Bedsores
DEFINITION
ნაწოლები ხანგრძლივი წნევითი ზეწოლის შედეგად კანისა და მის შიგნით მდებარე სტრუქტურების დაზიანების გამო ვითარდება. ყველაზე ხშირად, ნაწოლები კანის იმ ნაწილებში ვითარდება, რომლებიც ძვალს ფარავს: ქუსლები, კოჭი, თეძო, კუდუსუნის ძვალი.
ნაწოლების პათოლოგია აღენიშნებათ მძიმე ავადმყოფებს, რომელთაც რაიმე დაავადების გამო ხანგრძლივი დროის განმავლობაში უხდებათ წოლითი რეჟიმის დაცვა, ვერ იცვლიან პოზიციებს, ან მიჯაჭვულნი არიან სავარძელს.
ნაწოლი საკმაოდ სწრაფად ვითარდება და მისი მკურნალობა რთულია, თუმცა არსებობს რამდენიმე მეთოდი, რომელიც დაგეხმარებათ თავიდან აიცილოთ ნაწოლის გაჩენა ან დააჩქაროთ მისი მორჩენა.
CAUSES
Bedsores are caused by pressure against the skin that limits blood flow to the skin and nearby tissues. Other factors related to limited mobility can make the skin vulnerable to damage and contribute to the development of pressure sores. Three primary contributing factors are:
- Sustained pressure. When your skin and the underlying tissues are trapped between bone and a surface such as a wheelchair or a bed, the pressure may be greater than the pressure of the blood flowing in the tiny vessels (capillaries) that deliver oxygen and other nutrients to tissues. Without these essential nutrients, skin cells and tissues are damaged and may eventually die.
- This kind of pressure tends to happen in areas that aren’t well-padded with muscle or fat and that lie over a bone, such as your spine, tailbone, shoulder blades, hips, heels and elbows.
- Friction. Friction is the resistance to motion. It may occur when the skin is dragged across a surface, such as when you change position or a care provider moves you. The friction may be even greater if the skin is moist. Friction may make fragile skin more vulnerable to injury.
- Shear. Shear occurs when two surfaces move in the opposite direction. For example, when a hospital bed is elevated at the head, you can slide down in bed. As the tailbone moves down, the skin over the bone may stay in place — essentially pulling in the opposite direction. This motion may injure tissue and blood vessels, making the site more vulnerable to damage from sustained pressure.
SYMPTOMS
Bedsores fall into one of four stages based on their severity. The National Pressure Ulcer Advisory Panel, a professional organization that promotes the prevention and treatment of pressure ulcers, defines each stage as follows:
Stage I
The beginning stage of a pressure sore has the following characteristics:
- The skin is not broken.
- The skin appears red on people with lighter skin color, and the skin doesn’t briefly lighten (blanch) when touched.
- On people with darker skin, the skin may show discoloration, and it doesn’t blanch when touched.
- The site may be tender, painful, firm, soft, warm or cool compared with the surrounding skin.
Stage II
At stage II:
- The outer layer of skin (epidermis) and part of the underlying layer of skin (dermis) is damaged or lost.
- The wound may be shallow and pinkish or red.
- The wound may look like a fluid-filled blister or a ruptured blister.
Stage III
At stage III, the ulcer is a deep wound:
- The loss of skin usually exposes some fat.
- The ulcer looks crater-like.
- The bottom of the wound may have some yellowish dead tissue.
- The damage may extend beyond the primary wound below layers of healthy skin.
Stage IV
A stage IV ulcer shows large-scale loss of tissue:
- The wound may expose muscle, bone or tendons.
- The bottom of the wound likely contains dead tissue that’s yellowish or dark and crusty.
- The damage often extends beyond the primary wound below layers of healthy skin.
- Unstageable
- A pressure ulcer is considered unstageable if its surface is covered with yellow, brown, black or dead tissue. It’s not possible to see how deep the wound is.
Deep tissue injury
A deep tissue injury may have the following characteristics:
- The skin is purple or maroon but the skin is not broken.
- A blood-filled blister is present.
- The area is painful, firm or mushy.
- The area is warm or cool compared with the surrounding skin.
- In people with darker skin, a shiny patch or a change in skin tone may develop.
Common sites of pressure sores
For people who use a wheelchair, pressure sores often occur on skin over the following sites:
- Tailbone or buttocks
- Shoulder blades and spine
- Backs of arms and legs where they rest against the chair
For people who are confined to a bed, common sites include the following:
- Back or sides of the head
- Rim of the ears
- Shoulders or shoulder blades
- Hip, lower back or tailbone
- Heels, ankles and skin behind the knees
When to see a doctor
If you notice early signs or symptoms of a pressure ulcer, change your position to relieve the pressure on the area. If you don’t see improvement in 24 to 48 hours, contact your doctor. Seek immediate medical care if you show signs of infection, such as fever, drainage or a foul odor from a sore, or increased heat and redness in the surrounding skin.
