Bed sores develop on areas of the body that experience constant pressure from the bed against the patient’s skin. Bony areas of the body are usually where bed sores develop first: back of ears, elbows, spine, shoulder blades, tail bone, hips, heels. It is not uncommon for bed sores to also appear on backs of thighs and buttocks in patients who spend long hours in a wheelchair.
Bed sores are classified by stages of severity:
Stage 1 — skin intact with noticeable reddening or color change
Stage 2 — partial loss of skin with shallow, open ulcer
Stage 3 — total loss of skin and layer of fat exposed
Stage 4 — exposed muscle, tendon or bone
In addition to constant pressure from bed, pillows, or wheelchair, several other factors are prevalent.
Here are the most common
Many bedridden patients are older individuals. As we age, circulation slows due to thickening of the blood. Our blood supply is crucial to vibrant health. Our blood carries nutrients and oxygen to tissue and both are essential for healthy skin. When poor nutrition and reduced oxygen levels are present, the patient is at high risk of developing bed sores along with a variety of other health problems.
Acidification from Lack of Movement
Acid waste is a by-product of most bodily functions. These waste products are removed from the cells and organs by the blood as it circulates through the body. A healthy body moves all the time. Even when we sleep, we twist and turn. Movement increases blood flow. A sick or bedridden individual is often unaware or unable to move which severely limits blood flow. Acid build-up throughout the body is the result.
Decreased Body Awareness or Lack of Sensation
Patients who are unaware or only semi-aware of their surroundings are unable to feel uncomfortable pressure on their body. These individuals often cannot move themselves and are unable to ask for help from their caregiver.
When skin is constantly moist with perspiration, urine, or feces, the chances of developing bedsores greatly increases. With moisture, bacteria play a role in degrading the health of the patient’s skin.
Friction and Shearing
Rubbing the patient’s skin against bedding, clothing, patient sling, or towels can all cause the delicate skin of an at-risk patient to tear. Shearing occurs when the patient slides down the bed when the head of the bed is raised too high. Shearing can also happen when bedding is pulled from under the patient.
Inadequate Nutrition and Hydration
Insufficient vitamins and minerals in the patient’s diet are another major contributing factor. Sufficient hydration is important to keep skin healthy.
Patients taking prescription drugs are at risk due to the many side effects that come with taking drugs. Patients taking multiple prescription drugs are at high risk due to the overlapping and magnification of the side effects of their medications.
Bed Sore Risk Assessment Scale 1 to 5 (1 is most at risk, 5 lower risk)
1 Complete unawareness
1 Very limited cognition
2 Mild cognition impairment
5 No impairment
Moisture on Skin
1 Always wet from perspiration, urine or feces
2 Often wet
4 Occasionally wet
5 Never wet
Activity / Mobility
2 Walks, turns in bed, or gets out of bed with assistance
4 Walks, turns in bed, or gets out of bed w/o assistance
5 Not restricted in movements or mobility
Immune System Health
1 Long term illness, taking 1 or more medications, chemical-based nutrition taken through a feeding tube
1 Poor diet lacking nutrition; primarily eats fast or highly processed food, taking 1 or more medications
1 Has recurring infections, colds and general poor health and taking 1 or more medications
5 Eats organic with variety of lean protein, heart-healthy fats, no processed food, sugar and few simple carbohydrates with smart supplementation