Symptoms Of Stage 2 Bedsores
Stage 1 bedsores progress to stage two when they break the surface of the skin. As such, stage 2 bedsores are readily identifiable as blisters that may be intact or burst into an open, shallow sore. These sores often appear red or pink and have red and irritating skin surrounding them. If infected, a bedsore may also appear moist and be filled with pus or fluid.
Stage 2 bedsores often only affect the top layer of the skin, the epidermis. In some cases, such as when the ulcer presents as an open sore, the dermal layer of skin may be visible. The third layer of skin, the subcutaneous layer remains unaffected.
As a general rule, the more advanced the bedsore, the more difficult it is to treat. People who present with symptoms of a stage 2 pressure ulcer should receive prompt treatment and evaluate their root cause as soon as possible.
Other possible symptoms of stage 2 ulcers include:
- Skin irritation
- Warmth of the surrounding area, indicating possible infection
- Discoloration and redness
Caregivers who notice the symptoms of a stage 2 pressure ulcer should address the problem as soon as possible. At this stage, complications can quickly develop and progress to other, more serious stages of bedsores. In the more complex stages of bedsores, negative health outcomes such as amputation, systemic infection, or organ failure may be possible.
Hydrogel Dressings For Treating Pressure Ulcers
Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are areas of injury to the skin or the underlying tissue, or both. Pressure ulcers can be painful, may become infected, and affect quality of life. Those at risk of pressure ulcers include those with spinal cord injuries and people who are immobile or who have limited mobility such as some elderly people and people with acute or chronic conditions. In 2004 the total annual cost of treating pressure ulcers in the UK was estimated as being GBP 1.4 to 2.1 billion, which was equivalent to 4% of the total NHS expenditure. Pressure ulcers have been shown to increase length of hospital stay and the associated hospital costs. Figures from the USA suggest that ‘pressure ulcer’ was noted as a diagnosis for half a million hospital stays in 2006 for adults, the total hospital costs of these stays was USD 11 billion.
Dressings are one treatment option for pressure ulcers. There are many types of dressings that can be used these can vary considerably in cost. Hydrogel dressings are one type of available dressing. Hydrogel dressings contain a large amount of water that keeps ulcers moist rather than letting them become dry. Moist wounds are thought to heal more quickly than dry wounds. In this study we investigated whether there is any evidence that pressure ulcers treated with hydrogel dressings heal more quickly than those treated with other types of dressings or skin surface treatments.
Assessment Of Nutritional Needs
Undernutrition is common among patients with pressure injuries and is a risk factor for delayed healing. Markers of undernutrition include albumin < 3.5 g/dL or weight < 80% of ideal. Protein intake of 1.25 to 1.5 g/kg/day, sometimes requiring oral, nasogastric, or parenteral supplementation, is desirable for optimal healing. Current evidence does not support supplementing vitamins or calories in patients who have no signs of nutritional deficiency.
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Stage 2 Bedsore Causes
Bedsores and other pressure injuries develop when blood supply is interrupted. Sitting or lying in the same position for too long restricts blood flow and damages the surrounding skin.
Stage 1 bedsores do not break the skin, but lying in the same position after one has formed can cause the skin to tear open, meaning a stage 2 bedsore has developed.
Improper nursing home care can also cause bedsores. For example, poor training or understaffing may prevent staff members from being able to address residents mobility needs.
Stage 2 Bedsore Treatment
The Model Systems Knowledge Translation Center encourages people with stage 2 bedsores to see a health care provider as soon as possible.
Treatment for stage 2 bedsore typically involves:
- Bandaging: Bandages help keep bedsores dry and reduce the risk of infection.
- Cleaning: Doctors may use a saltwater solution called saline to clean the open wound when bandages are changed.
- Debriding: The Mayo Clinic notes that damaged and dead tissue must be removed so the bedsore can heal properly. This process is known as debridement.
- Getting Good Nutrition: The MSKTC recommends a diet rich in vitamin A and C, protein, zinc, and iron as part of a stage 2 bedsore treatment plan. Drinking enough water is also important. Johns Hopkins Medicine found that bedsores wont properly heal without these dietary changes.
- Reducing Pressure: Taking pressure off the bedsore will prevent it from getting worse and allow the skin to start repairing itself.
Seek medical advice from trusted doctors or nurses to learn more about treating pressure sores.
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Potential Biases In The Review Process
This was a sparse network and there may have been smallstudy effects which impacted on the network . The STATA routines have largely been developed for and tested on larger networks, and our work has contributed to modifications for sparse networks in the netweight routine. Other STATA routines can be modified by the user to take into account smallstudy effects, but we did not explore these approaches because there was too much uncertainty in the network for us to be confident of interpreting the results. Instead, we used the standard routines for NMA and adapted the recent approach to GRADE to bring in sparseness when assessing evidence certainty.
