tuberosity bone protuberance.3, erythema, blisters, ulcers trilogy pathological changes in the site of sustained pressure.
Bedsore - disease identificationAn early ulcer or erosion of the buccal mucosa cancer;
2, erosive lichen planus;
3, chronic mucosal ulcers.
Bedsore - TreatmentTreatment of treatment of pressure sores should start early principle of the oppressed to lift the affected area to promote blood circulation, strengthen the wound treatment. Bedsores once should regularly massage, changing position, local alcohol rubbed or infrared radiation, if the inflammation is significantly available 0.5% neomycin solution wet dressing. The second bed sores can be treated with antibiotic ointment and covered with sterile gauze. Three bedsores should be debrided, and small ulcers may be topical 0.5% silver nitrate wet compress to remove the infection. Drugs for external use to promote the formation of granulation tissue. Ulcers, large and clean can be layered skin grafts or covered to full-thickness flap. Gangrenous ulcers, removal of necrotic tissue, adequate drainage and then do the above treatment. For wound pus should be frequently culture and susceptibility testing to guide the selection of sensitive antibiotics, topical absence of systemic signs of infection, general health search without the use of antibiotics. In addition, supportive therapy for critically ill patients should be strengthened.
Bedsore preventionCare measures, fully aware of bedsores predilection sites and external factors, internal factors bedsores pressure and lack of protection of adipose tissue, muscle wrapped or muscular layer thinner bone protuberance, occur in the scapular ribs, vertebral body, carina at the elbow, iliac crest, greater trochanter, sacrococcygeal, knee, inside and outside the ankle, heel and other parts of the prone position can also occur in the anterior superior iliac spine, knee, rib along protrusions. Skin moisture, friction, burns, frostbite, and scratches easily lead to bedsores external factors; paraplegia, loss of consciousness, frail body weight loss, anemia, malnutrition, lack of protein, incontinence, fever, diabetes, infections easily lead to internal factors of pressure sores.2, grasp the skin color, texture (soft and hard), the observed temperature, redness: the redness of parts of the pressure of fading; skin cyanosis: the site of the skin cyanosis (purple), the pressure does not fade; skin blisters: The skin was the site of the blisters, and under the superficial layer of tissue necrosis. Gently touching the skin can feel the temperature and texture of the skin. When the temperature increased by 1 ° C per 13% increase in oxygen requirements of tissue metabolism, sustained stress-induced ischemia, the temperature will increase bedsores prone.
Ground stand up: stand up to the intermittent discharge of local compression in place effective prevention of bedsores are most effective, key measures. Bedridden patients turn over every 1-2 hours is generally found that the skin turns red, you should turn over once per hour, the left and right lateral decubitus, supine, prone position alternately, and with a soft pillow, air pillow, water pillows, donut cushions, sponge rings and other mat in the bone protruding parts, can play a local vacant, reducing pressure. Wheelchair-bound patients can put a sponge in the foot pad, hip soft pillow (cushion) or sponge pad, every 15-20 minutes to transform the center of gravity should prevent patients from a wheelchair for a long time (more than 2 hours), where possible, case, the patient standing, walking for 10 minutes.
4, the correct implementation of massage: supine, the hand placed under the buttocks, palms facing down up can be. Fully experience the skin temperature and under pressure situation, and massage the skin for 5 minutes, repeat every 20 minutes. Left, right side, sideways To the side in place, semi-flat hemi (Xiece,) with soft pillow supporting the lower back, skin color, temperature, texture, normal pressure areas can be used 50% safflower alcohol poured into the palm on both sides heavy → light → light massage for 5-10 minutes; found the skin to become red, and is not suitable for skin massage can be left vacant pressure red parts of the general lifting of the pressure return to normal skin color after 30-40 minutes. Sustained skin redness, cyanosis, but not massage, so as not to aggravate the injury.
5, mattresses, bed sheets Requirements: ambulatory patients mattress breathable, moderate hardness, water absorption, air bed available (egg nest shape is better), high density foam mattresses, bed sheets should be cotton, another in The sheets may be paved with a cotton bath towels, easy to replace. Sheets remain flat, dry, clean, no wrinkles, no residue, debris, no debris; air bed inflatable soft and hard to be modest, but hyperinflation will enable an increase in skin pressure. Change of bed linen should be for the patient to prevent the drag, pull, pull, to prevent damage to the skin.
6, keeping the skin clean and dry completely: variety of methods to prevent bedsores, we usually use warm sponge bath 1-2 times a day, scrub is not a strong irritant detergent, can not be forced to wipe, to prevent injury skin. Easy to sweating armpit, abdominal groove parts, used a small towel ready to wipe. To prevent skin damage local bashing "Johnson Baby Nappy powder or baby powder. Fecal incontinence in a timely manner to wash the perianal skin, coated with Johnson & Johnson baby the Nappy powder or Nappy cream can be effective prevention and treatment of perianal and perineal Jimi rotten, eczema; urinary incontinence can use bt high neck breathable of urine; application of hot-water bottle hot, the water temperature at 50 ° C, and with a towel wrapped hot compress 30 minutes, hot compress parts of the skin should always be observed, not hot compress at a site for a long time, to prevent burns. Cooling using the ice pack, ice packs should be placed on both sides of the neck, armpits, groin. Ice time to 10-30 minutes is appropriate to place a time not too long, to prevent frostbite.
