Bedsore
Description
Bedsore (decubitus ulcers) are localized areas of cellular necrosis which occur most often in the skin and subcutaneous tissue of underlying bony prominences, but which may also affect nearby bone and muscle. This condition can be caused by local, superficial skin irritation, with subsequent maceration of the affected surface, or may originate in deep underlying tissue. This tissue predisposes itself to bacterial invasion and infection.
The severity of this type of ulcer, governed by the intensity and duration of irritation, moderate irritations producing edema and multiple blood vessel thrombosis.
Treatment includes relieving pressure on the infected area, keeping the area clean and dry, and frequent repositioning when stationary for long periods of time.
Causes
Primary Factors
Excessive pressure, particularly over bony prominences which prevent normal
circulatory function
Predisposing Factors
External:
Altered mobility and immobilization to which paraplegics have a particular predisposition such as:
Prolonged bed rest
Confinement to a wheelchair
Wearing a cast or splint
Sleeping positions which do not evenly distribute weight
Internal:
Impaired neurologic function causing loss of pain and pressure sensations which normally prompt a person to shift positions
Malnutrition leading to weight loss and subsequent thinning of fat and muscle padding between bony prominences and the skin
Breakdown of subcutaneous tissue as a result of:
Edema
Incontinence
Fever
Obesity
Anemia
Infection
Muscle disease atrophy
Other pathologic conditions
Signs & Symptoms
Early Symptoms
Inflamed skin caused by bacterial infection (skin and underlying tissues are still soft), redness which disappears with pressure, superficial skin lesions, capillary changes over the compressed areas caused by reactive hyperemia and changes in skin color, turgor, temperature and sensation.
Late Symptoms
Small blisters, erosions, necrosis, foul-smelling purulent discharge from the affected area, edema and black eschar develops over the lesion and around the area due to infected necrotic tissue which prevents healthy granulation of scar tissue.
Nutritional Supplements
---------------------------------
General Supplements
---------------------------------
| Adult | Child/Adolescent | |
| Chromium | 200 - 300 mcg | 50 - 200 mcg |
| Vitamin B-5 | 200 - 500 mg | 50 - 200 mg |
| Vitamin C | 1,000 - 3,000 mg | 500 - 2,000 mg |
| Vitamin E | 400 - 800 IU | 200 - 400 IU |
| Zinc | 20 - 50 mg | 10 - 30 mg |
Note: All amounts are in addition to those supplements having a Recommended Dietary Allowance (RDA). Due to individual needs, one must always be aware of a possible undetermined effect when taking nutritional supplements. If any disturbances from the use of a particular supplement should occur, stop its use immediately and seek the care of a qualified health care professional.
Dietary Considerations
The individual should be encouraged to eat for strength. Many small meals, rather than three large meals may suit an individual in a weakened state.
A Protein Enriched Diet with vitamin and mineral supplements should be prescribed, as these nutrients are important in the repair and regeneration of healthy tissue. Protein and caloric supplements can also be added to foods for more nutrients.
Zinc supplements aid in wound healing.
Homeopathic Remedy
| 1.* Fluoricum acidum | 15C - 30C |
| 2.* Arnica montana tinct. | 15C - 30C |
| 3.*Hepar sulphuris calcarea | 30C |
| 4. Sulphuricum acidum | 15C |
| 5.*Petroleum | 30C |
Treatment Schedule
Doses cited are to be administered on a 3X daily schedule, unless otherwise indicated. Dose usually continued for 2 weeks. Liquid preparations usually use 8-10 drops per dose. Solid preps are usually 3 pellets per dose. Children use 1/2 dose.
Legend
X = 1 to 10 dilution - weak (triturition)
C = 1 to 100 dilution - weak (potency)
M = 1 to 1 million dilution (very strong)
X or C underlined means it is most useful potency
Asterisk (*) = Primary remedy. Means most necessary remedy. There may be more than one remedy - if so, use all of them.
References
Boericke, D.E., 1988. Homeopathic Materia Medica.
Coulter, C.R., 1986. Portraits of Homeopathic Medicines.
Kent, J.T., 1989. Repertory of the Homeopathic Materia Medica.
Koehler, G., 1989. Handbook of Homeopathy.
