If the damage and deformation of the skin tissues under the action of direct pressure or biasing force is used, the term “bed sores”. The degree of such tissue damage can range from persistent erythema to necrosis covering the skin, muscles, tendons and even bone. Place bedsores depends on the position in which the patient (Fig. 37). If he lelies on the back – is the sacrum, heels, shoulder blades, zatyLock and elbows. If sitting – ischial tuberosity, a hundrednN leg, shoulder blade. When lying on his stomach, suffering from bedsores ribs, knees, toes with tylNoah side, the iliac crest.
Three main factors are set, leading to the formation of bedsores: pressure, biasing force, friction.
Pressure – under the action of its own weight of body tissue compression occurs relatively poverhnosty, which supports the people. When compression of the TCAIt vascular diameter is reduced as a result of ischaemia occurs starvation tissues. At full compression of over two hours is formed necrosis. Compression of the vulnerable tissue is enhanced under the influence of heavy linen, the bandages tight clothing.
The biasing force – and the mechanical destruction of tissue damage under indirect givingLenia. It is caused by the displacement of tissues to the supporting surface. Microcirculation in the underlying tissues is broken, and the fabric camberIt is from oxygen deficiency. Offset TKAIt can occur when the patient is “moving out” of the bed down or pulled up to her bedside.
Friction is a component of the biasing force. It causes detachment of stratum corneum leading to ulceration its surface. age frictionIt is in skin moisture. It is the most susceptiblewho exposed patients with urinary incontinence, sweating, dressed in a wet and non-absorbent underwear and RaspaudLaga on non-absorbent surfaces (podkladnye oil cloth, plastic surface).
Signs of incipient bedsores is flushing. It warns of the need forratit attention to the damaged skin. which has already begun poor circulation.
Prevention of bedsores:
- change the position of the patient every two hours.
To control the regularity of the procedure of remended on a sheet of paper to draw qi hourferblat where allocate every second hour. cover upPete the picture on the wall in front of the patient, andat each turning mark in Figure another hour shift position of the patient;
- Find the most convenient position for patsienthat – is that body weight is evenly distributedflax (using conventional pillows) on each through each body portion has a minimal pressure;
- do not expose vulnerable areas of the patient’s body abrasion;
- wash the vulnerable areas of the body, observing personal hygiene;
- use liquid soap for washing;
- thoroughly dry the areas of the body after washing, lubricate them with cream (if the skin is dry);
- Encourage the patient to get out of bed or Cresla and a little walk (if he can walk);
- shorten the period of sitting in the chair, if the proLedge develop in the pelvis;
- Encourage seriously ill possibly take accumbency;
- change the position of the patient every 2 hours using extra pillows for support (on the left side, on the back, on the right side, on the belly permitting the patient);
- if the patient’s disease confined to a chair or wheelchair, advise him to weaken givingLenie buttocks every 15 minutes: lean forward, lifted, leaning on the handle Cresla, slightly tilted to the side, raising aboutoppositely half of the buttocks;
- every time you move, any deterioration or change in the patient’s condition regularly inspect the skin in the area of the sacrum, heels, ankles,
blades, neck, trochanter major braidti, in the axillae, perineum breast;
- Check the condition of the bed to shake crumbs, smooth wrinkles on the bed;
- eliminate the patient’s skin contact with a rigid part of the bed;
- Do not use rubber circles and pads – they lead to more squeezing wokpyr-pressure area and contribute to the spread of bedsores;
- Check each time you change the position ofstanding skin pressure areas;
- Be sure to follow the patient’s personal hygiene. Morning and evening wash with warm water and wipe dry with a dry cotton swab, SMOchennym 10% solution of camphor spirit or 40-degree solution of ethyl alcohol, or onepercent solution of salicylic alcohol places where often formed sores;
- bedding should be clean and suchemical;
- watch out for the regular emptying kishechNika;
– to prevent and treat incontinence;
– Avoid unbalanced diet patient;
– vitamins and vitamin C are necessary for tissue nutrition and protein deficiency, imbalance nitrogen, sulfur, phosphorus and calcium affect blood circulation and increase the predispositionNost patient to bedsores;
– low hemoglobin contributes Ishemission tissues, hence the patient requires regular prevention and treatment of anemia;
Treat pressure ulcers must be in withotvetstvii with the degree of lesion:
degree I limited to epidermal and dermalE layers. The skin is not broken. the Supervisoryetsya stable hyperemia, impassable after the pressure ceases. When bedsores 1 – 2 times a day to lubricate the skin is 5 – 10 percent solution of potassium permanganate.
degree II characterized by shallow topnostnymi impaired skin integrityIslands, extending to the subcutaneous fat layer. Persistent redness persists. Detachment of the epidermis occurs. Recommended remating with a 3 percent solution of hydrogen peroxide and the ointments “rescuer” lenkomitsino-wai ointment sintomitsinovaja ointment.
degree III reveals a complete breakdown of skinth sheet during its whole thickness down to the muscularth layer with the penetration into the very muscle.
degree IV – loss of soft tissue. Abouttransform of the cavity with the appearance of her nizhelezhaboiling tissues (tendons up to the bone).
First degree treated conservatively. re-epithelization process occurs if otmirayaIt is only epidermis. When the second power remove dead tissue layer. The third and fourth degree of pressure ulcers are treated by means of surgical dissection and removal of necrotic tissue.
Ligation education bedsores:
- cook: a bottle of 3 percent solrum hydrogen peroxide, sterile wipes (nakw), tweezers, a tube of ointment or vial odnopropercentage iodonata solution or 0.5 percent chlorhexidine bigluconate, scissors, a rubber sheet;
- put the patient;
- free space formation of bedsores;
- enclose oilcloth;
- wear gloves;
- sterile scissors to open a package;
- take tweezers sterile towel;
- drench 3-percent solution of reKazISS hydrogen;
- treat the wound blotting movements;
- throw the tissue in the garbage bag;
- take a second tissue forceps;
- wound dry blotting movements;
- throw the tissue in the trash bag
- take tweezers sterile towel;
- drench one percent solution iodonata or 0.5 percent solution hlorgek sidina bigluconate;
- treat the skin around the wound;
- take tweezers sterile towel;
- shift in the brush, holding a Pal CEM;
- Ointment applied to it from a tube or vial;
- intercept of the tips of the napkin;
- impose on the wound surface lubricated;
- take tweezers dry sterile towel;
- impose top gauze;
- fix on all four sides sticky plas tyrem;
- clean oilcloth;
- put the patient in a comfortable position for him;
- clear solutions, a garbage bag;
- off the gloves;
- Wash the hands.
Note: bandaging done regularly once a day. If the wound is in the area of the heel or elbowVågå joint – apply bandage.