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What is a Decubitus Ulcer?
Decubitus ulcer, pressure ulcer, pressure sore and bedsore are terms that are often used interchangeably even though they are medically different conditions. Decubitus ulcers are simply damaged skin, usually over bony areas, that result from lack of blood flow to the area because of a person staying in one position for too long. These pressure ulcers are more common with older people and occur mainly to people who are bedridden or have to stay in a wheelchair for a long period of time.
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Decubitus Ulcers Can Be Deadly
Decubitus ulcers can be life threatening if left untreated, and are the primary cause of death in 7 to 8 percent of all patients that are paralyzed. Investigations have determined that one-third of the patients hospitalized that have pressure ulcers die while they are hospitalized. Of those patients that develop a decubitus ulcer in the hospital, more than one-half will die within the next 12 months. Usually patients die because of their primary illness, but the ulcer might be a factor in some cases.
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If medical management of the decubitus ulcer is complete and meticulous, most ulcers can be treated and healed without the intervention of a surgeon. However, treating decubitus ulcers is demanding, and it is much easier to prevent the ulcer rather than having to treat it. Since skin and other tissues have been harmed or broken down, the healing is not ideal.
The severity of decubitus ulcers is measured in four stages. Most stage I and stage II decubitus ulcers will heal on their own within a couple of weeks with conventional methods. However, stage III and stage IV ulcers will probably not heal without special treatment and possible surgery.
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The best treatment for decubitus ulcers is to change the position of the patient regularly and not let them stay in one position for too long. If the patient can move themselves, they need to change position every ten minutes. If they cannot do it themselves, a caregiver needs to reposition the patient every two hours even if they are utilizing a specialty bed or surface. If a patient receives an ulcer by sitting too long, the patient should be put on bed rest and repositioned frequently. There are many pressure reduction devices that can aid the patient in keeping pressure off of the decubitus ulcer.
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Hygiene and Wound Dressings
Practice good hygiene. For stage I ulcers, wash the area with water and mild soap, rinse well and pat the area dry gently and carefully. Do not rub forcefully on the area directly over the wound. Usually Stage I decubitus ulcers will not need to be covered.
For Stage II and III ulcers, use saline solution to clean the wound and dry it carefully. Apply either gauze dampened with saline, a hydrocolloid dressing (for example DuoDerm), or a thin foam dressing such as Allevyn. The latter two dressings can be left on until they loosen or wrinkle for up to five days. If gauze is being used, the dressing should be changed twice each day and should stay damp between the times the dressing is changed. Always check to see if the ulcer is healing every time you change the dressing.
The best treatment for decubitus ulcers that are stage IV is to consult a physician for instructions. Many times these types of wounds require surgery and dressings for this kind of ulcer should be applied by a professional. A surgery called debridement is utilized to remove all dead tissue so that the wound will not become infected. Some minor debridement can be done at the bedside but larger areas need to be done in the operating room. The physician will medicate the patient because this is usually a painful procedure.
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Collison, M. D. (2008, October). Pressure Sores. Retrieved December 8, 2010, from MerckManuals.com: http://www.merckmanuals.com/home/sec18/ch205/ch205a.html
Kirman MD, C. (2010, July 29). Pressure Ulcers, Nonsurgical Treatment and Principles. Retrieved December 8, 2010, from Emedicine.Medscape.com: http://emedicine.medscape.com/article/1293614-overview
Mayo Clinic Staff. (2009, March 31). Bedsores (Pressure Sores). Retrieved December 8, 2010, from MayoClinic.com: http://www.mayoclinic.com/health/bedsores/DS00570/DSECTION=treatments-and-drugs
Taking Care of Pressure Sores . (n.d.). Retrieved December 8, 2010, from Northwest Regional Spinal Cord Injury System: http://sci.washington.edu/info/pamphlets/pressure_sores.asp