I-Bedsores ezosulelekileyo (Izilonda zoxinzelelo), i-Sepsis Risk, kunye ne-Emergency Repositioning Care¶

Xa umntu omdala ongakwaziyo ukuhamba, ongashukumiyo, obotshelelwe kwisitulo esinamavili, esiba nesilonda esinzulu soxinzelelo, esidla ngokubizwa ngokuba yi bedsore okanye decubitus ulcer, elo nxeba lingaphezulu lee kunolusu olukrazukileyo. Ukunyanzeliswa komatshini okuzinzileyo phakathi kwe-sacrum, i-tailbone, i-hip trochanter, i-ischial tuberosity, okanye isithende) kunye ne-mattress okanye i-cushion ityumza imithambo yegazi emincinci, ilamba ulusu, i-subcutaneous fat, kunye nezihlunu ezinzulu ze-oksijini de izicubu zife (ischemic necrosis). Emva kokuba ingozi yoxinzelelo iphula ulusu lube ngamanqatha anzulu (**Isigaba 3 **) okanye iveze imisipha engenanto, i-tendon, okanye ithambo (Inqanaba le-4 ** okanye ** I-Eschar engenakulinganiswa ), ibhaktheriya ihlasela ngokukhawuleza izicubu ze-necrotic, idala indlela ethe ngqo kwigazi kunye nethambo elinokubangela ukuba kubulawe i-sepsis, i-osteombone, i-osteombone, okanye i-osteombone fasciitis kwiiyure nje ezimbalwa.

Ukufumanisa icrater enuka kakubi, ekhupha amanzi kumqolo ongaphantsi, impundu, okanye isithende somntu omdala omdala, nokuba uhoye umzali ekhaya okanye uphakamisa amashiti xa utyelele esibhedlele okanye kwindawo yokonga abantu abanobuchule, yimeko engxamisekileyo yezonyango. Abantu abaninzi abakhathalela iintsapho baye bazenze mandundu izilonda ngokuzihlikihla ngecytotoxic hydrogen peroxide okanye ngokuzihlikihla ngotywala, bahlalise isigulana kwirabha “yedonathi” imiqamelo ekrwitsha unikezelo lwegazi, okanye ngokuqengqeleka isigulana silale kwicala elingama-90-degree esityumza ithambo lesinqe. This guide explains how to recognize systemic sepsis and spreading cellulitis, stage pressure injuries using the official NPIAP (National Pressure Injury Advisory Panel) criteria, dress and offload a deep wound safely until wound-care clinicians arrive, execute the 30-Degree Lateral Tilt repositioning schedule, and report nursing home neglect when a facility allows preventable Stage 3 or Stage 4 ulcers to develop.

