California Elder Law Attorney Blog

Sepsis and MRSA A Lethal Combination For Disaster says Nursing Home Abuse and Neglect Lawyer Steven Peck

Fri, 06 Jan 2012 06:00:00 -0800

Methicillin-resistant Staphylococcus aureus or MRSA is staph infection that has become immune to many types of antibiotics. Staphylococcus aureus is a common bacteria that lives on our skin and, most of the time, causes no ill effects. The problems begin to happen if there is a break in the skin - through a cut, a puncture, or some other opening - that allows the staph to enter into the body.

Unchecked MRSA may develop into sepsis. Sometimes called blood poisoning, sepsis is the body's often deadly response to infection or injury. Sepsis kills and disables millions and requires early suspicion and rapid treatment for survival.

Worldwide, one-third of patients who develop sepsis die. Almost 20% of patients who develop sepsis after surgery die. Many who do survive are left with organ dysfunction and/or amputations. (What is the prognosis (outcome) with sepsis?)

There are two types of MRSA infections: community acquired (CA) and hospital acquired (HA). Hospital-acquired infections of any type are called nosocomial infections. The most common type is HA-MRSA, but CA-MRSA is becoming more common.

MRSA infection can also cause pneumonia. This must be treated as quickly as possible to help avoid serious complications.

Sepsis and Urinary Tract Infections Can Cause Wrongful Death Indicates Nursing Home Abuse and Neglect Lawyer Steven Peck

Thu, 05 Jan 2012 06:05:00 -0800

Urinary tract infections, or UTIs, are a common infection that affect more women then men. Most often, they are treated quickly and effectively with antibiotics, the infection becoming a distant memory. Unfortunately, not all UTIs are treated quickly and some aren't even identified quickly, particularly in people who have limited no sensation below the waist or unable to speak for themselves.

An untreated UTI may spread to the kidney, causing more pain and illness. It can also cause sepsis. The term urosepsis is usually used to describe sepsis caused by a UTI.

Sometimes called blood poisoning, sepsis is the body's often deadly response to infection or injury. Sepsis kills and disables millions and requires early suspicion and rapid treatment for survival.

People shouldn't die from a UTI, but if sepsis begins to take over and develops to severe sepsis and then to septic shock, this is exactly what can happen. More than half the cases of urosepsis among older adults are caused by a UTI. Worldwide, one-third of people who develop sepsis die. Many who do survive are left with organ dysfunction and/or amputations.

What Is a Urinary Tract Infection?A urinary tract infection is an infection in the urinary tract, which runs from your kidneys, through the ureters, the urinary bladder and out through the urethra. UTIs are very common and, in general, easy to treat.

A lower UTI, the more common type, affects the lower part of the urinary tract, the urethra and urinary bladder. Infection of the urethra is called urethritis and of the bladder is called cystitis. If the kidney is infected, called pyelonephritis, this is an upper UTI, as the kidney is the highest part of the urinary tract.

A UTI can be caused by bacteria (the most common type of infection) or a fungus.

How Do You Get a UTI?The design of the human body makes it so it isn't difficult to get a bacterial UTI, because the infection comes from outside, through the urethra. Although the UTI is a sterile environment, free of bacteria, the genital area is not. The bacteria can be near the opening of the urethra and find its way in, either through wiping after going to the bathroom, sexual activity, or unsanitary conditions. Once the bacteria has entered the urethra, the body tries its best to fight it off, but sometimes the immune system can't do this, the bacteria multiply, and cause the infection.

In the case of a fungal infection, usually the fungus gets to the urinary tract through the blood stream. Those who develop this type of infection are usually ill with a disease that has compromised their immune system, such as AIDS. (Sepsis and HIV/AIDS)

In general, women get more UTIs than do men and this increases with age. Statistics show that many women get more than one. Almost 20% of women who have had one UTI will go on to have a second. Of this 20%, 30% of those will have a third, and in turn, 80% of these women will have more.

Definition of Sepsis Sometimes Called Blood Poisoning is the Body's Often Deadly Response to Infection or Injury

Wed, 04 Jan 2012 08:00:00 -0800

Medical professionals have been debating the exact definition of sepsis for decades. However, one thing they can agree upon is the origin of the disease. The word sepsis comes from the Greek meaning "decay" or "to putrefy." In medical terms, sepsis is defined as either "the presence of pathogenic organisms or their toxins in the blood and tissues" or "the poisoned condition resulting from the presence of pathogens or their toxins as in septicemia."

