Medical or Surgical Ways of Caring and Treating Decubitus - Essay Example

Medical/ Surgical Ways of Caring and Treating Decubitus Abstract As a healing strategy, lying down is used to rest different body parts in a patient. When the patient rests in such a position for a long time they run the risk of developing bedsores called ulcer decubitus. This is caused by three types of forces on a tissue. These are pressure, shear force and friction. It develops through four stages. The first stage damages the most superficial skin layer. The second stage causes damage between the epidermis and dermis, the third stage affects the subcutaneous layer and the fourth stage damages the skeletal muscles and bones. Treatment involves debridement and control of infections. Prevention, on the other hand, involves patient repositioning, eating a balanced diet and exercising. Medical/ Surgical Ways of Caring and Treating Decubitus As a healing strategy, lying down is used to rest different body parts in a patient. When the patient rests in such a position for a long time they run the risk of developing bedsores. This is as a result of the effects of unrelieved pressure on that part of the body. These bedsores are also referred to as ulcer decubitus and can be found on any body part especially on areas with bone and cartilage (Neizgoda et al., 2006). This condition, though life threatening, is treatable if found early. Sores caused by pressure result from inadequate supply of blood to tissues or an injury that leads to blood accumulating in the tissues. When one stays in the same position for a long time, blood supply in the areas under pressure is reduced. This causes a mild ache which is indicative of obstructed flow of blood. This implies that the tissues will not get nourishment from the blood resulting in their death. If pressure is not alleviated from this area, the skin breaks and opens up creating a sore and if untreated, it can become infected (Brem et al., 2004). This paper discusses decubitus, its cause, its stages of development, how to prevent its development and how to care and treat patients with this condition. Discussion Ulcer decubitus is caused by three types of forces on a tissue. These are pressure, shear force and friction. Pressure results from a bones force on a tissue which causes the tissue to compress. Over time, supply of blood to such tissues is inadequate leading to ischemia and cell death if left untreated in people with low immunity. When the skin stays in one place for a long time, gravity pulls down the skeletal muscles and the deep fascia resulting in shear force. This force can cut blood vessels thus depriving the tissues of nutrients which can lead to their death. Friction, on the other hand, is the force that prevents sloughing of the skin which may cause excess shedding of the epidermal layers. The situation can be even worse in conditions of excess skin moisture, which causes the epithelial cell bonds to weaken resulting in epidermal sloughing. Some medical conditions e. g. diabetes, age and nutrition among other factors contribute to sores development (Neizgoda et al., 2006). There are two theories that explain how sores develop. The first one, which is most accepted, claims that they begin around the skeleton and move outwards towards the skin. The second theory claims that deterioration begins with the skin and proceeds into the muscles (Wilkinson and Stone, 2008). Either way, there are four stages of sores development. First is the superficial stage where the topmost layer of the skin becomes hyperemic even when the pressure is relieved. The area may be painful with an unusual texture and higher or lower temperatures than normal. It is easy to identify in light skinned people where the skin is reddened, than in dark skinned people where the skin shows purple or blue shades (Brem et al., 2004). The second stage involves damages to the epidermis and the dermis creating a blister. In the third stage, damages extend to the subcutaneous layer which is hard to heal because it has poor blood supply. In stage four, the damage is done on the muscles and may extend to the bone. Deeper than this, and the sore contains dead cells and wound excretions like pus. For a patient with bedsores, the first step to care for them is pressure relief from the damaged tissues. This can be done by turning the patient every two hours and using a frame to stand. Catheters can be used to ensure there is no excess moisture which can lead to the development of the sores. Nutrition also plays a crucial part in the healing process. The patient should be placed on a diet that ensures enough protein synthesis to support tissue repair (Neizgoda et al., 2006). Pressure sores are treated through debridement and control of infections. Debridement is a must and involves removal of the dead tissues in the wound. This is because the dead cells harbor bacteria which prevent healing of the wound. Debridement can be done using the body enzymes, maggots, chemicals, force or surgery. Among this, use of force is most painful while surgery is the least painful. Infection of the wound inhibits wound healing that is why control of infection is a crucial step in the treatment process. Infections can arise from bacteria’s that breed in the wound. Infection of the wound is indicated by discharge from the wound, pain, high temperatures and swelling (Brem et al., 2004). Thus antibacterial drugs and antiseptics are used to kill the source of infection i.e. bacteria. Hydrogen peroxide is the most recommended antiseptic, while systemic antibacterials are being discouraged because they can lead to drug resistance. In bed ridden patients, development of the sores can be prevented by repositioning of the patient. This can be done by changing the patients’ position every two hours and using a frame to stand. Secondly the skin should be cared for by bathing, ensuring the skin is dry and inspecting the skin routinely to identify vulnerable areas early enough. Nutrition also plays a vital role in prevention of sore development. One should ensure a diet with enough proteins and fluids for rehydration. Lastly, one should quit activities that aid in the development of the sores, for example, smoking while staying active to reduce chances of their development (Wilkinson and Stone, 2008). Conclusion Sitting or lying down in the same position for a long time creates pressure on tissues leading to ischemia and overall necrosis. This results in formation of a sore whose treatment involves removal of the dead cells in the wound to facilitate healing and control infections. Debridement is done through the use of body enzymes, maggots, chemicals, force or surgically. Painful or not, it is the most critical step in the healing process. Infections caused by bacteria that flourish in the wound can be controlled by use of antiseptics and antibacterial drugs. To prevent sore development one needs to take proper care of the skin, eat well, exercise and avoid indulgencies like smoking that lead to their development. References Brem, H., Kirsner, R. S., & Falanga, V. (2004). Protocol for the successful treatment of venous ulcers. The American Journal of Surgery, 188(1), 1-8. Niezgoda, J. A., & Mendez-Eastman, S. (2006). Advances in skin & wound care: The effective management of pressure ulcers. The Journal for Prevention and Healing, 19(1), 3-15. Wilkinson, E. J., & Stone, K. (2008). Atlas of vulvar disease. 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