What are the dangers of bedsores in bedridden patients. How to treat bedsores in a lying elderly person with folk remedies. Stage III bedsores

The most important task in caring for the elderly and bedridden people is the prevention and treatment of pressure ulcers of the skin. This is the name of dystrophic changes in soft tissues in places of their prolonged compression. Competent full-fledged care is the key to the prevention and successful treatment of bedsores.

How does a pressure ulcer occur on the skin

In most cases, pressure ulcers are caused by prolonged pressure on the soft tissues between the bones and the surface of the bed. The resulting chronic disturbance of blood microcirculation leads to oxygen starvation of cells and increasing trophic disorders. Gradually, necrosis (necrosis) and rejection of tissues begins, at this stage a bacterial infection often joins.

Bedsores from pressure are formed in places of dense contact of the human body with the surface of the bed. The most vulnerable areas of bone protrusions, where there are few muscles and subcutaneous tissue. These are the heels, the sacrum, the angles of the shoulder blades, the back of the head, the spinous processes of the vertebrae. Bedsores can also form in the region of the ribs, wings of the pelvic bones. When positioned on the side, the area of \u200b\u200blarge trochanters at the hip joints is primarily affected.

In some cases, the appearance of bedsores in bedridden patients contributes to a significant displacement of superficially located tissues. This is possible when pulling a sheet from under a lying patient, dragging him along the bed, inaccurate delivery of the vessel.

Predisposing factors

Conditions associated with a high risk of developing pressure ulcers:

recumbent lifestyle;
paresis and paralysis after a stroke and spinal injuries;
overweight or underweight;
diabetes;
neurological diseases with impaired surface sensitivity;
pathology of the cardiovascular system.

The formation of a bedsore is facilitated by an uneven mattress, folds in linen, and the presence of crumbs. And the increased moisture of the skin and bed linen, pollution of the body with urine and feces accelerate the formation of ulcers.

Symptoms

There are 4 stages in the development of bedsores:

Stage of skin changes - the appearance of persistent congestive hyperemia, dense cold edema, cyanosis or blanching of the skin, which do not disappear after a change in body position;
The stage of detachment of the epidermis and the spread of changes to the subcutaneous tissue;
The appearance of skin defects with the formation of an ulcer, most often it is weeping, with purulent-necrotic discharge;
The spread of necrosis to the underlying tissues with the formation of cavities, the exposure of tendons and ligaments, the spread of the process to bone and cartilage structures.

The formation of bedsores significantly impairs the quality of life of patients. After all, in addition to local changes, they have severe pain, and their general well-being worsens. Even daily care and attempts to change the position of the body cause suffering.

The main danger of bedsores is the development of purulent-septic complications. These include erysipelas, cellulitis, gangrene, osteomyelitis, sepsis, and toxic shock. These conditions are potentially life-threatening and require the most intensive treatment possible. The patient usually needs hospitalization.

Principles of treatment and prevention

Systematic competent careful care is the basis for the prevention of bedsores and can prevent their further progression. The most important activities are the daily re-making of the bed, straightening the wrinkles in the linen, regular gentle washing and thorough drying of the skin. It is necessary to cleanse the body of urine and feces as soon as possible, arrange air baths.

Therapeutic treatment of the affected area begins already at stage 1 of the bedsore. By agreement with the doctor, rubbing, powders, ointments, sprays and other dosage forms are used. With the appearance of necrotic masses and signs of purulent inflammation, the help of a surgeon, careful regular cleaning of the wound and its drainage are required. Can also be prescribed drugs with proteolytic, antiseptic and antimicrobial action. In the absence of contraindications, various types of physiotherapy are used.

The appearance of granulations at the bottom of the wound is a favorable sign. To activate the healing processes, agents with anti-inflammatory, protective and regenerating effects are used, and physiotherapy is continued.

Bed patient care: at home or in a boarding house?

Prevention and treatment of bedsores requires an integrated approach and systematic procedures, which is not always possible to provide at home. A worthy solution to this problem is to place an elderly and / or bedridden person in a boarding house. Currently, there are private nursing homes, stay in which does not lead to psychological discomfort of the patient and his relatives. Even bedridden patients experience minimal physical and psychological discomfort during hygienic treatment. And the thoroughness and literacy of the complex care carried out helps prevent the appearance of bedsores and promotes the healing of existing trophic changes.

Elderly and especially bedridden people need special attention to their state of health. Be attentive, patient and correct when communicating and caring for them.

Prolonged forced stay in a supine position, weakening of body functions and insufficient skin care lead to the formation of bedsores in seriously ill people. Most often, the occurrence of such a problem is observed in people who have had strokes or bone fractures. Treatment of bedsores is not an easy task, therefore, like any other disease, it is better to prevent their formation. For this, relatives of the patient must have a clear idea of what pressure sores are, how long it takes for pressure sores to appear and what needs to be done to prevent their development.

Competent specialists of the rehabilitation clinic of the Yusupov hospital in Moscow provide advice on caring for bedridden patients, explaining how long it takes for bedsores to appear, which drugs are most effective for their treatment. In case of detection of bedsores in the late, advanced stages, hospitalization of the patient in the hospital of the rehabilitation clinic, where he will be provided with professional assistance, may be offered.

The main characteristics and localization of bedsores in bedridden patients

Bedsores are pathological changes in the skin, muscle and bone tissue. Their development is associated with impaired blood circulation, innervation and lymph circulation in certain parts of the body. Most often they are caused by prolonged contact with hard surfaces.