Patients are given a diagnosis of sepsis when they develop clinical signs of infections or systemic inflammation; sepsis is not diagnosed based on the location of the infection or by the name of the causative microbe. Physicians draw from a list of signs and symptoms in order to make a diagnosis of sepsis, including abnormalities of body temperature, heart rate, respiratory rate, and white blood cell count. Sepsis may be diagnosed in a 72-year-old man with pneumonia, fever, and a high white blood count, and in a 3-month-old with appendicitis, low body temperature, and a low white count.

Sepsis is defined as severe when these findings occur in association with signs of organ dysfunction, such as hypoxemia, oliguria, lactic acidosis, elevated liver enzymes, and altered cerebral function. Nearly all victims of severe sepsis require treatment in an intensive care unit for several days or weeks. While most cases of sepsis are associated with disease or injury, many events follow routine, even elective surgery.

More frightening is that sepsis can rage in response to incidents as seemingly benign as a playground scrape or a nicked cuticle from the beauty parlor. American hospitals spend approximately $20 billion each year combating sepsis, 40% of patients diagnosed with severe sepsis do not survive. Until a cure for sepsis is found, early detection is the surest hope for survival.

Nursing Home Named In Criminal Complaint says Nursing Home Abuse and Neglect Lawyer Steven Peck

Fri, 23 Dec 2011 15:05:00 -0800

A Yucaipa-based nursing home is named with three people in a criminal complaint filed by the California Attorney General's Office alleging elder abuse.

Braswell's Hampton Manor, Barbara Davis, 44, and Timothy Walker, 56, entered pleas of not guilty at an arraignment on December 22, 2011 in San Bernardino Superior Court.

The nursing home, Davis, Walker and a third person, Amy Nicole Hillrich, are each charged with one felony count of elder abuse causing great bodily injury occurring on Aug. 6, according to court records. The case was filed Dec. 16.

Hillrich, 38, was scheduled for video arraignment Thursday afternoon, according to court personnel. But it was not known if she had been arraigned.

Davis and Walker were released on their own recognizance. They return to court March 12.

In a separate case, Hillrich and David Olvera, 25, and Emilio Pelayo Saldana, 22, face murder charges in the death of Hillrich's ex-husband, John Hillrich, of Fontana, on Aug. 16 in Ontario.

Hillrich, Olvera and Saldana are being held without bail at West Valley Detention Center in Rancho Cucamonga, according to the Sheriff's Department.

Nursing Home Abuse and Neglect Laywer Steven Peck Comments On Bed Sores, Pressure Sores and Decubitus Ulcers

Tue, 06 Dec 2011 06:05:00 -0800

Mrs. W is an 80-year-old woman who was recently discharged from the hospital after treatment of a severe infection in her leg that took a very long time to heal. Her hospitalization was also complicated by facility-acquired Clostridium difficile infection. Because she was still frail, Mrs. W stayed with her daughter following discharge. One morning, her daughter found Mrs. W lying on the bathroom floor awake but nonresponsive and unable to move. Paramedics took Mrs. W to the emergency department of the nearest hospital, where it was determined that she had had a stroke. Mrs. W was admitted to the intensive care unit. On admission, nurses documented a bruise on her right trochanter that was assumed to have been caused by the fall . Eventually this bruise opened up into a full-thickness pressure ulcer.

Noting that Mrs. W was at high risk for a pressure ulcer, bed sores, and decubitus ulcers prevention interventions and skin protection were instituted immediately. Mrs. W was moderately obese and had diabetes, hypertension, and hypothyroidism. She also had evidence of poor peripheral perfusion, and her "tissue tolerance" was judged to be unusually low. These factors probably played a role in the rapid deterioration of Mrs. W's bed sore, pressure sore and skin ulcer and the inability of the nursing staff to halt the progression of the injury despite prompt and diligent nursing care. However, Mrs. W's family was angry about the pressure ulcer, blamed the nursing staff, and initiated a lawsuit against the nurses and the hospital.

