Author Archives: Adam Peck

Pressure ulcers is any injury caused by unrelieved pressure; a decubitus ulcer, bedsore, or pressure sore that usually occurs in bony prominence like the shoulder blades, elbows, hip bones, sacrum, knees, ankle bones, heel and toes. These are all pressure points because they bear the weight of the body in a certain position.

Stages of Pressure Ulcers:
Stage 1 – the skin is red. The color does not return to normal when the skin is relieved of pressure.
Stage 2 – the skin cracks, blisters, or peels. There may be a shallow crater.
Stage 3 – the skin is gone, and the underlying tissues are exposed. The exposed tissue is damaged. There maybe drainage from the area.
Stage 4 – muscle and bone are exposed and damaged. Drainage is likely.

Persons at risk for pressure ulcers:
-those confined to bed or chair
-unable to move
-have loss of bowel or bladder control
-have altered mental awareness
-have problems sensing pain or pressure
-have circulatory problems
-older, obese, very thin, or malnourished

Signs of Pressure Ulcers:
– pale skin or a reddened area is the first sign of a pressure ulcer.
-pain, burning, or tingling in the area.
-some do not feel anything unusual.

Prevention/Measures to prevent pressure ulcers:
-good nursing care
-cleanliness, and skin care
-reposition the person at least every 2 hours or as scheduled in the person’s care plan . Some persons are repositioned every 15 minutes. Use pillows for support as instructed by the nurse. The 30-degree lateral position is recommended.
-prevent shearing and friction during lifting and moving procedures.
-prevent friction by applying a thin layer of cornstarch to the bottom sheets.
-provide good skin care. The skin must be clean and dry after bathing. The skin is free of moisture from urine, feces, perspiration, and wound drainage.
-minimize skin exposure to moisture. Check incontinent persons (those without bowel or bladder control) often. Also check persons who perspire heavily and those with wound drainage. Change linens and clothing as needed, and provide good skin care.
– check with the nurse before using soap. Remember, soap can dry and irritate the skin.
– apply a moisturizer to dry areas such as the hands, elbows, legs, ankles, and heels. The nurse tells you what to use and the areas that need attention.
– give a back massage when repositioning the person. Do not massage bony areas.
– keep linens, dry, and free of wrinkles.
– apply powder where skin touches skin.
– do not irritate the skin. Avoid scrubbing or vigorous rubbing when bathing or drying the person.
-use pillows and blankets to prevent skin from being in contact with skin and to reduce moisture and friction.
– keep the heels off the bed. Use pillows or devices under the lower legs from midcalf to the ankles.
– use protective devices as instructed by the nurse and care plan.
– remind persons sitting in chairs to shift their positions every 15 minutes. This decreases pressure on bony points.
– report any signs of skin breakdown or pressure ulcers immediately to the nurse.

Northern Nevada nursing homes are regularly inspected by state agencies and cited for violations of care standards, but fines and other serious sanctions are rarely imposed– even when a patient dies as a result of neglect or mistreatment, according to a Reno Gazette-Journal investigation into government inspections of nursing homes.

Some states, including California and Washington, can fine nursing homes for violating regulations, but Nevada law mirrors federal Medicare procedures. Medicare’s “nonpunitive” system allows nursing homes to correct problems found during inspections instead of being fined for violations.

In Nevada, nursing homes can be cited for the same kinds of violations year after year. It’s only when they fail to correct the problems after multiple inspections that fines are levied. Eight Northern Nevada nursing homes have been fined in the past three years.

Examples the Reno Gazette-Journal found of deficient care in Northern Nevada nursing homes during the past three years that didn’t result in fines or serious sanctions included:

» A patient who had been left without care for 81 hours became severely dehydrated and died after being rushed to a hospital.

» Physical abuse by nursing home staff members against patients.

» Many documented cases of avoidable bedsores caused by patients left in the same position for many hours. In some cases, severe bedsores went unnoticed by staff members, and in other cases, infections went untreated for long periods.

» Patients given the wrong drugs, and some who overdosed on the medications.

“It’s very sad we’re doing this to our elderly people,” said LaVonne Schfler of Reno, whose mother has spent time in nursing homes for rehabilitation and who does volunteer work with the Special Advocates for Elders program at the University of Nevada, Reno.

“They spend their lives working hard, contributing to society, and then when they can’t care for themselves, their children have a choice between their survival or their parents’ survival. (The children) can’t do 24-hour care and work at the same time, so they wind up in nursing homes where they may be mistreated or neglected. It’s not right.”