I just went and visited my mom and dad at the NH. I'm so upset about how things have been with my dad the last few weeks. First I realized how much weight he was losing. He was not eating because he could not feed himself. I got that taken care of and he is receiving pureed food and is being fed, I knew he had a bed sore. He has had them for years. They changed his mattress on Sunday to an air mattress. Today I saw the sore and it is about 4 inches in diameter. I freaked out. They told me that it just all of a sudden came up. That it was small and then just all of a sudden got big. My question is if this is possible. They said at end of life sometimes the skin will do that. I just don't know what to do. I can't be at the NH all the time, but it feels like I need to be for proper care.

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Usually the damage from pressure sores starts deep and is much more extensive than it may seem so I can see how once the skin breaks open it would become enormous quickly. The thing is they should have been watching for any sign of redness and never have allowed it to get that far, at least that is my humble opinion.
Helpful Answer (11)
Reply to cwillie

The redness is a pressure point and when seen is a sign to do something right away. When my Dad entered rehab he had pressure points on his heels and it was noted on his admission work up. My Mom made a comment that when she put Dads diabetic socks on she broke thru a blister. She told the aide. They bandaged it. 4 days after my Dad was admitted, my RN daughter visited. Looked at the broken blisters and found there was black tissue. She immediately went to the DON that my Dad be put on an air mattress, which should have been done at the time he was admitted.

I would talk to the DON. If you don't get anywhere, call the Dr. who is taking care of Dad. If nowhere there, call APS. Dad needs wound care done by a nurse trained in wound care. They are hard to heal if where there isn't much tissue. But doesn't mean they do what they should.
Helpful Answer (10)
Reply to JoAnn29

Yes, they can pop up all of a sudden.

Try Colloidal Silver Gel - it was the only solution to curing my DH's pressure sore.
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Reply to RayLinStephens

The rapid development of a pressure ulcer is not really as rapid- rather too often not noticed in the early stages. The lack of nutrients, position changes and constant pressure contribute to pressure ulcer formation. The ulcers can often develop under the skin surface before they become apparent. The SNF should be on the look at for pressure ulcers as it is required and take action for prevention in patients who are demonstrating risk factors. Redness on the skin surface should not go unnoticed- and be tracked and measured before the skin breaks down. Early actions such as use of a alternating pressure mattress, frequent position changes, protein and vitamin supplements should be instituted.
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Reply to KAWnurse

My mom fell, was hospitalized and then went to rehab in a facility. There she developed a stage 4 wound near the tailbone area that was only told to me when she was rushed to hospital with a bad UTI. I was shocked. I did not send her back to that failure of a facility. I have been told though that these develop very fast and the skin is the first thing to go in a decline. I ended up taking care of my mom at my home while she was on hospice. Because of the location of the wound and her fecal incontinence I had to make a barrier with gauze several times a day to keep the wound clean. I used colloidal silver spray in the wound, and found that eating protein helped shrink the wound. Peanut butter on toast for protein. You have to be careful with protein with the kidneys though. I did get the wound to shrink by half it's size, but in the weeks before she died nothing seemed to help and it went back to where it was. I would recommend some protein, and of course keeping the patient off of the effected area with air mattress and turning.
Helpful Answer (8)
Reply to Katie22

srgdean, my father developed bed sores all of the sudden and he was on an air mattress. My caregiver alerted me to this. The one on his back was just developing and was simply red. The one on his heel was severe. The nurse told us to clean the wound with a saline solution and apply a patch that had honey in it. We also wrapped the heel in cushioned boots. Unfortunately my father passed away after developing other issues but the bed sores developed first. These sores can crop up suddenly so make sure that he not is sleeping in the same spot.
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Reply to demstress

srgdean - my dad sounded just like your dad.  He was in a NH too.    Losing weight, couldn't feed himself, put on pureed food.  He also had some sores that we knew about that all of a sudden got really bad.  Unfortunately, at the end of life, the skin starts to break down.  My dad passed away shortly after the bed sores started to get worse. It was heartbreaking to see this.  This was my recent experience.  I'm still not over it.  Prayers to you.
Helpful Answer (6)
Reply to LindainCT
LRMom2 Jan 10, 2019
Prayers are coming to you. I have been there.
Yes they can happen quickly. They can also heal quickly, but not always for everyone. There are so many factors that effect wounds: off-setting the pressure regularly, the weight of the patient, nutritional status, other medical conditions, integrity of the skin etc. I’ve seen some stubborn wounds that won’t go away even with a
skilled wound nurse seeing the patient every day, and a wound doctor seeing the patient weekly.
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Reply to SofiaAmirpoor

I agree with cwillie
Pressure sores can develop very quickly in geriatric skin. They develop from the bottom layer of skin up and show up first as a reddened area. They seem to get worse rapidly because the area under the red spot is already injured. The mostly likely first spots are where the skin is thin and located over a boney prominence. The staff should have been watching it more closely. Sometimes even the best of care does not prevent them The patient is just too fragile.If the pressure sore occurs first on the tailbone area, it is a sign that death is close
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Reply to woptmiscws

It’s too sad for me to read all the other responses but wanted to share my experience. My Mom developed huge pressure ulcers quite suddenly shortly before death. She was receiving wonderful care and it was no one’s fault. Seems there was a new one everyday. Her skin was just breaking down and she had no reserves. She couldn’t consume the protein she needed for healing, not even protein shakes. Wound care nurses lovingly dressed her wounds at least daily but this was part of her natural end stage decline. They became painful to her and I demanded that hospice start giving her morphine regularly. My neighbor, on the other hand, had a bedsore the size of a tennis ball and wonderful hospice nurses healed it. She’s doing well over 6 years later. Prayers for you and your parents.
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Reply to dmasty

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