The Peck Law Group Is California's Number One Nursing Home Abuse and Neglect Lawyers

Thu, 01 Dec 2011 08:20:00 -0800

The Peck Law Group, California's number one and soon to Be Arizona's premier Nursing Home Abuse and Neglect Lawyers are advocating for more oversight of nursing homes in California, Arizona, and all over the United States..

Recently we were advised of one patient at an nursing home facility that had maggots in her trachea and another patient that had maggots on an open bed sore also known as a pressure sore and decubitus ulcer.These type of cases are specific examples and unfortunately are not isolated incidents or unique to any particular nursing home. Rather, they are indicative of a statewide failures to provide quality nursing care at all times and to protect nursing facility residents from harm says Nursing Home Abuse and Neglect Lawyer Steven Peck.other incidents which we have litigated include, a skull fracture from a fall from wheelchair wherein the resident died three days later because of bleeding in the brain, another patient dying from injuries sustained in a fall from a wheelchair without foot pedals, and what seems like a typcial nursing home negelct problem of Elopement transpired when a resident was able to leave a nursing home facility and sat in a wheelchair on the side of the road and no staff members were disciplined.

Low Nurse Staffing Levels are Considered the Strongest Predictor of Poor Nursing Home Quality Leading to Abuse and Neglect says California Elder Abuse Attorney Steven Peck

Wed, 30 Nov 2011 07:40:00 -0800

Low nurse staffing levels are considered the strongest predictor of poor nursing home quality leading to abuse and neglect says California Elder Abuse Attorney Steven Peck.

The 10 largest for-profit chains operate about 2,000 nursing homes in the United States, controlling approximately 13 percent of the country's nursing home beds.

In recent decades, nursing home chains have undergone a considerable expansion. A number of chains were publicly-traded companies until the early 2000s, when five of the country's largest chains went bankrupt. Following restructuring and ownership changes, as well as increases in Medicare payments, the largest chains became more financially stable. More recently, some of the largest publicly held chains were purchased by private equity investment firms, which invest funds received from investors, with whom they share profits and losses.

The researchers compared staffing levels and facility deficiencies at the for-profit chains to those at homes run by five other ownership groups to measure quality of care. The 10 largest chains were selected because they are influential in the nursing home industry and are the most successful in terms of growth and market share.

The study found that for-profit homes strive to keep their costs down by reducing staffing, particularly RN staffing which lower staffing could lead to bed sores, malnutrition, dehydration, and infections.

Recent Medicare cuts in payment rates for nursing home residents - by 11 percent in October, 2011 - may further jeopardize the health and safety of residents if the chains respond by reducing staffing and wages, Harrington said.

The 10 largest for-profit chains in 2008 were HCR Manor Care, Golden Living, Life Care Centers of America, Kindred Healthcare, Genesis HealthCare Corporation, Sun Health Care Group, Inc., SavaSeniorCare LLC, Extendicare Health Services, Inc., National Health Care Corporation, and Skilled HealthCare, LLC.

From 2003 to 2008, these chains had fewer nurse "staffing hours" than non-profit and government nursing homes when controlling for other factors. Together, these companies had the sickest residents, but their total nursing hours were 30 percent lower than non-profit and government nursing homes. Moreover, the top chains were well below the national average for RN and total nurse staffing, and below the minimum nurse staffing recommended by experts.

The 10 largest for-profit chains were cited for 36 percent more deficiencies and 41 percent more serious deficiencies than the best facilities. Deficiencies include failure to prevent pressure sores, bed sores and decubitus ulcers, resident weight loss, falls, infections, resident mistreatment, poor sanitary conditions, and other problems that could seriously harm residents such as malnutrition and dehydration.

The study also found that the four largest for-profit nursing home chains purchased by private equity companies between 2003 and 2008 had more deficiencies after being acquired. The study is the first to make the connection between worse care following acquisition by private equity companies.

The authors said that more study is needed on the subject. They also said that greater accountability and quality oversight mechanisms would help improve nursing home care, along with effective funding incentives and sanctions for low staffing and poor quality.

Source: UCSF

C. Difficile Infections Are Prevelant In Nursing Homes says Elder Abuse Lawyer Steven Peck

Wed, 23 Nov 2011 06:05:00 -0800

A couple of new developments on the C. difficile front should be encouraging news to anyone who is familiar with this potentially deadly bacterial infection. You might also know it as CDI, or Clostridium difficile infection.

