By Tedler D. Depaynos, MD
Bedridden patients are very prone to complications. They maybe bedridden due to various unfortunate medical etiologies like a stroke or head and spinal injury and advanced cardiac and pulmonary conditions. Because of their non-movement, they may develop pneumonia, atrophy of their muscles, stiffening of their joints and even constipation. All of these may be prevented by good nursing care.
One of the most common complications which may necessitate hospital confinement but could be avoided by good nursing care of the patient is Decubitus Ulcers.
Decubitus Ulcers in layman’s term is simply bedsores. “Decubitus” refers to the position one takes while lying down. Since most of the time it is the buttocks in contact with the bed, decubitus ulcers or bedsores are located there.
Bedsores occur usually due to non-movement of bedridden patients. With the weight of the patient compressing the blood vessels at the buttocks, gangrene occurs. It usually starts at the skin and eventually the underlying or deeper tissues are involved like the muscles. Hence ulcers occur.
These ulcers may eventually get infected because of the presence of necrotic tissues and also because their location is adjacent to the anus. Hence at least daily cleaning is a must. With uncontrolled infection which may spread and even cause serious sepsis, surgical debridement may be required.
Debridement may be surgically easy but the healing of the wound is a problem especially in conditions where the deeper tissues are involved. Besides if the patient would again have no excellent nursing care and would be constantly lying on her buttocks where the blood vessels would again be compressed, healing would be difficult.
It is routine in most hospital settings that patients expected to have very limited physical movements are referred to Physical Rehab MDs and personnel. Appointments may be made where physical rehabilitation may be done at the patient’s residence after discharge.
Heat or ultrasound may be applied to relieve the pain, to relax the muscles and to dilate the blood vessels. Massage with stretching and contraction of the muscles to prevent atrophy and strengthen them may also be done. To prevent joint stiffness, flexing, no matter how painful is basic. Of course, the Rehab Specialists would determine what is best for the patient.
They may even teach good nursing care to the relatives and whoever would be taking care of the patients so the unwanted complications could be prevented. Finally, psychological strengthening and encouragement should never be forgotten!
We have encountered several patients suffering such malady. One of them was a retired nurse who suffered several mild strokes several years ago but because of her strong determination, she refused to be bedridden. When her 2 children applied for work abroad she did not object and in fact encouraged them because she did not want to inhibit their ambitions and opportunities.
With time however, due to joint pains which were probably due to osteoarthritis she was eventually confined to her bed. Unfortunately, her children were not around to take care of her. Close relatives took care of her but eventually she was left alone most of the time because of their work and family responsibilities. Nursing aides were hired but probably were incompetent or not properly supervised, hence she developed bedsores.
Her tale was a sad one but she was with all smiles and happy when her children came home to visit her while confined in the hospital and knowing that they are very successful.
**