Yenza oku ngoku¶

1. Fowunela iinkonzo zikaxakeka ngoko nangoko ukuba umntu lowo ubonakalisa naziphi na iimpawu ze-sepsis okanye usulelo olunwenwa ngokunzulu. Ukuba umntu omdala onesifo sokulala uba nokudideka okutsha I-delirium esibhedlele, ukomelela okugqithisileyo, ukugodola okungcangcazelayo, umkhuhlane ongaphezu38.0 degrees celcius (100.4 degrees Fahrenheit) OKANYE ubushushu bomzimba obusezantsi ngokuyingozi ngaphantsi 36.0 degrees celcius (96.8 degrees Fahrenheit), ukuphefumla ngokukhawuleza, isantya sentliziyo ebalekayo, okanye imivimbo ebomvu esasazeke ngaphandle kwinombolo engxamisekileyo yendawo yakho ( fowuna911 eUnited States naseKhanada, 112 kwiManyano yaseYurophu, 999 eUnited Kingdom) usebenzisa eyethu amanani kaxakeka ulawulo. Xelela umthumeli: * "Ndinomntu omdala omdala onesilonda soxinzelelo olusulelekileyo obonisa iimpawu zekliniki ze-sepsis enzima."
2. Thatha i-100 leepesenti lobunzima bomzimba kwisilonda ngokukhawuleza ("Zero Pressure Offloading"). Akukho mayeza okubulala iintsholongwane okanye ukunxitywa eMhlabeni okunokunyanga isilonda sokulala ngoxa umguli esalele okanye ehleli phezu kwaso. Gquqa ngobumnene kwaye uxhase isigulane kwicala elichanekileyo usebenzisa imithwalo eboshwe emva komqolo wabo kwi- ** 30-degree tilt **, okanye udada isithende esibuhlungu ngokupheleleyo emoyeni ngokubeka imithwalo ngobude ngaphantsi kwethole elisezantsi ukusuka edolweni ukuya kwi-tendon ye-Achilles.
3. **Ungaze ubeke i-hydrogen peroxide, i-alcohol yotywala, i-povidone-iodine (i-Betadine), okanye isepha ebukhali ngaphakathi kweSigaba se-3 okanye iSigaba se-4 sokulala. i-fibroblasts ezama ukuphinda yakha ibhedi yenxeba. Gcoba isilonda soxinzelelo oluvulekileyo ngobunono usebenzisa kuphela nje i-saline yesiqhelo engenazintsholongwane (0.9% sodium chloride) okanye amanzi okusela acocekileyo, obushushu bomzimba, kwaye uwagqume ngegawusi enetyuwa efumileyo okanye ngelasholo elinogwebu ade avavanywe ngugqirha.
4. Ungaze usebenzise i-"donut cushion" emile okweringi okanye i-pad yesikhumba seegusha kuphela ukukhupha i-tailbone bedsore. Iringi okanye i-donut cushions igxininise i-100 lepesenti yobunzima bomzimba womntu ibe yiringi emxinwa ejikeleze inxeba, esebenza njenge-tourniquet enqumla ukuhamba kwegazi kwi-arterial ukuya embindini wesilonda kwaye yandisa ukufa kwezicubu.
5. Jonga yonke indawo yoxinzelelo lwamathambo ukusuka entloko ukuya eluzwaneni ngoku. Apho kukho isilonda sokulala, kusoloko kukho esesibini esifihliweyo. Sebenzisa isibane esikhanyayo ukujonga i sacrum / tailbone, zombini ezinqeni zangaphandle (i-trochanters enkulu), zombini amathambo ahleliyo (ischial tuberosities), zombini izithende, zombini amaqatha angaphandle (malleoli), amagxa amagxa, iingqiniba, umva wokakayi, nasemva kweendlebe (apho i-nasal oxygen icinezela ulusu lwe-oxygen).
6. Ukuba ufumanisa iNqanaba lesi-3 elingaxelwanga, iNqanaba lesi-4, okanye isilonda esimnyama esingalawulekiyo kwikhaya labalupheleyo okanye esibhedlele, sifote kunye nerula kwaye ufune ugqirha okhawulezileyo / ukhathalelo lwenxeba. Kwiziko lokhathalelo lwexesha elide, ukuphuhlisa iSigaba 3 okanye iSigaba se-4 soxinzelelo lwezilonda kukwaphulwa komgaqo (jonga isikhokelo sethu ukuxhatshazwa kwekhaya labongikazi, ukungahoywa, kunye nokugxothwa). Beka irula yemetric ecocekileyo okanye ingqekembe yemali ecaleni kwenxeba (ngaphandle kokuchukumisa ibhedi evulekileyo) ukuze ubhale ubude nobubanzi bayo obuchanekileyo ngaphambi kokuba ufune ukudluliselwa ngokukhawuleza kwisibhedlele esibuhlungu ukuba kukho usulelo.