First, scientists from UCLA and the University of Texas have been looking at possible cellular defense mechanisms against the two toxins that are released into the gut whenever C. difficile germs are growing in number. The scientists believe that human cells in the gut are capable of releasing molecules that will knock down these toxins, and that the cells can put up a fight through a drug-induced process called protein s-nitrosylation.

The process is seen as a much-needed new therapeutic approach toward an infection that often resists treatment with antibiotics. As of August 2011, the research team was ready to conduct clinical trials on humans, after successful trials on animals.

Second, the fight against C. difficile continues with at least three different research projects that show the effectiveness of fecal microbiota transplants for those patients whose infections keep recurring. That's right -- fecal material is transplanted into the patient's body, usually by colonoscopy or by an infusion into the rectum.

Though it may sound unpleasant, the evidence suggests it can quickly stop C. difficile-related diarrhea and may eventually prove useful in reversing inflammatory bowel disease. The introduction of healthy fecal bacteria can restore balance to a digestive system wracked by CDI, the experts said.

The majority of C. difficile infections occur in hospital or nursing home settings, often because of poor hygiene. Overuse of antibiotics poses another problem, as the body loses the strains of bacteria that could normally fend off C. difficile.

In the United States, hundreds of thousands of people acquire C. difficile infections each year, with fatalities numbering between 15,000 and 20,000, according to an April 14, 2009, article in The New York Times. The symptoms include moderate to severe diarrhea, fever, nausea, loss of appetite, abdominal pain and, in some cases, colitis.

Sepsis Infection Can Cause Septic Shock a Potentially Lethal Drop In Blood Pressure Due to the Presence of Bacteria In the Blood indicates Elder Abuse Lawyer Steven Peck

Tue, 22 Nov 2011 06:05:00 -0800

Sepsis refers to a bacterial infection in the bloodstream or body tissues. This is a very broad term covering the presence of many types of microscopic disease-causing organisms says Elder Abuse Lawyer Steven Peck. Sepsis is also called bacteremia. Closely related terms include septicemia and septic syndrome.

Sepsis can originate anywhere bacteria can gain entry to the body; common sites include the urinary tract, the liver and its bile ducts, the gastrointestinal tract, and the lungs. Broken or ulcerated skin (bed sores, pressure sores and decubitus ulcers) can also provide access to bacteria commonly present in the environment. Invasive medical procedures, including dental work, can introduce bacteria or permit it to accumulate. Entry points and equipment left in place for any length of time present a particular risk. Heart valve replacement, catheters, ostomy sites, intravenous(IV) or arterial lines, surgical wounds, or surgical drains are examples. IV drug users are at high risk as well.

The most common symptom of sepsis is fever, often accompanied by chills or shaking, or other flu-like symptoms. A history of any recent invasive procedure or dental work should raise the suspicion of sepsis and medical help should be sought.

The presence of sepsis is indicated by blood tests showing particularly high or low white blood cell counts. The causative agent is determined by blood culture.

Identifying the specific cause ultimately determines how sepsis is treated. However, time is of the essence, so a broad-spectrum antibiotic or multiple antibiotics will be administered until blood cultures reveal the culprit and treatment can be made specific to the organism. Intravenous antibiotic therapy is usually necessary and is administered in the hospital.

Septic shock is a potentially lethal drop in blood pressure due to the presence of bacteria in the blood.

Septic shock is a possible consequence of bacteremia, or bacteria in the bloodstream. Bacterial toxins, and the immune system response to them, cause a dramatic drop in blood pressure, preventing the delivery of blood to the organs. Septic shock can lead to multiple organ failure including respiratory failure, and may cause rapid death. Toxic shock syndrome is one type of septic shock.

During an infection, certain types of bacteria can produce and release complex molecules, called endotoxins, that may provoke a dramatic response by the body's immune system. Released in the bloodstream, endotoxins are particularly dangerous, because they become widely dispersed and affect the blood vessels themselves. Arteries and the smaller arterioles open wider, increasing the total volume of the circulatory system. At the same time, the walls of the blood vessels become leaky, allowing fluid to seep out into the tissues, lowering the amount of fluid left in circulation. This combination of increased system volume and decreased fluid causes a dramatic decrease in blood pressure and reduces the blood flow to the organs. Other changes brought on by immune response may cause coagulation of the blood in the extremities, which can further decrease circulation through the organs.