The main characteristics of bedsores include:

the appearance of injuries on the body at the points of contact with a hard surface;
a phased process of development of bedsores: first of all, in a separate area of \u200b\u200bthe body, there is a violation of blood circulation. In the absence of treatment, the subsequent occurrence of wet or dry neurotrophic necrosis, sepsis, or gas gangrene is noted;
the risk of developing bedsores increases in patients suffering from a disease of the cardiovascular system and metabolic disorders;
the formation of bedsores occurs on protruding areas of the patient's body.

Localization of bedsores directly depends on the position in which the patient is forced to be:

in patients who have been lying on their back for a long time, bedsores occur on the sacrum, coccyx, buttocks, spinous processes of the spine, shoulder blades, heels;
when the patient is in a supine position on the stomach, lesions develop on the knee joints, iliac crests, protruding surface of the chest;
when the patient lies on his side, bedsores affect the ischial tubercles;
sometimes bedsores can be found on the back of the head and in the folds of the mammary glands.

Stages of development of bedsores

Bedsores are characterized by gradual occurrence. There are four main stages of their development.

At the first stage, venous erythema occurs in the area that is in contact with a hard surface. Its appearance leads to a violation of the outflow of blood.

At the second stage, there is a thinning of the upper layer of the skin, peeling of the epidermis, the appearance of bubbles in the affected areas. Venous congestion causes malnutrition of tissues, the appearance of an excess amount of fluid, swelling and rupture of epidermal cells. The most important signs of bedsores of this stage include peeling and thinning of the skin, a violation of its integrity.

In the third stage, bedsores become wounds, in some cases with purulent discharge. It is possible to speak about bedsores of the third stage if the deep layers of the skin are affected in the patient, suppurations appear and necrosis begins.

The fourth stage is characterized by the appearance of local cavities, defects, the formation of which is associated with tissue necrosis, expansion of the necrosis zone, as well as the occurrence of purulent secretions and inflammatory processes.

Reasons for the development of bedsores

The formation of bedsores can be due to the following factors:

irregular bed making;
irregular change of underwear to dry and clean, as bedsores quickly appear on wet skin;
irregular hygiene procedures or their complete disregard;
prolonged stay of the patient on a hard, uneven surface.

In addition, the appearance of bedsores can be triggered by factors that are associated with the individual characteristics of the patient:

advanced age of the patient;
obesity, or, conversely, exhaustion;
the presence of cardiovascular diseases;
violation of innervation;
violation of metabolic processes;
unhealthy diet, protein dystrophy;
uncontrolled defecation, urination.

Pressure ulcers in bedridden patients can be caused by smoking, diabetes, lack of water, overweight or underweight, urinary and fecal incontinence, crumbs and small objects in bed, buttons on underwear, injuries, and increased sweating.

Prevention of bedsores in bedridden patients

The formation of bedsores in bedridden patients occurs in a very short time, since cell death can begin in a few days, and sometimes even several hours after exposure to negative factors. Treatment is associated with many difficulties and does not always end with a positive result. Therefore, special attention should be paid to the relatives of the patient to prevent the development of decubitus wounds.

The following rules for caring for a seriously ill person must be observed:

change the position of the patient's body several times a day;
monitor the absence of folds and foreign objects (crumbs, buttons, etc.) on bedding and underwear;
regularly change the bed linen of the patient;
to prevent the development of bedsores, use a rubber circle;
wipe the skin areas that are constantly in contact with the surface of the bed with a disinfectant solution;
wash areas of the body most prone to the development of pressure sores several times a day with water, clean with alcohol and powder.

Professional care for bedridden patients is offered by the Yusupov Hospital Rehabilitation Clinic. Clinic specialists have extensive experience in dealing with seriously ill patients. The clinic strictly observes all the necessary rules of care, absolute sterility. For the convenience of patients, comfortable rooms are equipped with special beds with anti-decubitus mattresses.

Competent doctors select an individual treatment regimen for bedsores using the most modern and effective medicines. The choice of drug depends on the general condition of the patient, the stage of bedsores and the presence of concomitant diseases.

You can ask questions about the conditions of hospitalization in the rehabilitation clinic, find out the cost of the services provided and make an appointment with a specialist by calling the Yusupov hospital or on the clinic's website by contacting our coordinating doctors.

Bibliography

ICD-10 (International Classification of Diseases)
Yusupov hospital
Badalyan L. O. Neuropathology. - M.: Enlightenment, 1982. - S.307-308.
Bogolyubov, Medical rehabilitation (manual, in 3 volumes). // Moscow - Perm. - 1998.
Popov S. N. Physical rehabilitation. 2005. - P.608.

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*The information on the site is for informational purposes only. All materials and prices posted on the site are not a public offer, determined by the provisions of Art. 437 of the Civil Code of the Russian Federation. For exact information, please contact the clinic staff or visit our clinic. The list of paid services provided is indicated in the price list of the Yusupov hospital.

A person's life path ends with his death. You need to be prepared for this, especially if there is a bed patient in the family. Signs before death will be different for each person. However, the practice of observations shows that it is still possible to identify a number of common symptoms that portend the imminence of death. What are these signs and what should be prepared for?

How does a dying person feel?