flowchart TD
    A["Fumanisa ubuBomvu, iBlister, Black Eschar, okanye Vula iCrater kwi-Immobile Senior"] --> B{"Ngaba i-Sepsis okanye i-Infection ye-Infection Iimpawu zikhona? (Ukubhideka, umkhuhlane> 38C okanye i-Temp <36C, i-Foul Pus, i-Red Halo, ukuphefumla ngokukhawuleza)"}
    B -->|"Ewe-i-Acute Sepsis okanye usulelo olunzulu"| C["Fowunela u-911/112/999 Ngoko nangoko kwi-Emergency IV Antibiotics kunye noTyando lokuNxibelela"]
    B -->|"Hayi - IiVitali ezizinzile"| D{"Leliphi inqanaba lokwenzakala koxinzelelo (NPIAP Staging)?"}
    C --> E["Khupha i-100% yobunzima kwinxeba ngelixa ulinde i-Ambulensi"]
    D -->|"Inqanaba loku-1 (UBomvu obuNgasondeziyo) okanye iSigaba 2 (Idyungudyungu elingenzulwanga/Umbhobho oPinki)"| F["Khupha Kwangoko + Khusela ngeSilicone Foam Ukunxiba + Jika rhoqo kwiiyure ezi-2"]
    D -->|"Inqanaba lesi-3 (i-Deep Fat Crater), i-Stage 4 (Ithambo / i-Muscle Exposed), okanye i-unstageable (i-Black Eschar)"| G["Lungiselela uVavanyo lweMini enye/uGqirha wosuku olulandelayo okanye uMongikazi oQinisekisiweyo wamanxeba (WOCN)"]
    G --> H["Gubha ngobunono nge-0.9% yeSaline eNtsholongwane kuphela (Akukho Peroksidi/Butywala) + Isinxibo esifumileyo esiNzalwe"]
    F --> I["Sebenzisa iShedyuli ye-30 ye-Lateral Tilt + izithende ezidadayo + i-Pressure-Redistributing mattress"]
    H --> I

Indlela yokubeka i-bedsore: I-NPIAP esemthethweni / i-EPUAP yokuhlelwa kwe-matrix¶

Iiklinikhi kwihlabathi jikelele zihlela ukulimala koxinzelelo usebenzisa i-standardized **I-National Pressure Injury Advisory Panel (NPIAP) ** kunye ** I-European Pressure Ulcer Advisory Panel (EPUAP) ** inkqubo yokubeka. Ukuchonga elona nqanaba lichanekileyo kukuxelela ukuba ngaba ujongene nophawu lwesilumkiso kwangoko okanye uqhaqho olungxamisekileyo.

"Uvavanyo lwe-Finger Blanch" lokufunyanwa kweNqanaba loku-1¶

Xa ubona ibala elibomvu okanye elimnyama lesikhumba kwindawo enamathambo (efana nethambo lomsila, inyonga, okanye isithende), cofa umnwe ococekileyo, oneglavu ngobunono kumbindi wendawo ebomvu3 imizuzwana, uze uyeke:

• Blanchable Erythema (Normal Reactive Hyperemia): Indawo ijika ibe mhlophe (iiblantshi) umzuzwana xa icinezelwe ize iphinde ibepinki kwakhona njengoko igazi libuyela ngaphakathi. susa lonke uxinzelelo kwindawo ngokukhawuleza kwaye ububomvu buya kuphelelwa phakathi kwemizuzu engama-30 ukuya kuma-60.
• Non-Blanchable Erythema (Inqanaba loku-1 Ukulimala koxinzelelo): Xa uphakamisa umnwe wakho, indawo ** ihlala ibomvu eqaqambileyo, imfusa emnyama, okanye i-maroon ** kwaye ayijiki ibe mhlophe. Kwiitoni zesikhumba ezimnyama (apho ubomvu bungabonakali ngokucacileyo), khangela i-patch yendawo ekhangeleka ** i-purplish, bluish, okanye imnyama kunesikhumba esijikelezileyo **, ivakalelwa ** ishushu okanye ipholile ** emva kwesandla sakho, okanye ivakalelwa ** ilukhuni / i-boggy (i-indurated) ** xa kuthelekiswa nezicubu ezikufutshane. Le yi **Inqanaba loku-1 lokulimala koxinzelelo **, oku kuthetha ukuba umonakalo we-capillary sele uqalile.

I-NPIAP Uxinzelelo loNzakalo weStaging kunye neTheyibhile yokuSebenza ngokuNgxamisekileyo¶

Ukuqaphela i-bedsores ezosulelekileyo kunye ne-sepsis esongela ubomi kubantu abadala¶

Phantse zonke izigulo ezinganyangekiyo ezivulelekileyo *zigqunywe yintsholongwane yolusu olungaphezulu, nto leyo engathethi ukuba isigulana sikwiseptic shock. Kufuneka wazi indlela yokwahlula phakathi kwenxeba eliphilisayo elizinzileyo kunye ne-**intsholongwane esasazeka kakhulu okanye i-sepsis **.