Septic shock is seen most often in patients with suppressed immune systems, and is usually due to bacteria acquired during treatment at the hospital. The immune system is suppressed by drugs used to treat cancer, autoimmune disorders, organ transplants, and diseases of immune deficiency such as AIDS. Malnutrition, chronic drug abuse, and long-term illness increase the likelihood of succumbing to bacterial infection. Bacteremia is more likely with preexisting infections such as urinary or gastrointestinal tract infections, or bed sores, pressure sores and decubitus ulcers. Bacteria may be introduced to the blood stream by surgical procedures, catheters, or intravenous equipment.

Septic shock is usually preceded by bacteremia, which is marked by fever, malaise, chills, and nausea. The first sign of shock is often confusion and decreased consciousness. In this beginning stage, the extremities are usually warm. Later, they become cool, pale, and bluish. Fever may give way to lower that normal temperatures later on in sepsis.

Other symptoms include:

•Rapid heartbeat
•Shallow, rapid breathing
•Decreased urination.
•Reddish patches in the skin.

Septic shock may progress to cause "adult respiratory distress syndrome," in which fluid collects in the lungs, and breathing becomes very shallow and labored. This condition may lead to ventilatory collapse, in which the patient can no longer breathe adequately without assistance.

Diagnosis of septic shock is made by measuring blood pressure, heart rate, and respiration rate, as well as by a consideration of possible sources of infection. Blood pressure may be monitored with a catheter device inserted into the pulmonary artery supplying the lungs. Blood cultures are done to determine the type of bacteria responsible. The levels of oxygen,carbon dioxide, and acidity in the blood are also monitored to assess changes in respiratory function.

Septic shock is treated initially with a combination of antibiotics and fluid replacement. The antibiotic is chosen based on the bacteria present, although two or more types of antibiotics may be used initially until the organism is identified. Intravenous fluids, either blood or protein solutions, replacethe fluid lost by leakage. Coagulation and hemorrhage may be treated with transfusions of plasma or platelets. Dopamine may be given to increase blood pressure further if necessary.

Respiratory distress is treated with mechanical ventilation and supplemental oxygen, either using a nosepiece or a tube into the trachea through the throat.

Identification and treatment of the primary infection site is important to prevent ongoing proliferation of bacteria.

Septic shock is most likely to develop in the hospital, since it follows infections which are likely to be the objects of treatment. Because of this, careful monitoring and early, aggressive therapy can minimize the likelihood of progression. Nonetheless, death occurs in at least 25% of all cases.

The likelihood of recovery from septic shock depends on may factors, including the degree of immuno suppression of the patient, underlying disease, promptness of treatment, and type of bacteria responsible. Mortality is highest in the very young and the elderly, those with persistent or recurrent infection,and those with compromised immune systems.

The risk of developing septic shock can be minimized through treatment of underlying bacterial infections, and prompt attention to signs of bacteremia.

Patient Care In Nursing Homes Is Regulated In The State of California says Nursing Home Abuse and Neglect Attorney Steven Peck