A bedridden patient before death, as a rule, experiences mental anguish. In sound consciousness there is an understanding of what is to be experienced. The body undergoes certain physical changes, this cannot be overlooked. On the other hand, the emotional background also changes: mood, mental and psychological balance.

Some lose interest in life, others completely close in on themselves, others may fall into a state of psychosis. Sooner or later, the condition worsens, the person feels that he is losing his own dignity, more often he thinks about a quick and easy death, asks for euthanasia. These changes are hard to observe, remaining indifferent. But you will have to come to terms with this or try to alleviate the situation with drugs.

With the approach of death, the patient sleeps more and more, showing apathy towards the outside world. In the last moments, a sharp improvement in the condition may occur, reaching the point that the patient who has been lying for a long time is eager to get out of bed. This phase is replaced by the subsequent relaxation of the body with an irreversible decrease in the activity of all body systems and the attenuation of its vital functions.

Bedridden patient: ten signs that death is near

At the end of the life cycle, an elderly person or a bedridden patient feels more and more weak and tired due to a lack of energy. As a result, he is increasingly in a state of sleep. It can be deep or drowsy, through which voices are heard and the surrounding reality is perceived.

A dying person can see, hear, feel and perceive things that do not actually exist, sounds. In order not to upset the patient, this should not be denied. It is also possible to lose orientation and the Patient is more and more immersed in himself and loses interest in the reality around him.

Urine due to kidney failure darkens to almost brown with a reddish tint. As a result, edema appears. The patient's breathing quickens, it becomes intermittent and unstable.

Under pale skin, as a result of a violation of blood circulation, dark “walking” venous spots appear, which change their location. They usually first appear on the feet. In the last moments, the limbs of a dying person become cold due to the fact that the blood, draining from them, is redirected to more important parts of the body.

Failure of life support systems

There are primary signs that appear at the initial stage in the body of a dying person, and secondary ones, indicating the development of irreversible processes. Symptoms may be external or hidden.

Disorders of the gastrointestinal tract

How does the bedridden patient react to this? Signs before death, associated with loss of appetite and a change in the nature and volume of food consumed, are manifested by problems with the stool. Most often, constipation develops against this background. A patient without a laxative or an enema finds it increasingly difficult to empty the bowels.

Patients spend the last days of their lives refusing food and water altogether. You shouldn't worry too much about this. It is believed that dehydration in the body increases the synthesis of endorphins and anesthetics, which to some extent improve overall well-being.

Functional disorders

How does the condition of patients change and how does the bed patient react to this? Signs before death, associated with the weakening of the sphincters, in the last few hours of a person's life are manifested by fecal and urinary incontinence. In such cases, you must be prepared to provide him with hygienic conditions, using absorbent underwear, diapers or diapers.

Even in the presence of appetite, there are situations when the patient loses the ability to swallow food, and soon water and saliva. This may lead to aspiration.

With severe exhaustion, when the eyeballs are very sunken, the patient is not able to completely close the eyelids. This has a depressing effect on those around you. If the eyes are constantly open, the conjunctiva must be moistened with special ointments or saline.

and thermoregulation

What are the symptoms of these changes if the patient is bedridden? Signs before death in a weakened person in an unconscious state are manifested by terminal tachypnea - against the background of frequent respiratory movements, death rattles are heard. This is due to the movement of the mucous secretion in the large bronchi, trachea and pharynx. This condition is quite normal for a dying person and does not cause him suffering. If it is possible to lay the patient on his side, wheezing will be less pronounced.

The beginning of the death of the part of the brain responsible for thermoregulation is manifested by jumps in the patient's body temperature in a critical range. He can feel hot flashes and sudden cold. The extremities are cold, the perspiring skin changes color.

Road to death

Most patients die quietly: gradually losing consciousness, in a dream, falling into a coma. Sometimes it is said about such situations that the patient died on the “usual road”. It is generally accepted that in this case, irreversible neurological processes occur without significant deviations.

Another picture is observed in agonal delirium. The movement of the patient to death in this case will take place along the “difficult road”. Signs before death in a bedridden patient who embarked on this path: psychosis with excessive excitement, anxiety, disorientation in space and time against the background of confusion. If at the same time there is a clear inversion of the wakefulness and sleep cycles, then for the patient's family and relatives such a condition can be extremely difficult.

Delirium with agitation is complicated by a feeling of anxiety, fear, often turning into a need to go somewhere, to run. Sometimes this is speech anxiety, manifested by an unconscious flow of words. The patient in this state can perform only simple actions, not fully understanding what he is doing, how and why. The ability to reason logically is impossible for him. These phenomena are reversible if the cause of such changes is identified in time and stopped by medical intervention.

Pain

Before death, what symptoms and signs in a bedridden patient indicate physical suffering?

As a rule, uncontrolled pain in the last hours of a dying person's life rarely increases. However, it is still possible. An unconscious patient will not be able to let you know about this. Nevertheless, it is believed that pain in such cases also causes excruciating suffering. A sign of this is usually a tense forehead and deep wrinkles appearing on it.

If, during examination of an unconscious patient, there are assumptions about the presence of a developing pain syndrome, the doctor usually prescribes opiates. You should be careful, as they can accumulate and, over time, aggravate an already serious condition due to the development of excessive overexcitation and convulsions.

Giving help

A bedridden patient before death may experience significant suffering. Relief of symptoms of physiological pain can be achieved with drug therapy. Mental suffering and psychological discomfort of the patient, as a rule, become a problem for relatives and close family members of the dying.