1. Iimpawu zengingqi zosulelo lwenxeba elinzulu (iCellulitis, ithumba, kunye neOsteomyelitis)¶

Hlola isilonda kunye ne-10 yeesentimitha ezijikelezileyo (ii-intshi ezi-4) zolusu phantsi kokukhanya okulungileyo:

• Ukusasaza i-Erythema (Cellulitis Halo): Ububomvu obuqaqambileyo, ukudumba, ukuqina (ukuqina), kunye nobushushu obudlulela ngaphezu kwe-2 yeesentimitha (0.8 intshi) ngaphandle ukusuka kungqameko lwesilonda. Sebenzisa isiphawuli solusu esihlambekayo okanye ipeni ukuzoba kancinci umgca onamachaphaza ecaleni komphetho wobomvu kwaye ubhale ixesha (2:00 PM); ukuba ububomvu busasazeka ngaphaya komgca we-inki phakathi kweeyure ezimbalwa, usulelo luhamba ngokukhawuleza kwaye lufuna i-antibiotics engxamisekileyo.
• Imfucumfucu eyiPurulent Drainage kunye nePutrid Anaerobic Ivumba: Umthubi ongqindilili, oluhlaza, omdaka, okanye ubisi lobubofu obudibene kwi crater, okanye ivumba elibi, elibolileyo, elibolayo lenyama eliqhubeka nasemva kokuba uhlanjululwe ngobunono inxeba ngesaline eyinyumba. (Qaphela: Izinxibo zeHydrocolloid ngokwendalo zenza ijeli emthubi enukayo xa zifunxa ulwelo oluqhelekileyo lwesilonda; soloko uhlambulula inxeba ngesaline kuqala phambi kokuba ugwebe ivumba).
• I-Fluctuance kunye neCrepitus (Irhasi ekwiTissues: Utyando oluNgxamisekileyo): Ukuba ucinezela ngobunono ngomnwe oyiglavu esikhumbeni esingqonge isilonda okanye phezu kwekepusi ye-eschar emnyama kwaye uve ipokotho eboshiweyo, ezaliswe lulwelo ngaphantsi (fluctuance), kukho ithumba elivalelekileyo. Ukuba uvakalelwa ** ukukrazula okanye ukukhupha imvakalelo phantsi kwesikhumba njengeRice Krispies okanye i-bubble wrap (* subcutaneous crepitus *) *, ibhaktheriya eyenza igesi ( iClostridium * okanye i-polymicrobial ** i-nectizing fasciitis **) iyonakalisa i-fcia enzulu; fowunela u-911/112/999 ngoko nangoko ukwenzela utyando olungxamisekileyo olusindisa ubomi.
• Eveziweyo okanye eGritty Bone (i-Osteomyelitis): Kwinqanaba lesi-4 isilonda apho unokubona ithambo eliluthuthu/engwevu ezantsi kwe-crater, okanye apho isilonda singavumi ukuphilisa iiveki nangona sikhutshiwe, iibhaktheriya zisenokosulela ithambo ngokwalo (**osteomyelitis **), efuna i-MRI okanye ithambo le-biopsy kunye neeveki ezi-6 ze-antibiotics ekujoliswe kuzo.

2. Iimpawu zeSistim zeSepsis kubantu abadala abadala (Kutheni abantu abadala bahlala ABANGAfumani umkhuhlane ophezulu)¶

Step-by-step emergency bedside wound care and offloading (While waiting for a clinician)¶

If you are caring for an immobile senior at home and discover an open Stage 2, Stage 3, or Stage 4 bedsore today (without immediate life-threatening sepsis requiring an ambulance), follow this exact protocol to stabilize the wound until the visiting wound nurse or doctor arrives:

Step 1: Gently irrigate the wound bed with 0.9% Sterile Saline (or homemade emergency saline)¶