Fri, 18 Nov 2011 07:40:00 -0800

Nursing Service -Patient Care.
(a) No patient shall be admitted or accepted for care by a skilled nursing facility except
on the order of a physician.
(b) Each patient shall be treated as individual with dignity and respect and shall not be
subjected to verbal or physical abuse of any kind.
(c) Each patient, upon admission, shall be given orientation to the skilled nursing facility
and the facility's services and staff.
(d) Each patient shall be provided care which shows evidence of good personal hygiene,
including care of the skin, shampooing and grooming of hair, oral hygiene, shaving or
beard trimming, cleaning and cutting of fingernails and toenails. The patient shall be free
of offensive odors.
(e) Each patient shall be encouraged and/or assisted to achieve and maintain the highest level of self-care and independence. Every effort shall be made to keep patients active, and out of bed for reasonable periods of time, except when contraindicated by physician's
orders.
(f) Each patient shall be given care to prevent formation and progression of decubiti,contractures and deformities. Such care shall include:
(1) Changing position of bedfast and chairfast patients with preventive skin care in
accordance with the needs of the patient.
(2) Encouraging, assisting and training in self-care and activities of daily living.
(3) Maintaining proper body alignment and joint movement to prevent contractures and
deformities.
(4) Using pressure-reducing devices where indicated.
(5) Providing care to maintain clean, dry skin free from feces and urine.
(6) Changing of linens and other items in contact with the patient, as necessary, to
maintain a clean, dry skin free from feces and urine.
(7) Carrying out of physician's orders for treatment of decubitus ulcers. The facility shall
notify the physician, when a decubitus ulcer first occurs, as well as when treatment is not
effective, and shall document such notification as required in Section 72311(b).
(g) Each patient requiring help in eating shall be provided with assistance when served,
and shall be provided with training or adaptive equipment in accordance with identified
needs, based upon patient assessment, to encourage independence in eating.
(h) Each patient shall be provided with good nutrition and with necessary fluids for
hydration.
(i) Measures shall be implemented to prevent and reduce incontinence for each patient
and shall include:
(1) Written assessment by a licensed nurse to determine the patient's ability to participate
in a bowel and/or bladder management program. This is to be initiated within two weeks
after admission of an incontinent patient.
(2) An individualized plan, in addition to the patient care plan, for each patient in a bowel
and/or bladder management program.
(3) A weekly written evaluation in the progress notes by a licensed nurse of the patient's
performance in the bowel and/or bladder management program.
(j) Fluid intake and output shall be recorded for each patient as follows:
(1) If ordered by the physician.
(2) For each patient with an indwelling catheter:
(A) Intake and output records shall be evaluated at least weekly and each evaluation shall be included in the licensed nurses' progress notes.
(B) After 30 days the patient shall be reevaluated by the licensed nurse to determine
further need for the recording of intake and output.
(k) The weight and length of each patient shall be taken and recorded in the patient's
health record upon admission, and the weight shall be taken and recorded once a month
thereafter.
( l) Each patient shall be provided visual privacy during treatments and personal care.
(m) Patient call signals shall be answered promptly

Surgical Treatment of Bed Sores, Pressure Sores and Decubitus Ulcers Can Be Very Painful and Costly Says Nursing Home Abuse and Neglect Lawyer Steven Peck

Thu, 17 Nov 2011 07:00:00 -0800

Surgical Treatment There are many different types of surgeries used to treat pressure sores, bed sores and decubitus ulcers.. Debridement is an option to surgically clean and remove any dead or infected skin and muscle. This debriding creates a larger wound, but the area is healthy and more likely to heal. In many cases a small amount of bone is also removed from the base of the wound to decrease recurrence of infection. In some cases, the hip joint will need to be removed along with a portion of the thigh bone.

Reconstructive surgery involves the removal of healthy tissue from one place on the body to cover a wound somewhere else. The skin and/or muscle (the flap) is usually taken from the back, buttocks or thigh. This flap tissue, which has a good blood supply, is repositioned to cover the wound and help nourish the tissue around the pressure sore. Once the pressure sore is covered, the area where the flap tissue was removed is closed. Sometimes skin grafts are used to close these areas.

Multiple Pressure Sores Some people have more than one pressure sore. It is not uncommon that surgery on these areas must be spread out over more than one surgery. If reconstruction can be accomplished with a single operation, it may require a more radical treatment option if there are multiple or very large wounds. In severe cases, a leg may be amputated to provide the necessary tissue for the reconstruction. For example, a total thigh flap requires amputation of the leg so the skin and muscle from the front of the thigh is used to fill the wound.

Postoperative Care After surgery, it is very important take care of the repaired area to reduce the risk for complication. Care starts with transferring from the operating table to the air-fluid bed. Patients are positioned flat in the air-fluid bed for 4 weeks. Movement is limited to prevent shearing and tension across the flap repair. After 4 weeks, patients can be wedged carefully into the semi-sitting position. Six weeks after surgery, patients can begin sitting for 10 minute intervals. After each interval, the flap area is examined for discoloration and wound edge separation. The sitting periods are increased at 10 minute intervals over 2 weeks and reaching up to 2 hours of sitting at a time. Pressure reliefs are needed for 10 seconds at least every 15 minute while sitting. Patients will need to continue using a pressure-reducing mattresses and turn in bed every 2 hours.

