What is a bedsore? What are it's stages? / Risk Measurement Scale (Norton Scale)

During lying, the weight of the body exerts pressure on the parts which contact the bed. At those who are dependent to a chair or a bed this pressure is always exerted on the exact same spot.Thus, at the parts which the pressure is exerted the blood flow and nutrition are interrupted, skin and sub surface skin tissue are damaged. As a result of all these, bedsores may occur. Frictions makes it easy for bedsores to occur, pushes newly occured bedsores forward. Urine, sweat and stools also cause bedsores. Infections occuring on the bedsores is also a common issue.

Although bedsores are seen as an issue of chronical patients, the beginning of ulcers generally coincides with the acute period of diseases. The main reason for it is that all the attention is focused on the primary disease of the patients and the risk of ulcer development is usually ignored.

63% of all the ulcers are developed while the patient is still in the hospital. It is reported that bedsores are developed 41% during cardiovasculer diseases, 27% during acute neurologic defects, and 15% after orthopedic woundings.

Bedsores interrupt one's comfort, increases the risk of diseases and death, prolongs the period of hospitalization and increases the financial burden. Thus, bedsores are important health problems.

However, this issue can be solved before it can start with the use of very basic methods.

Who are under the risk of bedsores? Those who are dependent on a chair or a bed, those whose movements are limited, those who have sensation fault due to nerve damages (spinal cord damages, diabetics etc.), those with circulation issues, the elders and those who are overweight or underweight are under the risk of bedsores. Since more pressure is exerted on the tissues the overweight and due to the lack of sufficient sub surface skin tissue the underweight are under the risk of bedsores. At those who have urinary incontinence - encopresis and who are not on a healthy diet - don't drink sufficient liquid, the occurance of bedsores is much common. If a bedsore has occured on a place, the risk of a second bedsore at the same spot is even higher.

Bedsore Occurance Spots: Bedsores occur at spots that carry the body weight. These places are sacrococcyeal articulation, hips, elbows, heels, shoulders, knees, ankles, head and ears. The spot under the breasts, abdominal areas and the areas between body curves are also at risk for the overweight. The red dotted areas in the picture are the areas which bedsores may occur.

How to protect against bedsores? Check the areas, which contacts with the bed, of the patient daily. To protect one from bedsores, you should check the skin of the patient's skin regularly.

Make the patient change his/her lying position more often. Changing the lying position also changes the areas which the pressure is exerted. Make the patient change his/her lying position at every 2 hours for optimal protection. Using an air bearing is one of the precautions against bedsores.

Keep the bed linings of the patient dry, clean and creaseless. Bed linings, wheelchair, chair etc of the patient should always be kept clean and dry. The bed linings should not be creased. Do not use synthetic clothes or bed linings that do not suck up sweat and wet. The skin of the patient should be clean and dry. After a toilet visit, the area should be
cleaned with materials that are not irritant and cool water then should be dryed immidiately. Alcohol and  cologne
should not be rubbed at patient's skin.

Make sure that your patient is on a healthy diet and consumes sufficient liquid. A healthy diet and sufficient liquid consumption are protective against bedsores. You can always talk to your doctor or a diet expert for some tips.

Do some massages to your patient and make him/her do some exercise. Massages and exercises at the motionless area speeds up the blood flow at the parts which the pressure is exerted and prevents the bedsore occurance.

Do not forget that even though all these precautions, bedsores may still occur. For this reason, you should look at what to do to treat bedsores as soon as possible.

How do you realise that a bedsore is about to occur? A redness that does not go away after straitening, a rise in temperature and oedema can be seen on the spot that the bedsore is occuring. After the damage in the skin has started, a drop in the temperature replaces the rise. In the advanced stages blue-purple change in color and hydrocele is reported to be seen.

If you find any change in color or temperature and hardness on the protruding body parts of the patient that contacts the bed, you should talk to your doctor immidiately.

Classification of bedsores: Although there are different classifications of bedsores in terms of deepness, the most common one has 4 phases.

First Phase: There is a redness and oedema that do not go away when straitened. Pressure has damaged the skin, but with well care the recovery will be fast and complete. This phase is also called as the early phase.

Second Phase: There is a  bionecrosis that advanced to sub surface skin tissue. Recovery can still be achieved through non-surgical methods.

Third Phase: There is a complete bionecrosis in the skin. The damage is now in the sub surface skin tissue. If a secondary infection occurs, the treatment will be hard to accomplish. Surgery in wide lesions is required.

Fourth Phase: The damage now also includes the bony tissue and has advanced to the splint. The only treatment now is surgery.

What kind of medical experts treats bedsores? Dealing with bedsores includes preventing the occurance of bedsores, early diagnosis, and properly treating it. This conditions can only be achieved through a team which is in well communication. This team includes the patient (should be  conscious and even if limited, should have locomation), patient relatives, nurses,  physiotherapists, skin diseases experts and plastic surgeons.



*External Factors





*Internal Factors

-Old age

-Diabetics and other

-Chronic diseases

-Blood pressure

-Unhealthy diet

-Loss of sense and hypokinesia

-Overuse of steroids


Measuring the risk of bedsore (Norton Scale)


Motivation-Age-Skin-Additional Disease-Body Condition-Mental Condition-Mobility-Locomotion-Incontinence

Full-Normal-None-Good-Clear-Can Walk On His/Her Own-Full-None

Average-Dry,Scurfy-Fever,Diabetics,Anemia-Average-Apathic,Depressive-Can Walk with Help-Limited-Sometimes

Low-Wet-MS,Ca,Cachexia,Adipositas-Bad-Convulsive-Wheel Chair-Very Limited-Often

None-Allergic,Crevices-Coma,Paralysis-Too Bad-Unconscious-Confined to bed-All Limited-Urine and Feces

If your total point is below 25, there is a risk of bedsores. You should take protective precautions. (Source:NPUAP.ORG)