An experienced doctor at the stage of assessing the general condition of the patient can recognize the initial symptoms of irreversible pathological changes in cognitive processes. First of all, this is: absent-mindedness, perception and understanding of reality, the adequacy of thinking when making decisions. You can also notice violations of the affective function of consciousness: emotional and sensory perception, attitude to life, the relationship of the individual with society.

The choice of methods of alleviating suffering, the process of assessing the chances and possible outcomes in the presence of the patient, in individual cases, can itself serve as a therapeutic tool. This approach gives the patient a chance to really realize that they sympathize with him, but they are perceived as a capable person with the right to vote and choose possible ways to solve the situation.

In some cases, a day or two before the expected death, it makes sense to stop taking certain medications: diuretics, antibiotics, vitamins, laxatives, hormonal and hypertensive drugs. They will only exacerbate suffering, cause inconvenience to the patient. Painkillers, anticonvulsants and antiemetics, tranquilizers should be left.

Communication with a dying person

How to behave relatives, in whose family there is a bed patient?

Signs of approaching death can be obvious or conditional. If there are the slightest prerequisites for a negative forecast, it is worth preparing in advance for the worst. Listening, asking, trying to understand the non-verbal language of the patient, you can determine the moment when changes in his emotional and physiological state indicate the imminent approach of death.

Whether the dying person will know about it is not so important. If he realizes and perceives, it alleviates the situation. False promises and vain hopes for his recovery should not be made. It must be made clear that his last will will be fulfilled.

The patient should not remain isolated from active affairs. It is bad if there is a feeling that something is being hidden from him. If a person wants to talk about the last moments of his life, then it is better to do it calmly than to hush up the topic or blame stupid thoughts. A dying person wants to understand that he will not be alone, that he will be taken care of, that suffering will not touch him.

At the same time, relatives and friends need to be ready to show patience and provide all possible assistance. It is also important to listen, let them talk and say words of comfort.

Medical assessment

Is it necessary to tell the whole truth to relatives in whose family there is a bed patient before death? What are the signs of this condition?

There are situations when the family of a terminally ill patient, being in the dark about his condition, literally spends his last savings in the hope of changing the situation. But even the best and most optimistic treatment plan can fail. It will happen that the patient will never get back on his feet, will not return to active life. All efforts will be in vain, spending will be useless.

Relatives and friends of the patient, in order to provide care in the hope of a speedy recovery, quit their jobs and lose their source of income. In an attempt to alleviate suffering, they put the family in a difficult financial situation. Relationship problems arise, unresolved conflicts due to lack of funds, legal issues - all this only aggravates the situation.

Knowing the symptoms of imminent death, seeing irreversible signs of physiological changes, an experienced doctor is obliged to inform the patient's family about this. Informed, understanding the inevitability of the outcome, they will be able to focus on providing him with psychological and spiritual support.

Palliative care

Do relatives who have a bed patient need help before death? What symptoms and signs of the patient suggest that she should be treated?

Palliative care for the patient is not aimed at prolonging or shortening his life. Its principles affirm the concept of death as a natural and regular process of the life cycle of any person. However, for patients with an incurable disease, especially in its progressive stage, when all treatment options have been exhausted, the question of medical and social assistance is raised.

First of all, you need to apply for it when the patient no longer has the opportunity to lead an active lifestyle or the family does not have the conditions to ensure this. In this case, attention is paid to alleviating the suffering of the patient. At this stage, not only the medical component is important, but also social adaptation, psychological balance, peace of mind of the patient and his family.

A dying patient needs not only attention, care and normal living conditions. Psychological relief is also important for him, easing the experiences associated, on the one hand, with the inability to self-service, and on the other hand, with the realization of the fact of an imminent imminent death. Trained nurses also know the subtleties of the art of alleviating such suffering and can provide significant assistance to terminally ill people.

Predictors of death according to scientists

What to expect for relatives who have a bed patient in the family?

Symptoms of the approaching death of a person "eaten" by a cancerous tumor were documented by the staff of palliative care clinics. According to observations, not all patients showed obvious changes in the physiological state. A third of them did not show symptoms or their recognition was conditional.

But in the majority of terminally ill patients, three days before death, a marked decrease in the response to verbal stimulation could be noted. They did not respond to simple gestures and did not recognize the facial expressions of the personnel communicating with them. The “smile line” in such patients was omitted, an unusual sounding of the voice (grunting of the ligaments) was observed.

In some patients, in addition, there was hyperextension of the cervical muscles (increased relaxation and mobility of the vertebrae), non-reactive pupils were observed, patients could not close their eyelids tightly. Of the obvious functional disorders, bleeding in the gastrointestinal tract (in the upper sections) was diagnosed.

According to scientists, the presence of half or more of these signs may most likely indicate an unfavorable prognosis for the patient and his sudden death.

Signs and folk beliefs

In the old days, our ancestors paid attention to the behavior of a dying person before death. Symptoms (signs) in a bedridden patient could predict not only death, but also the future prosperity of his family. So, if the dying person asked for food (milk, honey, butter) in the last moments and relatives gave it, then this could affect the future of the family. There was a belief that the deceased could take wealth and good luck with him.

It was necessary to prepare for imminent death if the patient shuddered violently for no apparent reason. It was like looking into his eyes. Also a sign of close death was a cold and pointed nose. There was a belief that it was for him that death was holding the candidate in the last days before his death.