Individuals with SCI have other concerns. Involuntary muscle spasms must be well controlled to allow proper healing after surgery. Bacteria, which is the source of infection, is easily brought into the bladder with Intermittent Catheterization, Foley, and Suprapubic methods of bladder management. It is important to prevent infections, and antibiotic treatment is needed if bacteria are present in urinary cultures or urinalysis.

Special equipment is also needed to allow healing to progress normally. Because this is so important, all equipment are secured before surgery is scheduled. The equipment might include a pressure-reducing mattress (such as an air-fluidized bed or low air loss mattress) and a proper seat cushion for patients using wheelchairs. In addition, plans for recovery include setting up home health care or staying in a rehabilitation facility or assisted living center to recover.

In most cases the area of the pressure sore and reconstructive flap does not have sensation. It is also important to note that reconstruction cannot restore normal sensation. Wound disruption or delayed wound healing is possible, and some areas of the flap skin may heal abnormally or slowly.

Without these precautions, wound breakdown or pressure sore recurrence is extremely likely. Treatment may require frequent dressing changes or further surgery to remove the non-living tissue and an additional reconstructive procedure.

Risks of Flap Reconstruction
Every surgical procedure involves a certain amount of risk, and it is important that you understand the risks involved with the reconstruction of a pressure sore. An individual's choice to undergo a surgical procedure is based on the comparison of the risk to potential benefit. Although the majority of patients do not experience the following complications, you should discuss each of them with your surgeon to make sure you understand the risks, potential complications, and consequences of reconstruction with flap surgery.

Bleeding is possible during or after surgery. If bleeding occurs, it may require emergency treatment to drain accumulated blood (hematoma).

Infection can occur after surgery. Should an infection occur, treatment including antibiotics or additional surgery may be necessary. If an infection does not respond to antibiotics, the reconstruction may to be opened. After the infection is treated, additional reconstruction may be needed.

Flap Failure is possible despite all best efforts. Failure sometimes occurs when a blockage or compression occurs at the point of blood flow to the flap.

Even though risks and complications occur infrequently, the risks cited above are the ones that are commonly associated with flap reconstruction surgery. Other complications and risks can occur but are uncommon. Should complications occur, additional surgery or other treatments may be necessary.

Every pressure sore, bed sore and decubitus ulcer is unique, and a great deal depends on individual circumstances. Ask your doctor to explain anything you do not understand. Also, you should also ask your doctor for educational information that specifically details the procedure you are considering for yourself.

Bed Sores, Pressure Sores and Decubitus Ulcers Are a Result of Prolonged Pressure

Wed, 16 Nov 2011 06:30:00 -0800

What Are Bedsores?
Bedsores are also known as pressure sores or pressure ulcers. They occur as a result of prolonged pressure on the skin and underlying tissue in sensitive areas, most often the boney areas of the body such as the back, buttocks, hips, ankles and heels. Bedsores can develop quickly and can be difficult to treat because those who are most often affected are those with mobility issues that keep them from changing positions easily. Those who are bedridden or are confined to a wheelchair are at a high risk for developing bedsores.

Causes and Risk Factors
There are three factors that play a role in bedsores developing:
•Sustained Pressure: When the skin is trapped between a bony surface and the surface of a bed or wheel chair, blood flow can be interrupted because the pressure that depriving the area of blood flow is greater than the body's ability to pump blood to that area.
•Friction: When someone tries to move after being in a certain position for a long period of time, as is the case with those people in wheelchairs or those who are bedridden, friction between the skin and the surface they are on can contribute to bedsores. Friction is worse if the skin is moist, as in the case of those with urinary incontinence.
•Shear: Shear occurs when two surfaces move in opposite directions, such as when the head of a hospital bed is raised. As the head of the bed moves up, gravity pulls the body downward, resulting in a shear effect between a person's back and the bed.
Those most at risk for developing bedsores are those who have limited mobility. Immobility can be caused by a number of problems:

•Poor health
•Obesity resulting in immobility
•Sedation
•Injury or illness requiring bed rest or wheel chair use
•Recovery after surgery
•Paralysis
•Coma
Other factors that contribute to bedsores include:

•Lack of sensory perception
•Poor nutrition or hydration
•Age
•Decreased mental awareness
•Weight loss
•Incontinence
•Excessive moisture or dryness of skin
•Smoking
•Decreased circulation
•Muscle spasms

There Are Many Distinct Factors Which Contribute to The Development of Pressure Sores, Bed Sores and Decubitus Ulcers says Elder Abuse Attorney Steven Peck

Tue, 15 Nov 2011 07:05:00 -0800

Many factors contribute to the development of Pressure sores also known as Bed Sores and Decubitus Ulcers. Pressure leading to ischemia is the final common pathway. Tissues are capable of withstanding enormous pressures when brief in duration, but prolonged exposure to pressures initiates a downward spiral towards ulceration.

Impaired mobility is an important contributing factor. Patients who are neurologically impaired, heavily sedated, restrained, or demented are incapable of assuming the responsibility of altering their position to relieve pressure. Moreover, this paralysis leads to muscle and soft-tissue atrophy, decreasing the bulk over which these bony prominences are supported.

Contractures and spasticity often contribute by repeatedly exposing tissues to pressure through flexion of a joint. Contractures rigidly hold a joint in flexion, while spasticity subjects tissues to considerable repeated friction and shear forces.

Sensory loss also contributes to ulceration, by removing one of the most important warning signals, pain.

Paralysis and insensibility also lead to atrophy of the skin with thinning of this protective barrier. The skin becomes more susceptible to minor traumatic forces, such as friction and shear forces, exerted during the moving of a patient. Trauma causing deepithelialization leads to transdermal water loss, creating maceration and adherence of the skin to clothing and bedding, which raises the coefficient of friction for further insult.

Malnutrition, hypoproteinemia, and anemia reflect the overall status of the patient and can contribute to vulnerability of tissue and delays in wound healing. Poor nutritional status certainly contributes to the chronicity often observed with these lesions. Anemia indicates poor oxygen-carrying capacity of the blood. Vascular disease also may impair blood flow to the region of ulceration.

Bacterial contamination from improper skin care or urinary or fecal incontinence, while not truly an etiological factor, is an important factor to consider in the treatment of pressure sores and can delay wound healing

Nursing Home Abuse and Neglect Often Transpires Because of Understaffing

Mon, 14 Nov 2011 07:45:00 -0800

Nursing Home Neglect and Abuse is often caused by the understaffing of the nursing care facility. The results of understaffing in any medical care facility can be catastrophic. An overworked nursing staff may leave an elder patient sitting or lying too long in one place, fail to clean up an elder properly, or not give the resident their medication when it is critical that it is done so, Elder patients are especially vulnerable to skin breakdown and need to be turned and repositioned at least very two hours otherwise the elder will certainly acquire bed sores, pressure sores and decubitus ulcers.

Evidence shows that higher staff levels and lower nurse turnover are linked to fewer pressure ulcers, catheterized patients, and urinary tract infections. Inadequate food intake (malnutrition) is a major reason frail elderly people die in nursing homes. Nursing homes must be sufficiently staffed to attend to residents who need assistance and supervision at mealtimes to assure proper nutritional intake and hydration. Low staffed facilities are unable to encourage residents to remain as independent as possible and to encourage participation in activities intended to promote in mental acuity and physical health.

Nursing Home Infections Are Cause For Concern says Elder Abuse Attorney Steven Peck

Sat, 12 Nov 2011 14:50:00 -0800

Health care-associated infections caused by antimicrobial drug-resistant bacteria have caused both endemic infections and outbreaks in nursing homes in the United States. The frequent movement of patients between hospitals and nursing homes undoubtedly facilitates the transfer of resistant microbes. During the last 2 decades, gram-negative uropathogens with multidrug resistance and methicillin-resistant S. aureus have received the most attention[. Gram-negative enteric bacilli have recently become resistant to fluoroquinolones and extended-spectrum cephalosporins. In addition, vancomycin-resistant enterococci and penicillin-resistant pneumococci have been identified in long-term care facilities[. The appearance of the latter organism, which is seldom regarded as a nosocomial pathogen, again underscores the unique situation of this health-care setting. Because the frequent interchange of patients between hospitals and nursing homes, infections caused by antimicrobial drug-resistant bacteria will continue to emerge in geriatric populations.