A further effect of the sparseness of the network may have been to hide any inconsistencies. The various statistical tests for inconsistency were generally not significant, but this may have been due to a lack of sensitivity of the tests and the wide CIs around the measures. Despite this, we found inconsistencies in the network for contrasts involving phenytoin. We cannot be sure that there are no other inconsistencies, but this may not matter given the already identified large uncertainties.
What Causes Pressure Sores
Pressure sores are caused by sitting or lying in one position for too long. Its important to know that a pressure sore can start quickly. In fact, a Stage 1 sore can occur if you stay in the same position for as little as 2 hours. This puts pressure on certain areas of your body. It reduces blood supply to the skin and the tissue under the skin. If you dont change position frequently, the blood supply will drop. A sore will develop.
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Wound And Pressure Ulcer Management
Education of patients, families, caregivers and healthcare providers is the key to a proactive program of prevention and timely, appropriate interventions . Wound management involves a comprehensive care plan with consideration of all factors contributing to and affecting the wound and the patient. No single discipline can meet all the needs of a patient with a wound. The best outcomes are generated by dedicated, well educated personnel from multiple disciplines working together for the common goal of holistic patient care .
Significance of the problem:
Anatomy of Normal Skin
What is a Pressure Ulcer?
There are many contributing factors.
Treating And Preventing Pressure Ulcers
Treatment for pressure ulcers includes the use of dressings, creams and gels designed to speed up the healing process and relieve pressure. Surgery is sometimes recommended for the most serious cases.
For some people, pressure ulcers are an inconvenience that require minor nursing care. For others, they can be serious and lead to life-threatening complications, such as blood poisoning or gangrene.
Read more about the complications of pressure ulcers.
Pressure ulcers can be unpleasant, upsetting and challenging to treat. Therefore, a range of techniques is used to prevent them developing in the first place. These include:
- regularly changing a person’s position
- using equipment to protect vulnerable parts of the body such as specially designed mattresses and cushions
Unfortunately, even with the highest standards of care, it’s not always possible to prevent pressure ulcers in particularly vulnerable people.
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What Causes A Pressure Ulcer
A pressure ulcer is caused by a lack of blood flow due to mechanical stress on the skin and tissues over a bony area that has been under pressure for a prolonged period. If the blood supply is cut off to an area of skin for more than 23 hours, the skin is deprived of oxygen and begins to die. In addition, when slowly sliding down a bed or chair, friction to the outer skin layer such as from wrinkled bedding and clothing contribute to skin injury and ulceration. Excessive exposure to moisture, such as sweat, blood, urine or faeces, also increases the likelihood of developing a pressure ulcer.
Stages Of Pressure Ulcers And Treatment
Pressure ulcers can progress in four stages based on the level of tissue damage. These stages help doctors determine the best course of treatment for a speedy recovery.
If caught very early and treated properly, these sores can heal in a matter of days. If left untreated, severe bedsores may require years to heal.
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Agreements And Disagreements With Other Studies Or Reviews
We have been unable to identify any network metaanalyses directed at healing pressure ulcers and incorporating both dressings and topical agents. The AHRQ guideline reviewed the evidence for dressings in a series of pairwise comparisons and stated that overall, they did not find substantial evidence to support certain local wound applications over others . The most recent NICE guideline on the prevention and management of pressure ulcers considered all RCT evidence on dressings and separately all RCT evidence on topical agents. NICE recommendations are to not use saline gauze dressings and for the health professional and adult to discuss the type of dressing to use, taking into account pain and tolerance, position of the ulcer, amount of exudate and frequency of dressing change. These recommendations rely heavily on consensus decisions, weakly supported by the evidence, and as such, agree with the findings of this review.
Stage 2 Bedsore Prevention
Stage 2 bedsores can be prevented if stage 1 bedsores are treated early on. This involves removing pressure from the bedsore, cleaning and drying it, and seeking medical care if it doesnt clear up in 2-3 days.
Family members or loved ones can look for stage 1 bedsores marked by discolored, painful patches of skin when visiting a nursing home resident. Nursing home residents can also prevent stage 2 bedsores by noting signs or symptoms of stage 1 bedsores and voicing their concerns to caregivers.
If a resident believes that the staff members arent listening to their worries, they can talk to a trusted family member or long-term care ombudsman. The family may be able to intervene on the residents behalf, and ombudsmen are trained to resolve issues between nursing home staff and residents.
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Symptoms Of Pressure Sores
Pressure sores go through 4 stages.
- Stage 1. During this stage, the area of the sore looks red. It may feel warm to the touch. It may burn, hurt, or itch. The pressure sore may look blue or purple in people who have dark skin.
- Stage 2. During this stage, the area is more damaged. The sore may be open. It may look like a cut or blister. The skin around the sore may be discolored. The sore is painful.