The ancestors were convinced that if a person turns away from the light and most of the time lies facing the wall, he is on the threshold of another world. If he suddenly felt relieved and asked to be transferred to his left side, then this is a sure sign of an imminent death. Such a person will die without pain if the windows and the door are opened in the room.

Bedridden patient: how to recognize the signs of impending death?

Relatives of a dying patient at home should be aware of what they may encounter in the last days, hours, moments of his life. It is impossible to accurately predict the moment of death and how everything will happen. Not all of the symptoms and symptoms described above may be present before the death of a bedridden patient.

The stages of dying, like the processes of the origin of life, are individual. No matter how hard it is for relatives, you need to remember that it is even more difficult for a dying person. Close people need to be patient and provide the dying person with the maximum possible conditions, moral support and attention and care. Death is an inevitable outcome of the life cycle and it cannot be changed.

Natalia

Hello! What are the chances of curing a very deep bedsore with tissue necrosis on one half of the priests of my father, 86 years old (almost 87 years old, his father is a disabled veteran of the Second World War). At first, I lubricated this pressure sore for my father with potassium permanganate, as advised in the hospital in which he lay for 1.5 months (first in traumatology - he got there with a shoulder dislocation, they were reduced under general anesthesia, then in neurology, then in therapy, the pressure sore formed already in therapy - 3 weeks before discharge), in the hospital there was a crust over the bedsore, at home from Friday 03/01/13, I continued to lubricate with potassium permanganate solution, but the edges around the crust began to recede and there, in the depths, it was clear that pus was coming through, every day deeper and more necrosis and pus, and the smell of putrefaction intensified. Today I called a surgeon from the clinic, he cut off the crust with scissors - a deep hole with tissue necrosis and pus gaped under it, the surgeon brought Dioxidin ampoules with him, one ampoule was poured onto a napkin and placed in this recess, glued with a plaster, after the surgeon had left after some time this bandage got wet and the patch came off (adhesive patch “Bintley-M”), I put the same napkin in the wound again, because. the surgeon said that it was necessary to change it once a day, and re-glued it with a new patch, then re-glued it again, because. This patch bandage gets wet all the time and peels off after a while. Am I doing it right, is such a treatment sufficient - 1 rub per day to apply a napkin moistened with 1 Dioxidin ampoule? What are the chances of this pressure sore healing? The surgeon hinted that there was little chance, they say, he might live until May 9, no longer. Could he be wrong in his prediction? Before the hospital (before the dislocation of the shoulder), our father himself moved around the house and went to the toilet himself, and in the hospital he fell ill (after congestive pneumonia at a rate of 39, which lasted a long time and changed one antibiotic to another, and deep vein thrombosis of the lower extremities, which happened to my father after droppers with prednisolone (appointed by the head of the department, without looking at previous extracts that my father already has a tendency to increased thrombosis, and contraindications to prednisolone indicate that it is impossible with a tendency to thrombophlebitis, thrombosis, etc. ., causes increased blood clotting, in general, the doctor did not take into account that the father had repeated thrombosis, pulmonary embolism, after which in 2008 a cava filter was installed in 2008 in the City Clinical Hospital my legs were swollen (after the 1st, they were also swollen in the evening, but it was still not so noticeable), and the doctor (after I told him about prednisolone) blamed the fact that my father had such edema due to heart failure, but at my father never had such edema due to heart failure, but there were multiple thromboses, after these droppers my father could no longer stand on his feet, he also stopped turning in bed, and my touching his legs to move or turn him in bed, cause pain to his father (both in the hospital and still), he himself lies motionless in bed, does not turn around (as you lay him down, he will lie in this position). This evening, I decided to change the bandage with Dioxidin (although the surgeon said that only tomorrow it would be necessary to change the bandage), because. everything was wet and the plaster peeled off again. Wetted a new napkin with Dioxidin and put the bed sore in the hole. There is a dark spot at the bottom - almost black, is this a bad sign? What to do? Help advice. Maybe other medicines should be used? Can such a bedsore heal? How much time will it take? In the instructions for Dioxidin, I read that it is used only in a hospital and after that, when other antibiotics do not help. And we immediately started with this medicine (on the advice of a half-ki surgeon). Is it right? What results do others have with Dioxidine in the treatment of these pressure sores?

Hello. 1. Diseases, indeed, have accumulated a lot. This is bad. 2. It is necessary to activate the father as actively as possible. For thrombosis, you need to wrap elastic bandages all over the leg. And you also needed (it was) to inject injections "" - I don’t know, you probably got it in the hospital, but after discharge you had to transfer your father to oral anticoagulants - for example, which you need to take for many months so that thrombosis passes faster. I don’t know if you were given such recommendations when you were discharged, and in general, on the basis of what methods it was confirmed. 3. Need breathing exercises. The simplest thing is to make him inflate a balloon several times a day or more often. Cough up mucus. 4. Buy an anti-decubitus mattress. If not possible, turn it over. Ideally - every 2 hours, from the back to the side and then to the other. But this is almost impossible, so just turn over more often. And even lying on a mattress. 5. "Ventilate" and "dry" bedsores. You can peel off the bandage and let it air dry. You can also process its edges or potassium permanganate. 20-30 minutes "dries" - then a bandage with ointment "levomekol". 6. Necrosis, which is in the depth of the bedsore, must be removed by the surgeon. If there is no surgeon, you can try it yourself. Obvious black or dead tissue - cut off with scissors, they do not bleed. Then put a bandage with ointment " " and change it once a day, or more often if it comes off. Do not spare the ointment, the bandage will get wet profusely - this is good. Put more napkins each time, so that "longer" is enough. After a few days (1-2 weeks), the bedsore will completely or almost clear, and this ointment will no longer be necessary. 7. Eat more, drink fluids, etc. and the recommendations that were given to you at discharge. 8. Read my previous posts about the treatment of bedsores. 9. Now the most important thing for you is care.