1. Wash your hands thoroughly with soap and water for 20 seconds and put on clean disposable nitrile gloves.
2. Use sterile 0.9% sodium chloride (normal saline) wound wash: If you do not have a pressurized can of sterile saline wound spray from the pharmacy, you can make emergency isotonic saline at home by boiling 1 liter (4 cups) of clean tap or bottled water mixed with 2 level teaspoons (9 grams) of plain non-iodized table salt for 5 minutes in a covered pot, then letting it cool completely to lukewarm body temperature (37°C / 98.6°F) before use. (Never use cold water on a wound bed, as cooling the wound below 33°C halts white blood cell and mitotic healing activity for up to 4 hours).
3. Place a folded towel under the patient's hip or lower back to catch runoff, and gently flush the ulcer using a clean 30 mL syringe or squeeze bottle held 5 to 10 centimeters (2 to 4 inches) away. Never scrub the inside of an open bedsore with a rough washcloth or dry gauze.

Step 2: Apply a safe temporary "Moist-to-Moist" protection dressing¶

• Never perform an old-fashioned "Wet-to-Dry" dressing (where wet gauze is packed into a wound, allowed to dry into a hard crust, and ripped out dry), because ripping out dry gauze tears away healthy new tissue and causes severe pain.
• For a shallow Stage 2 ulcer: Pat the surrounding intact skin dry, apply a thin border of zinc oxide barrier cream around the outside if incontinence is an issue, and cover the shallow pink bed with a hydrocolloid wafer or silicone-bordered foam dressing.
• For a deep Stage 3 or Stage 4 crater: Wet a sterile non-woven gauze pad (or calcium alginate rope) with sterile normal saline, wring it out so it is damp (moist, not dripping wet), fluff it loosely, and lay it gently into the crater so it touches the wound surfaces without tightly packing or cramming the cavity. Cover the top with a dry sterile abdominal pad (ABD pad) or foam dressing and secure the edges onto healthy intact skin with gentle paper or silicone tape.

Step 3: Execute the "30-Degree Lateral Tilt" turning schedule (Every 2 Hours)¶

Why do we use a 30-degree tilt instead of rolling the patient all the way onto their side at 90 degrees? When you roll a frail older adult completely onto their side at a 90-degree angle perpendicular to the mattress, 100 percent of their body weight rests directly on the sharp bony knob of their hip (the greater trochanter) and their outer ankle bone, creating a brand-new Stage 3 hip bedsore within 24 hours while you were trying to heal their tailbone sore.

flowchart TD
    A["2-Hour Bedbound Repositioning Cycle (Never Exceed 30-Degree Tilt)"] --> B["Hours 0 to 2: 30-Degree Right Lateral Tilt (Pillows Under Left Back/Hip; Sacrum & Right Hip Bone Both Floating Free)"]
    B -->|"Use Draw Sheet to Lift - Never Drag Skin"| C["Hours 2 to 4: Supine (Flat on Back with Head <= 30 Degrees & Heels Floating Off Mattress on Calf Pillows)"]
    C -->|"If Sacral/Tailbone Ulcer Present: Skip Supine"| D["Hours 4 to 6: 30-Degree Left Lateral Tilt (Pillows Under Right Back/Hip; Pillow Between Knees & Ankles)"]
    D --> B

How to position a patient in the 30-Degree Lateral Tilt step by step¶

1. Always use a two-person "Draw Sheet Lift" (Never drag the patient across the sheet): Friction and shear (when the skin sticks to the cotton bedsheet while the skeleton slides downward inside the body) tear subcutaneous blood vessels. Place a folded cotton draw sheet (or low-friction nylon slide sheet) under the patient from shoulders to thighs, and lift the patient slightly off the mattress before shifting them.
2. Keep the Head of the Bed (HOB) at or below 30 degrees: Unless the patient is actively eating, drinking, or receiving tube feedings (or has severe heart failure/COPD requiring upright breathing), never leave the head of the hospital bed cranked up at 45 to 60 degrees for hours. When the head of the bed is raised above 30 degrees, gravity pulls the patient's torso down toward the foot of the bed, grinding the sacrum and tailbone with massive shear forces.
3. Wedge pillows behind the back and buttocks at a 30-degree angle:
   • Roll the patient gently toward you, fold two firm pillows lengthwise behind their shoulder blades and lower back/buttocks, and let them roll back onto the pillows so their pelvis rests at a 30-degree angle to the mattress.
   • Perform the "Hand-Slide Check": Slide your flat hand underneath the patient's lower back right over the sacrum/tailbone and over the lower hip bone (trochanter). In a true 30-degree tilt, your hand should slide freely past the sacrum (it is floating in the air) AND the patient's weight is resting on the fleshy gluteal muscle rather than directly on the point of the hip bone.
4. Place a pillow lengthwise between the knees and ankles, and "Float the Heels":
   • Never let one bony knee or ankle rest directly on top of the other knee or ankle; place a long pillow between the legs from groin to foot.
   • To float the heels: Place one or two pillows lengthwise underneath both lower calves from just below the knee down to the Achilles tendon, so both heels hang completely suspended in mid-air over the edge of the pillow with zero contact against the bedsheet.