Shingale, J.N., 1992. Bedside Prescriber.
Smith, Trevor, 1989. Homeopathic Medicine.
Ullman, Dana, 1991. The One Minute (or so) Healer.
Tissue Salts
Herbal Approaches
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Herbs
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Chlorophyll
Lemon balm
Plantain plant
Witch hazel
Note: The misdirected use of an herb can produce severely adverse effects, especially in combination with prescription drugs. This Herbal information is for educational purposes and is not intended as a replacement for medical advice.
Aromatherapy - Essential Oils
Related Health Conditions
Anemia
Edema
Fever
Infection
Obesity
Paraplegia
Thrombosis
References
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Baker, J.L. The Effectiveness of Vitamin E In Reducing the Incidence of Spherical Contracture Around Breast Implants. Plastic And Reconstructive Surgery, 68, 1981.
Beeson, P.B. & W. Mc Dermott eds. 1975. Textbook Of Medicine. 14th ed. Saunders Pub. Co., Philadelphia. 1892 pp.
Bergstrom NI: Strategies for preventing pressure ulcers. Clin Geriatr Med, 1997 Aug, 13:3, 437-54.
Berkow, R. 1977. The Merck Manual. Merck Sharp and Dohme Research Laboratories Pub., Rahway, New Jersey. 2165 pp.
Bland, Jeffrey. Nutraerobics. San Francisco: Harper & Row, 1983.
Bland, Jeffrey. Medical Applications of Clinical Nutrition. New Canaan, Conn.: Keats, 1983.
Breslow-RA & Bergstrom- N : Nutritional prediction of pressure ulcers. J-Am-Diet-Assoc. 1994 Nov; 94(11): 1301-4; quiz 1305-6.
Carvell, J.E. & Grundy, D.J.: Complications of spinal surgery in acute spinal cord injury. Paraplegia. 1994 Jun; 32(6): 389-95.
Comorosan-S et al: The effect of diapulse therapy on the healing of decubitus ulcer. Rom-J-Physiol. 1993 Jan-Jun; 30(1-2): 41-5.
Cordell WH et al., Pain and tissue-interface pressures during spine-board immobilization. Ann Emerg Med, 1995 Jul, 26:1, 31-6.
Davalos A et al., Effect of malnutrition after acute stroke on clinical outcome. Stroke, 1996 Jun, 27:6, 1028-32.
Declair V: The usefulness of topical application of essential fatty acids (EFA) to prevent pressure ulcers. Ostomy Wound Manage, 1997 Jun, 43:5, 48-52, 54.
Gilmore SA et al., Clinical indicators associated with unintentional weight loss and pressure ulcers in elderly residents of nursing facilities. J Am Diet Assoc, 1995 Sep, 95:9, 984-92.
Goldbaum, J.S. Vitamin C in the Use of Megascorbate Therapy in General Medicine. Austalas Nurses Journal, 11, 1982.
Hamilton, H.K. ed. 1982. Professional Guide To Diseases Intermed Communications Inc. Pub, Springfield, Massachusetts. 1323 pp.
Himes D: Nutritional supplements in the treatment of pressure ulcers: practical perspectives. Adv Wound Care, 1997 Jan-Feb, 10:1, 30-1.
Honde-C et al: Local treatment of pressure sores in the elderly: amino acid copolymer membrane versus hydrocolloid dressing.. J-Am-Geriatr-Soc. 1994 Nov; 42(11): 1180-3.
Hui, Y.H. 1983. Human nutrition & diet therapy. WadsWorth, Inc; Belmont, CA. 1039 pp.
Johnson, J.: Pressure area risk assessment in a neurological setting. Br. J. Nurs. 1994 Oct 13-26; 3(18): 926-8, 930-1,933-5.
Kirschmann, J.D. 1990. Nutrition Almanac: Nutrition Search. McGrew-Hill: New York.
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Martin-J Jr et al: Congenital kyphosis in myelomeningocele: results following operative and nonoperative treatment. J-Pediatr-Orthop. 1994 May-Jun; 14(3): 323-8.
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Schubert, V. et al: Skin microcirculatory and thermal changes in elderly subjects with early stage of pressure sores. Clin. Physiol. 1994 Jan; 14(1): 1-13.
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