From this article you will learn:

Why do older people get pressure sores?

What are the stages and degrees of bedsores

Who is at risk for the disease

What are the first signs of bedsores

How to treat bedsores in the elderly

Will surgical treatment of pressure ulcers in the elderly work?

What anti-decubitus mattresses and pillows to buy for the elderly

Due to a long forced stay in a supine position, weakening of body functions and insufficient skin care, bedsores appear in the elderly. As a rule, the problem occurs in those who are bedridden due to a stroke or bone fractures. Treating pressure ulcers in the elderly is no easy task. In this article, we will look at how this is done, and what methods are used for this.

Why do pressure ulcers occur in the elderly?

Bedsores are pathological changes in the skin, muscle and bone tissues. Bedsores of an elderly person are caused by a violation of innervation, blood circulation, lymph circulation in a separate part of the body. As a rule, they appear due to prolonged contact with a hard surface.

We list the main characteristics of bedsores:

appear on areas of the body that have been in contact with a hard surface;

bedsores in the elderly have a gradual development. First, blood circulation is disturbed in a separate part of the body. If pressure ulcers are left untreated in an elderly person, then wet or dry neurotrophic necrosis, sepsis, or gas gangrene will occur;

if a pensioner suffers from diseases of the cardiovascular system, then the bedsores of an elderly person develop very quickly;

pressure sores in the elderly affect bulging areas of the body.

Consider the areas where wounds most often appear:

if we are talking about patients who are constantly lying on their backs, then bedsores in the elderly affect the sacrum, coccyx, buttocks, spinous processes of the spine, shoulder blades, heels;

if the patient lies on his stomach, then bedsores affect the knee joints, the iliac crests, the protruding surface of the chest;

if the patient lies on his side, then bedsores appear on the ischial tubercles;

in rare cases, bedsores in the elderly occur in the back of the head and folds of the mammary glands.

Sometimes bedsores in the elderly appear under a plaster cast, in a place where a moisture-proof material fits snugly against the body, under a bandage, etc.

Sometimes pressure sores in the elderly affect the area under the denture. A wound may occur in the urethra due to prolonged drainage of the urethra. Bedsores in the elderly can also appear on the vascular mucosa. As a rule, the reason is their long-term catheterization.

What are the stages and degrees of bedsores

Bedsores in the elderly develop in stages. Consider 4 stages of the development of the disease:

I stage bedsores

Venous erythema occurs in the area adjacent to the solid material. Its appearance is caused by obstructed outflow of blood. How venous erythema differs from bruising and arterial hyperemia, we will consider below.

Difference from arterial hyperemia:

Venous erythema is characterized by a red-cyanotic color, and arterial erythema is bright red;

With venous erythema, the temperature in the affected area of the body does not rise, and arterial hyperemia suggests that the area becomes warm.

Difference from a bruise:

If you press your finger on the bruise, then its color will not change;

With venous congestion, the same action will cause blanching of the skin area.

Venous erythema of a protruding area of the human body adjacent to a foreign surface is the most important sign of pressure ulcers.

Stage II bedsores

Bedsores in the elderly are characterized by thinning of the top layer of the skin, which begins to peel off, and bubbles appear on the affected area. Tissue nutrition is disturbed due to venous stasis, an excess amount of fluid appears in the skin, epidermal cells swell and rupture.

Thinning and peeling of the skin, violation of its integrity are the most important signs of pressure ulcers of the second stage.

Stage III bedsores

Bedsores in the elderly are wounds that may be suppurated.

The defeat of the deep layers of the skin, muscles, the appearance of suppuration, the beginning of necrosis are important signs of the third stage.

Stage IV bedsores

Bedsores in the elderly are local cavities, defects that have formed as a result of tissue necrosis and at this stage are accompanied by the release of pus and inflammation.

Necrosis and expansion of its zone, the inflammatory process are signs of the fourth stage.

Who is at risk for the disease

Pressure ulcers in the elderly can develop in different ways. In medical institutions, the Norton, Braden or Waterlow scales are used to systematize the assessment of risk factors for the development of wounds on the body. Consider the factors that contribute to the appearance of bedsores, below.

1. Factors associated with errors in the organization of patient care:

irregular bed making;

underwear is irregularly changed to clean and dry;

hygiene procedures are carried out irregularly or are completely ignored;

the bed has a hard, uneven surface.

2. Factors associated with the individual characteristics of the patient's condition:

old age;

obesity of the patient or his exhaustion;

problems with the cardiovascular system;

violation of the innervation of the body;

disturbed metabolic processes;

unhealthy diet, protein dystrophy;

uncontrolled defecation, urination.

Bedsores in the elderly may be provoked smoking, diabetes, lack of water, overweight or underweight, fecal/urinary incontinence, crumbs and small objects in bed, allergic reaction to one of the cosmetics, buttons on underwear, injuries, increased sweating.