Step 4: Manage incontinence moisture and boost protein/calorie nutrition immediately¶

1. Incontinence-Associated Dermatitis (IAD) and Fecal Contamination: Liquid stool contains digestive enzymes (proteases and lipases) that digest human skin on contact, and when urine mixes with fecal bacteria, urease converts urea into caustic ammonia that raises skin pH and burns the dermis. Check briefs at least every 2 hours, cleanse gently with a pH-balanced no-rinse perineal cleanser (never harsh bar soap), apply a thick zinc oxide or dimethicone moisture barrier paste over intact skin, and ask the physician whether a temporary external urinary catheter (such as a PureWick female external suction wick or male condom catheter) is appropriate while a sacral ulcer heals.
2. Emergency Nutritional Support (NPIAP Guidelines): Healing a Stage 3 or Stage 4 bedsore requires massive metabolic energy, as the body is literally trying to regrow muscle and skin while losing protein in wound exudate. Under NPIAP / EPUAP nutritional guidelines, an older adult with a pressure ulcer needs 30 to 35 kilocalories per kilogram of body weight per day and 1.25 to 1.5 grams of protein per kilogram of body weight per day (roughly 85 to 105 grams of protein daily for a 68 kg / 150 lb senior, unless restricted by un-dialyzed end-stage kidney failure), plus high-protein oral nutritional supplements enriched with L-Arginine, Zinc, and Vitamin C.

Advocating against nursing home or hospital neglect (Stage 3 & 4 "Never Events")¶

In the United States, the Centers for Medicare & Medicaid Services (CMS) classifies an unstageable, Stage 3, or Stage 4 pressure ulcer acquired after admission to a hospital or skilled nursing facility as a Hospital-Acquired Condition (HAC) / Serious Reportable "Never Event." Under the federal Nursing Home Reform Act (42 CFR § 483.25(b)(1)), a nursing home must verify that a resident who enters the facility without pressure ulcers does not develop them unless the resident's clinical condition demonstrates that they were unavoidable, and that a resident with pressure ulcers receives necessary treatment and services (including a Group 2 Alternating-Pressure Low-Air-Loss Mattress or Group 3 Air-Fluidized Bed) to promote healing and prevent infection.

If you visit a loved one in a nursing home or hospital and discover a deep, foul-smelling bedsore that staff hid or downplayed as a "little rash":

1. Demand to see the facility's Weekly Skin Assessment and 2-Hour Turning Logs: Ask the Director of Nursing (DON): "When was this pressure ulcer first staged in the chart, what stage is documented, when did the wound-care physician last examine it, and why is my parent still lying on a standard foam mattress instead of a powered alternating-pressure low-air-loss mattress?"
2. Insist on immediate hospital transfer if any infection or sepsis signs are present: Nursing homes sometimes hesitate to send a resident with a Stage 4 infected bedsore to the hospital emergency room because hospitalizing the resident triggers automatic state health department scrutiny. Remember that you do not need the nursing home's permission to call 911 from your cell phone while standing at your parent's bedside if they are septic, feverish, or delirious.
3. File a formal complaint with your State Long-Term Care Ombudsman and Department of Health Survey Agency: Read our full guide on ukuxhatshazwa kwekhaya labongikazi, ukungahoywa, kunye nokugxothwa for the exact state reporting hotlines and evidence-preservation steps.