- Stage 3. During this stage, the sore will have a crater-like look. This is due to increased damage below the surface. This makes the wound deeper.
- Stage 4. This is the most serious stage. Skin and tissue are severely damaged. The sore becomes a large wound. Infection is possible. Youre likely able to see muscle, bones, tendons, and joints.
Infected pressure sores take a long time to heal. Also, the infection can spread to the rest of your body. Signs of infection at the site include:
- Thick, yellow, or green pus
- A bad smell coming from the sore
- Redness or skin that is warm to the touch
- Swelling around the sore
Signs that the infection has spread include:
What Is A Pressure Ulcer
A pressure ulcer happens when an area of skin, generally over a prominent bony structure, experiences excessive friction and breakdown. These commonly occur in settings where one is confined to a bed or a chair and is spending a lot of time in the same position. A pressure ulcer develops when there is significant damage not only to the upper layers of skin but in the deep bodily tissues beneath.
You are at high-risk for developing bedsores if you:
- Use a wheelchair
- Stay in bed for prolonged periods
- Are an older adult
- Have trouble moving on your own
- Are diabetic
- Have weak skin and/or impaired healing
- Are incontinent
- Have nutritional deficiencies
- Are mentally impaired
Pressure sores can happen anywhere on your body but are common at the bottom of the spine, on the buttocks, over the hip bones, on the soles of the feet, ankles, over the elbow joint, on the back of the head, and on the shoulders.
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The Different Stages Of Bedsores And Their Treatment
18 June, 2021
The evolution of a bedsore will depend on its severity. Today, well tell you what bedsores are, explain the different stages of bedsores, and talk about their treatment.
Bedsores are damage to the skin and the underlying tissue due to prolonged pressure or friction against a hard surface. They occur frequently in patients who are bedridden for long periods of time.
In addition, the stages of bedsores are greater in the elderly, as these ulcers cause serious problems among this age group.
Theyre very painful and produce a high number of local and general infections. Theyre located in the most prominent parts of the body, sacrum, trochanters , heels, scapulae, and the occipital region.
Its severity varies from reddening of the skin to the loss of the skin and may expose the underlying bone.
Symptoms Of Stage 2 Pressure Ulcers
Stage 2 pressure ulcers are shallow with a reddish base. Adipose and deeper tissues are not visible, granulation tissue, slough and eschar are not present. Intact or partially ruptured blisters that are a result of pressure can also be considered stage 2 pressure ulcers. Note that causes of erosion, ulceration, or blistering that aren’t a result of pressure are not included in the definition of a stage 2 ulcer.
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Why It Is Important To Do This Review
The diversity of dressings and related materials available to health professionals for treating pressure ulcers makes evidencebased decisionmaking difficult when determining the optimum treatment regimen for a particular patient . With increasingly sophisticated technology being applied to wound care, practitioners need to know the relative effectiveness and costeffectiveness of these sometimes expensive dressings. Even where cost is not an issue, the most effective treatment may not be available or may be difficult or to use, so that information on the second and third best treatments is important too .
Current evidence syntheses include four Cochrane Reviews , two other systematic reviews , and two recent clinical guidelines . Each of these consists of a series of pairwise comparisons. No review finds clear evidence of any effect of one dressing compared to another in terms of assessed outcome measures, including complete wound healing.
In the absence of an overview or network metaanalysis, decisionmakers have to consider the findings of multiple pairwise randomised controlled trials simultaneously and qualitatively to judge, in the face of uncertainty, which dressing they might decide to use. It is extremely difficult to do this effectively, and this difficulty is compounded when the evidence comprises single small trials, about which decisionmakers may have little confidence.
A glossary of NMA terms is given in .
Caring For A Pressure Sore
Stage I or II sores will often heal if cared for carefully. Stage III and IV sores are harder to treat and may take a long time to heal. Here’s how to care for a pressure sore at home.
Relieve the pressure on the area.
- Use special pillows, foam cushions, booties, or mattress pads to reduce the pressure. Some pads are water- or air-filled to help support and cushion the area. What type of cushion you use depends on your wound and whether you are in bed or in a wheelchair. Talk with your health care provider about what choices would be best for you, including what shapes and types of material.
- Change positions often. If you are in a wheelchair, try to change your position every 15 minutes. If you are in bed, you should be moved about every 2 hours.
Care for the sore as directed by your provider. Keep the wound clean to prevent infection. Clean the sore every time you change a dressing.
Avoid further injury or friction.
- Powder your sheets lightly so your skin doesn’t rub on them in bed.
- Avoid slipping or sliding as you move positions. Try to avoid positions that put pressure on your sore.
- Care for healthy skin by keeping it clean and moisturized.
- Check your skin for pressure sores every day. Ask your caregiver or someone you trust to check areas you can’t see.
- If the pressure sore changes or a new one forms, tell your provider.
Take care of your health.
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