The first signs of bedsores in an elderly person

As a rule, a patient who develops bedsores informs those who care for him about the following:

He is concerned about the "tingling" that occurs in some parts of the body;

He noticed that the skin lost sensation or became numb for 2-3 hours;

It is necessary to start treating bedsores in a bedridden elderly person in a timely manner. Therefore, it is important for caregivers to know what the signs of an incipient injury are.

Blood and lymph stagnate, venous erythema appears, which has a bluish-red color. Bedsores in the elderly tend to have blurred boundaries, appearing in areas where bone and muscle protrusions come into contact with the bed;

The skin becomes thinner, flaky, purulent vesicles form on it

If you notice something like this, then treatment should not be postponed. How to treat bedsores in the elderly? Consider what needs to be done to prevent further development of wounds.

It is necessary that the patient change position every 2 hours. It is recommended to use special pillows that change the position of the arms, legs and the whole body. Their use is possible if the patient has no contraindications.

Pay attention to the level of the head of the bed;

Use hygiene products to regulate the moisture content of the patient's skin. Carry out procedures aimed at cleansing and moisturizing the skin at least twice a day. If bedsores in the elderly are caused by uncontrolled defecation, then the skin should be cleaned of feces immediately after they appear;

If the patient has excessive moisture on the skin, then it must be regularly removed. For this, absorbent pads, diapers, napkins, towels, films are suitable;

Bed linen should be changed regularly;

Performing intensive massage is contraindicated. You can lightly stroke areas of the skin that show signs of stagnation. The procedure should be carried out with great care;

Pressure ulcers in the elderly can be prevented by using an anti-decubitus mattress. It is better to give preference to a model with a silent compressor that maintains and changes the hardness of the bed, with the ability to regulate and program the inflation of different areas of the mattress.

It is useful to use pillows filled with gel-foam. If we are talking about a patient in a wheelchair, then it is important to change the position of the patient's body every hour.

Why are bedsores dangerous for the elderly?

Bedsores in the elderly is a problem that is best avoided. If it was still not possible to prevent their appearance, then, alas, long-term treatment will be required. As a rule, the causes of the development of bedsores are:

extensive excision of soft tissues, impaired innervation and blood circulation;

limb amputation;

necrotic lesions of periosteal and bone tissues;

weakened immunity.

If bedsores in the elderly are accompanied by infection of the affected areas, then the situation is aggravated, because purulent processes are very dangerous.

With dry necrosis, bedsores in the elderly heal very slowly.

How to treat bedsores in an elderly person

Pressure sores in the elderly can be treated with various ointments. Consider the most effective:

1) Argosulfan- a cream based on the antibiotic sulfathiazole, which effectively fights the growth and reproduction of pathogenic microflora. The drug allows you to relieve pain, moisturize the wound, accelerate its healing. The cream is applied to the previously cleaned surface of the bedsores with a layer of 2-3 mm 2-3 times a day. The drug can be used in conjunction with an occlusive dressing. Treatment lasts no more than two months. Analogues of the drug are sulfargin (50 grams / 200 rubles) and dermazin (50 grams / 200 rubles, 250 grams / 530 rubles). Prices for argosulfan: 15 grams / 200 rubles, 40 grams / 350 rubles.

2) Ointment "Iruksol". With the help of this drug, you can clean pressure sores and eliminate dead tissue. The ointment has a bacteriostatic effect. How to treat bedsores in elderly bedridden people? Apply the drug to decubitus wounds, previously cleaned with saline, 2 times a day. The cost of the medicine is 1300 rubles. for 30 grams.

3) Ointment "Levosin". The drug contains sulfadimethoxine and levomycetin, which have an antimicrobial effect, methyluracil, which promotes healing, and trimecaine, which relieves pain. The ointment allows you to eliminate bedsores in the elderly in a short time. Decubitus wounds are cleared of purulent accumulations, dead tissues, gradually heal. The ointment should be applied every day to previously cleansed skin, and then cover the treated area with a dressing. The ointment can be injected into the purulent cavity with a syringe. The cost of the drug is 80 rubles / 40 grams.

4) Levomekol. The composition of the ointment includes methyluracil and chloramphenicol. Thanks to the use of the drug, tissue regeneration improves. The ointment also has an antibacterial effect. It is used if bedsores in the elderly are purulent-necrotic in nature. The cost of the drug is about 80-100 rubles.

5) Metronidazole gel 0.75%. The drug contains metronidazole, which has a powerful antimicrobial effect. The gel is used with dressings. It inhibits the growth of microbes, eliminates unpleasant odors from decubitus wounds. If bedsores in the elderly are accompanied by profuse discharge, then it is recommended to use a foam bandage with metronidazole. If we are talking about dry bedsores, then hydrogel dressings with metronidazole are better suited. The cost of the drug is 100-120 rubles.

6) Hydrogel "Intrasite" allows you to cleanse the skin of dead skin. The drug is used with an external bandage. Its choice and frequency of change depend on the condition of the bedsores in the elderly. The drug gently and quickly cleans the wound from necrotic tissue due to the adsorption of excess exudate. The gel costs 2100 rubles.

Treating bedsores in the elderly at home is not so easy. However, thanks to the achievements of modern medicine, this is possible. It is necessary to regularly cleanse festering wounds, provide conditions for the bedsores in the elderly to dry out and gradually heal.