Imibuzo edla ngokubuzwa¶

Kwakutheni ukuze ugqirha athi isilonda sokulala somzali wam siye "sikhulu kwaye sinzulu" kanye emva kokuba ikliniki yesilonda isicociwe?¶

Xa iSigaba sesi-3 okanye isilonda soxinzelelo esingaguqukiyo sigqunywe ngumnqwazi omnyama **eschar** okanye umthubi ongqindilili **slough** (ofileyo, izicubu zenecrotic), izicubu ezifileyo zisebenza njengeplagi efihla ubunzulu bokwenyani kunye nobubanzi becrater ngaphantsi, ngelixa ikhusela izicubu ezisempilweni ekukhuleni nasekutyiseni ibhaktheriya. Nje ukuba ugqirha wenxeba okanye umongikazi wenxeba oqinisekisiweyo enze **i-debridement ebukhali okanye i-enzymatic** ukususa izicubu ezifileyo, imilinganiselo yokwenyani yomngxuma ongaphantsi iyatyhilwa. Ukubona izicubu ezicocekileyo, ezibomvu zenyama yenkomo, ezinamahlalutye kancinane (**granulation tissue**) emazantsi embobo enkulu emva kokumoshwa linyathelo lokuqala elifunekayo lokuphiliswa ukusuka ezantsi ukuya phezulu.

Kukangaphi kufuneka umntu omdala ongashukumiyo ohleli nkqo kwisitulo esinamavili okanye kwisitulo esinamavili abekwe ngokutsha?¶

Ukuhlala nkqo kwisitulo esinamavili okanye kwi-geriatric recliner kugxininise **uxinzelelo oluphezulu** kumathambo amabini amancinane ahleliyo (**ischial tuberosities**) kunye nomsila kunokulala mcaba ebhedini. Phantsi **izikhokelo ze-NPIAP**, isigulana esibotshelelwe kwisitulo esinamavili okanye esibotshelelwe kwisitulo esingakwaziyo ukutshintsha ubunzima baso kufuneka sibekwe kwindawo enye **ubuncinane rhoqo ngeyure enye** (kwaye ukuba banokusebenzisa iingalo zabo, bafanele bafundiswe ukwenza i-shift-shift encinci incike rhoqo **imizuzu eli-15**). Ukuba umntu omdala sele evulekile kwiSigaba sesi-3 okanye kwiSigaba se-4 isilonda kwithambo labo lokuhlala (ischium) okanye i-sacrum, ** isitulo sokunciphisa ukuhlala ngokungqongqo ** (okanye ugweme ukuhlala kwisilonda ngokupheleleyo) kwaye ubeke umyalelo ** i-air-cell okanye i-gel / i-foam pressure-redistributing wheelchair cushion (efana ne-ROHO cushion) ** kwisitulo okanye i-pillow yokujikeleza.

Ngaba ndingasebenzisa i-Ointment Triple Antibiotic Ointment (Neosporin) okanye ubusi ngaphakathi kweSigaba 3 okanye iSigaba se-4 sokulala?¶

Musa ukupakisha i-petroleum-based Triple Antibiotic Ointment (Neosporin / Polysporin) kwiNqanaba elinzulu le-3 okanye iSigaba se-4 soxinzelelo lwezilonda zesilonda; Amafutha e-OTC e-neomycin enziwe kuphela imikrwelo emincinci emphezulu, abangela ukudibana rhoqo kwe-aleji yedermatitis ukuya kuthi ga kwi-10 lepesenti yabasebenzisi, ayingeni i-necrotic slough enzulu, kwaye ibambe ulwelo lwe-anaerobic kwimingxuma enzulu. Ngelixa liyinyumba, i-gamma-irradiated **i-medical-grade Manuka honey dressings** (efana ne-Medihoney) isetyenziswa ngokusemthethweni ziikliniki zamanxeba ukonakalisa i-autolytic debridement of sloughy ulcers, **ungaze ubeke ubusi ekhitshini legrosari ekrwada kwinxeba elivulekileyo**, njengoko ubusi bokutya obukrwada bunokuqulatha *i-sporidi ekrwada.