7, better nutrition: (1) given high-protein, beans. (2) eat more vegetable oil such as peanut oil, sesame oil, soybean oil, rapeseed oil and other Runchang effect, which will help to alleviate constipation. ③ selection of plant fiber-rich foods such as whole grains, vegetables, fruits, beans and so on. (4) consumption of foods rich in vitamin b1, such as whole grains, beans, lean meat, animal offal, fresh vegetables. ⑤ more fresh juices, fresh fruit, jam, honey, and so stimulate peristalsis. ⑥ drink plenty of water, beverages, so as not to dry stool. ⑦ When necessary, small meals to facilitate digestion and absorption. ⑧ where accompanied by indigestion, enteritis, diarrhea, constipation, patients should eat more yogurt.
8, early detection and early treatment: bedsore early skin redness, stand up, decompression, and other measures can be improved. When the skin of superficial ulcers, ulcers, exudate for a long time you should go to hospital for treatment.
9, in the treatment proposed to build can be used by the Shaanxi Johnson & Johnson Pharmaceutical production of "ice stone callus ointment has a unique sterilization, remove rotten tissue regeneration, detoxification convergence, anti-inflammatory analgesic and other effects. Short course of treatment of bedsores, effective, and pain immediately after the smear, anti-inflammatory cured rot myogenic function, the drug of choice for the treatment of trauma and burns and other illnesses infection.
Bed sores - nursing points1, the initial local skin irritation, with 45% alcohol down in the palm of the hand to a local massage of 10 minutes, then rub talcum powder several times a day; skin discoloration purple, the formation of blisters or skin damaged, with 1% gentian Purple rubbed surface, partial drying, to avoid re-compression of the affected area.
60-watt lamp at 30 cm from the wound, broken blisters, local infection shallow necrosis available concentration of 1:5000 potassium permanganate solution, rinse, dry the wound and surrounding skin, baking, drying and healing available vaseline gauze treated wound coverage.
Patients mattress should be soft, flat sheets, clean and replace the ground; to patients every two hours turn around time, and avoid procrastination; massage parts of the ground often under pressure in the compression the Ministry pad sponge pad, balloon or a soft pillow to alleviate the pressure.
4, keeping the skin clean and dry to prevent the urine, feces contaminated skin or wound.
5, the room should be fresh air, plenty of sunshine, to keep warm, to prevent upper respiratory tract infection Erzhi fever rapidly expanding due to high fever can make bedsores or the prognosis of recurrence.
Bed sores - preventionBeds to be soft and smooth, as often as possible to change the position of the bedridden patients, help patients turn over, the general turn over every 2 to 3 hours, if necessary, once every one hour stand up, the longest not more than four hours. Stand up action should be gentle, to avoid pushing, dragging, pulling, etc., to prevent skin abrasions.
Second, regular checks of patients with prominent bone at the pressure areas, regularly massage the whole back pressure at the top-down massage, pressure from light to heavy, from heavy to light, do not scratch the skin. The pressure on local pad balloon cotton ring, sponge pad.
Incontinent patients should be promptly replaced its changing mat, to keep the skin and bedding dry and clean.
The use of splints or other orthopedic devices in patients with soft liner, the observation of the patient's reaction, at any time to adjust the splint or device elastic.
Five ambulatory patients can not be used out of porcelain bedpan. To use the potty should be to help patients raise the buttocks, to prevent local skin abrasions, hips and toilet pad of soft paper, sponge or sponge pad.
To encourage patients to eat, to ensure adequate nutrition. The diet should have enough protein, vitamins and calories, and easily digestible food. Note that the daily intake of adequate amounts of fruits and vegetables.
Seven, usually pay attention to physical activity. Activities for the elderly, do not sleep on too much; can not separate actors, activities should be moderate in the help of others; sick bed who, once the disease should be out of bed as soon as possible.
Eight, often with warm water bath, Cabei keep the skin of patients with clean, promote blood circulation.
Decubitus - a healthy diet① given high protein foods(2) eat more vegetable oil such as peanut oil, sesame oil, soybean oil, rapeseed oil and other Runchang effect, which will help to alleviate constipation.③ selection of plant fiber-rich foods such as whole grains, vegetables, fruits, beans and so on.(4) consumption of foods rich in vitamin b1, such as whole grains, beans, lean meat, animal offal, fresh vegetables.⑤ more fresh juices, fresh fruit, jam, honey, and so stimulate peristalsis.⑥ drink plenty of water, beverages, so as not to dry stool.⑦ When necessary, small meals to facilitate digestion and absorption.⑧ where accompanied by indigestion, enteritis, diarrhea, constipation, patients should eat more yogurt.