It is recommended to use disposable bandages with an antiseptic effect, the choice of which is very wide. As a rule, such materials have a narrow focus and recommendations for their use at a certain stage in the development of pathology.

7) Proteox-TM. This remedy is used to treat infected bedsores in the elderly. The drug is suitable for influencing decubitus wounds at the last stage. It allows you to clean bedsores from pus, dead tissue, prevents the development of the inflammatory process, promotes healing. The cost of the drug is 180 rubles.

8) Multiferm- a drug for the treatment of bedsores of the first and second degree. The bandage is applied for a day or two. The cost of the medicine is 180 rubles.

9) Biaten AG. The drug allows you to treat weeping bedsores in the elderly, including those infected. Treatment requires the use of 1-10 dressings, each of which is applied for 1-7 days. Dressings are changed as they become soaked. The cost of the medicine is 950 rubles.

10) Komfil plus suitable for the treatment of uninfected decubitus wounds. The cost of the drug is 140 rubles.

Does surgical treatment of pressure ulcers in the elderly make sense?

Surgical treatment should only be used as a last resort. Incorrect and inappropriate intervention can only increase the area of the lesion and lead to aggravation of the skin condition.

Surgical treatment involves free skin grafting, excision of bedsores and subsequent matching of wound edges, plasty. Alas, treating bedsores in the elderly in this way is not always effective. The fact is that transplanted tissues do not take root well in the area where blood circulation is disturbed. In addition, the reason is the non-sterility of the pressure ulcer.

Surgical intervention can result in unpleasant consequences. There is a high probability of marginal necrosis, wound necrosis, development of bleeding, divergence of the seam, etc. In addition, fistula formation is possible in the future, leading to the fact that pressure sores in the elderly will appear again.

How to treat bedsores in a lying elderly person with folk remedies

When it comes to such a problem as bedsores in the elderly, folk remedies can act as an auxiliary measure. However, their use allows wounds to be cleaned and new tissues to form. It is important to remember that any folk method involves the use of a medicinal plant, which is fraught with the appearance of allergic reactions. If you plan to treat pressure sores in the elderly with these remedies, we recommend that you first consult with your doctor.

Consider recipes that allow you to treat bedsores in the elderly:

Lubricate bedsores in the elderly several times a day with juice prepared from lungwort leaves;

Apply dressings with Kalanchoe leaves cut in half to bedsores;

Apply black elderberry leaves to bedsores twice a day. They must first be scalded with boiling milk;

Prepare an ointment from calendula flowers and petroleum jelly. Apply it to bedsores in the elderly twice a day;

Mix fresh crushed potatoes in half with honey and apply to bedsores in the elderly;

Mix sea buckthorn oil and tea tree oil, lubricate bedsores with the mixture in the elderly several times a day;

Mix celandine juice, aloe juice, honey in a ratio of 2:2:1 and apply to bedsores in the elderly twice a day;

Powder bedsores in the elderly with starch.

Prevention of pressure ulcers in the elderly

Pressure ulcers in the elderly form very quickly, and cells can begin to die after just a few days. Treatment of the disease causes many difficulties and is not always effective. For this reason, special attention should be paid to the prevention of pressure ulcers.

Prevention of bedsores:

Turn the patient several times a day;

Make sure that there are no wrinkles and foreign objects (crumbs, buttons, etc.) on bedding and underwear;

Take care of the cleanliness of bed linen;

Places of skin that are constantly in contact with the surface of the bed are wiped with a disinfectant solution;

The place where bedsores may appear in the elderly is washed with cold water, wiped with alcohol, and powdered.

What anti-decubitus mattresses and pillows to buy for the elderly

Bedridden care- difficult task. If we are talking about a disabled person who is not even able to roll over, then taking care of him involves serious physical exertion. The anti-decubitus mattress makes the work of the nurse easier. It can be bought at a pharmacy by pre-order or in one of the online stores. By the way, such a mattress not only prevents the appearance of bedsores, but is also convenient for a sick person.

Thanks to the anti-bed mattress, blood circulation is activated in the area prone to pressure sores. The pressure points change alternately, which provides a massage effect. Mattresses are balloon and cellular.

A cellular mattress is suitable for a patient weighing no more than 120 kg. It is suitable for the prevention and treatment of bedsores 1, 2 stages. If we are talking about a patient whose weight exceeds 100-120 kg, then it is better to give preference to a balloon mattress. It is also suitable for the treatment of bedsores 3, 4 degrees. Thanks to the unique laser micro-perforation, additional air flow is provided, and sweating is also prevented.

The cost of a balloon mattress is higher than a cellular one. However, treating pressure ulcers with medical or surgical methods will cost you much more.

A special pillow will help prevent bedsores in the elderly. It is of three types:

A foam pillow is the most economical option. However, it gradually loses its elasticity, and its effect becomes less effective after a short period of time;

Gel pad prevents bedsores in the elderly. It hardens if the temperature in the room drops significantly;

The air cushion is used to treat pressure sores in the elderly, but can also be used as a preventive measure.

In our boarding houses we are ready to offer only the best:

Round-the-clock care for the elderly by professional nurses (all staff are citizens of the Russian Federation).

5 meals a day full and diet.

1-2-3-seater placement (for recumbent specialized comfortable beds).

Daily leisure (games, books, crossword puzzles, walks).