Ndiyifumana njani i-Medicare okanye i-Medicaid ukuhlawulela i-alternating-pressure umatrasi yomoya kumzali wam obotshelelwe ebhedini ekhaya?¶

Phantsi **I-Medicare Icandelo B Isixhobo soNyango esiLungileyo (i-DME) iMimiselo yoMgangatho weNdawo (i-LCD L33820: Uxinzelelo lokuNcitshiswa kweNkxaso yeNkxaso)**, i-Medicare igubungela i-**Iqela le-1 leNkxaso yoMphezulu** (i-alternating-pressure pad, i-gel overlay, okanye i-high-density foam mattresses) ukuba isigulane sinoxinzelelo olupheleleyo lwe-mattress i-trunk / i-pelvis kunye ubuncinane kunye nomngcipheko omnye (ukungakwazi ukuzibamba, ukungondleki, okanye ukuguqulwa kombono woluvo). I-Medicare ihlanganisa ** i-Powered Group 2 Alternating-Pressure / Low-Air-Loss Mattress System ** xa isigulane sine-*multiple Stage 2 ulcers ** ezingazange ziphuculwe emva kweentsuku ze-30 kwi-Group 1 surface, OKANYE ine-** enkulu okanye enye iSigaba 3 okanye iSigaba 4 soxinzelelo lwesilonda kwi-trunk okanye i-pelvis, i-pelvis, i-pelvis, i-pelvis Cela ugqirha wonyango wabazali bakho okanye ikliniki yamanxeba ukuba ingenise **Umyalelo woBuso ngobuso we-DME yeQela le-2 le-Loss-Air-Loss Mattress yeQela (HCPCS Code E0277)** kumthengisi we-DME obhalisiweyo we-Medicare namhlanje.

Imithombo ijongiwe¶

• **I-Panel yeSizwe yokuNgcebeleka ye-Pressure Injury (NPIAP), iPhaneli yeNgcebiso ye-Ulcer yaseYurophu (EPUAP), kunye ne-Pan Pacific Pressure Injury Alliance (PPPIA): ** UThintelo kunye noNyango lweZilonda zoxinzelelo / iingozi: iSikhokelo sokuSebenza kweKliniki, i-International Edition (NPIAP Staging System, i-30-Degree ye-30 ye-Degree, i-30 ye-Heel, i-30 ye-Degree, i-30 ye-Degree ye-30 kcal/kg & 1.25 ukuya 1.5 g/kg Protein Nutrition Standards) (International).
• I-Arhente yoPhando lwezeMpilo kunye noMgangatho (AHRQ): *Ukuthintela izilonda zoxinzelelo kwiZibhedlele kunye noNonophelo lwaseKhaya: Gwema i-Cytotoxic Antiseptics (i-Hydrogen Peroxide / i-Povidone-Iodine) kunye neRing / Donut Cushions * (eUnited States).
• Iphulo lokusinda kwi-Sepsis (SSC) kunye ne-Infectious Diseases Society of America (IDSA): *Izikhokelo zamazwe ngamazwe zoLawulo lwe-Sepsis kunye ne-Septic Shock & Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections * (International / United States).
• Amaziko e-Medicare & Medicaid Services (CMS): *42 CFR § 483.25 (b) (1) (Umgangatho woNyango: Izilonda zoxinzelelo kwiZibonelelo zoNyango lwexesha elide) kunye ne-Medicare LCD L33820 (iNkxaso yokuNciphisa iNkxaso yeNkxaso: Iqela le-1, i-2, kunye ne-3 DME) * i-United States ye-DME)
• Iziko leSizwe lezeMpilo kunye nokuGqwesa kweNkathalelo (NICE): *ISikhokelo seKlinikhi CG179: Izilonda zoxinzelelo, uThintelo kunye noLawulo * (eUnited Kingdom).

Izikhokelo ezinxulumeneyo¶

• Ukuxhatshazwa kwekhaya labongikazi, ukungahoywa, kunye nokugxothwa
• I-delirium yesibhedlele, ukudideka ngequbuliso, kunye nokuthethelelwa okuphezulu
• Abantu abadala bawela ukuchacha xa bengakwazi ukuma
• Ukungakwazi ukusebenza komnakekeli ngesiquphe kunye nokuhlangulwa kwabantu abadala abaxhomekeke kuye
• Uluhlu lweenombolo zexesha likaxakeka