Skin Breakdown Or Decubitus Ulcers

Bed sores or decubitus ulcers are seen in many health care arenas and have become a major concern with clients that are unable to ambulate without assistance, have difficulty moving or they are bedfast for a length of time. The development of an ulcer is dependent upon many factors and it is important that these factors be reduced as much as possible to limit the causes for tissue degradation. Skin breakdown and ulcers has become a reason that healthcare reimbursement may be held and the facility treating the patient will not be compensated for treatment especially if there is clear evidence that the ulcer developed either during the clients stay and no evidence of current skin breakdown prior to being admitted.

The management of decubitus

Changing body positions not only helps decrease the risk for developing an ulcer but it helps clients with existing wounds from progressing into the next stage. Decubitus ulcers are categorized by stages, stage one through four, a fifth stage of unstageable and a sixth stage of suspected deep tissue injury. Each stage uses parameters to stage the wound correctly. Stage one ulcers are ones that have the skin intact but may be red and painful. Stage two is where the skin has a break or a tear, may be painful and red and have a blister or scrape like wound that penetrates below the surface of the skin. Stage three ulcers are ulcers that have progressed, a crater or opening deep into the tissue is usually noted fat maybe seen in this stage. Stage four ulcers are deep wounds that extend into the muscles, bones, and tendons, these are deep wounds and are painful and presents severe tissue damage. During stages three and four the risks for developing sepsis and osteomyelitis is increased due to the open wound leading to deep tissues. Unstageable wounds are just that, they cannot be staged usually due to the layers of dead/dying skin, pus, or infection skin covering the wound. Wounds that are unstageable are unclear ulcers and cannot be staged because the base of the sore is hidden. Debridement is typically needed to stage these type of wounds. Suspected deep tissue injury is a large area that the skin is intact

This scale was developed in the late 1980’s using six criteria, sensory perception, moisture, activity, mobility, nutrition, and friction and sheer. All together these six categories assist nurses in understanding each client’s risk factors and in turn helps alert the healthcare providers of the potential risk for skin breakdown. Each category is rated from 1 to 4 except for the friction and sheer category it is rated from 1 to 3. The higher the score the less at risk the client is to develop an ulcer, the lower the level of the score indicates a low level of functioning and an increased risk for wound development. Scores are no higher than twenty-three no risk to a low score of nine highest