Assessment

What is exudate?

Many clinicians will note that a bed sore has ‘exudate’ in or around the wound when describing bed sore.  Exudate is fluid, such as pus, that leaks out of blood vessels into nearby tissues. The fluid is made of cells, proteins, and solid materials. Because a wound may be covered with exudate, it may make [...]

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What is ‘eschar’ and why is it used when describing bed sores?

Eschar is dead tissue that is cast off from the surface of the skin that is frequently seen in bed sores. Sometimes physicians also refer to eschar as a “black wound” because the wound is covered with thick, dry, black necrotic tissue.
It is important for health professionals to document if a wound has eschar, both [...]

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How does the use of the Braden Scale help in the prevention of bed sores?

The Braden Scale for Predicting Pressure Sore Risk is a universally accepted tool to help staff in nursing homes and hospitals identify individuals who may be at risk for developing bed sores (also called decubitus ulcers, pressure sores or pressures ulcers).  The Braden Scale for Predicting Pressure Sore Risk evaluates each resident in the following [...]

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What information should a facility document in individuals with bed sores?

Assessment and documentation of bed sores / wounds should be carried out at least weekly.

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What are the stages of bed sores?

Bed sores are categorized by severity, from Stage I (earliest signs) to Stage IV (worst):
Stage I: A reddened area on the skin that, when pressed, is “non-blanchable” (does not turn white). This indicates that a pressure ulcer is starting to develop.
Stage II: The skin blisters or forms an open sore. The area around the sore [...]

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