DECUBITUS

ULCER

Presenters:
Angod, Lady Aizahlyn I.
Apat, Joselle Janina F.
Araune, Trixie Mariel E.
OVERVIEW OF
THE DISEASE
• The skin is comprised of three major components:
-Epidermis
-Dermis
-Subcutaneous tissue
• Though interrelated, each layer of skin has different
structures, cell types and functions.
 Definition
• “Decubitus” from the Latin decumbere, “to lie
down”
• Decubitus ulcers, also known as bedsores and
pressure sores, are caused by impaired blood
supply and tissue malnutrition owing to prolonged
pressure over skin, soft tissue, muscle, or bone.
• Can occur anywhere on body
 Overview
• It can develop on any part of the body where
sustained pressure and compressive forces
are maintained for a sufficient period of time.
• Decubitus ulcers are listed as the direct
cause of death in 7–8% of paraplegics.
• Some estimates suggest that 60,000 people
die from decubitus ulcers or their sequelae
per year.
RISK FACTORS
 Risk Factors and Causes
• The factors causing pressure ulcers are divided into
2 Groups

INTRINSIC - Disease, medication, malnourishment,

age, dehydration/fluid status, lack of mobility,
incontinence, skin condition, weight.

EXTRINSIC – External influences which cause skin

distortion – 
Pressure, Shearing Forces, Friction, Moisture.
Pressure
Tissues that are dependent on capillaries are deprived
of their blood supply because of pressure. Eventually
the ischaemic tissues will die.

Shearing Forces
Shearing forces will only exist if pressure, usually caused by the
persons own body weight, is also present. Shear forces occur
when a part of the body tries to move but the surface of the
skin remains fixed.
Friction
Friction forces occur when the shearing force increases
sufficiently to overcome the bodies resistance to
movement. The movement has an abrasive action

Moisture
Skin should not be left wet as moist skin sticks to
material (e.g. bathing, perspiration, incontinence (as
urine and feces are acidic, amniotic fluid) as it can
become macerated making it more susceptible to shear
and friction.
SIGNS AND
SYMPTOMS
• A bedsore appears first as a reddened area of
skin, which then starts to break down to form an
open, raw, oozing wound.

Bedsores occur at areas of abnormal pressure on

the body:
• In a wheelchair, this is usually the tailbone
(coccyx) or buttocks area, shoulder blades,
spine, or backs of the arms or legs.
• In a bed, they may occur on the back of the
head, ears, shoulder blades, hips, lower back,
tailbone, or the backs or sides of the knees,
elbows, ankles, or toes.
 Bedsores occur in stages:

• Stage 1 has unbroken, but pink or ashen (in

darker skin) discoloration with perhaps slight
itch or tenderness.
• Stage 2 has red, swollen skin with a blister or
open areas.
• Stage 3 has a crater-like ulcer extending deeper
into the skin.
• Stage 4 extends to deep fat, muscle, or bone and
may have a thick black scab (eschar).
Here are some signs to indicate that an infection has
developed:
• Thick yellow or green pus
• A bad smell from the sore
• Redness or warmth around the sore
• Swelling around the sore
• Tenderness around the sore
Signs that the infection may have spread include:
• Fever or chills
• Mental confusion or difficulty concentrating
• Rapid heartbeat
• Weakness
DISEASE
PROCESS
Individuals sitting/lying in the same
position for long periods of time

Inadequate blood supply to tissues

(ischemia)

Tissue damage and cell death

Bed Sore or decubitus ulcer

Pressure Ulcer Stages
 Stage I Pressure Ulcer
Skin is intact:
• The ulcer appears as a defined area of
persistent red, blue, or purple hues in
lightly pigmented skin.
• In darker skin tones, it may appear with
discoloration, warmth, edema,
induration or hardness.
 Stage II Pressure Ulcer

Superficial ulceration of the skin:

• Partial thickness skin loss involving

epidermis, dermis, or both.
• The ulcer is superficial and presents
clinically as an abrasion, blister, or shallow
crater.
 Stage III Pressure Ulcer

A deep crater; full thickness loss of

skin tissue:

• damage to or necrosis of subcutaneous tissue that

may extend down to, but not through, underlying
fascia.

• The ulcer presents clinically as a deep crater with or

without undermining of adjacent tissue.
 Stage IV Pressure Ulcer

Full thickness skin loss:

• extensive destruction, tissue necrosis, or damage

to muscle, bone, or supporting structures
(e.g. tendon, joint capsule).

• Undermining and sinus tracts also may be

present.
COMPLICATIONS
• Osteomyelitis
• Hypercalcemia
• Myonecrosis
• Necrotizing fasciitis
• Amyloidosis
• Sepsis
• Gangrene
• Death 
• Autonomic dysreflexia
DIAGNOSTIC
TESTS
How does the doctor diagnose bedsores?

A doctor can make the diagnosis by

examining the patient's skin. Special
diagnostic tests are usually
unnecessary unless there are symptoms
of infection. 
When are lab investigations necessary?

• If a patient with bedsores develops symptoms of

infection, then a doctor may order diagnostic
tests to determine whether the infection has
invaded the soft tissues, bones, bloodstream or
some other site. These tests may include a
complete blood count, a culture of the infected
bedsore, blood cultures to rule out sepsis, and
bone X-rays to look for evidence of
osteomyelitis.
PREVENTIONS
• Relieving pressure on vulnerable areas
of skin
• Reducing shear and friction
• Inspecting the patient's skin at least once
each day
• Minimizing irritation from chemicals
• Encouraging the patient to eat well
• Encouraging daily exercise
• Keeping the skin clean and dry