Causes of bed sores are?

RUHS, Jaipur, M.Sc Nursing Entrance Exam-2018

Medical Surgical Nursing

Easy

Appeared in: RUHS, Jaipur, M.Sc Nursing Entrance Exam-2018

Explanation

Bed sores (pressure injuries) are multifactorial, meaning they result from several combined causes.
Friction abrades the superficial layer of the skin, compromising its integrity.
Moisture from incontinence or sweat weakens the skin through maceration, making it more susceptible to breakdown.
Pathogenic organisms, often introduced in moist environments, can cause infection in compromised skin, which exacerbates tissue damage and prevents healing.
Because all listed options are recognized contributing factors to the development and progression of bed sores, the most comprehensive answer is 'All of the above'.

Option A: This option is correct, but it represents only one of several contributing factors. Choosing this option alone would be incomplete.
Option B: This option is a valid contributing factor, but it is not the sole cause. The answer is incomplete.
Option C: This is a correct contributing factor, especially in the progression and non-healing of a pressure injury, but it is not the only cause. The answer is incomplete.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Etiology of Pressure Injuries (Bed Sores) as background academic context rather than a clinical decision trigger.
Nurses use risk assessment tools like the Braden Scale to evaluate a patient's risk for developing pressure injuries. This scale specifically assesses sensory perception, moisture, activity, mobility, nutrition, and friction/shear.
Preventing bed sores is a key nursing responsibility. Interventions are targeted at the causes: frequent repositioning (to relieve pressure), using lifting devices (to reduce friction/shear), and implementing a toileting schedule or using barrier creams (to manage moisture).
What if? If a patient has good mobility and is continent but has poor nutrition, their primary risk is not friction or moisture but poor tissue tolerance. The nursing focus would shift to nutritional support to strengthen the skin from within, although other preventive measures remain important.

How to Approach the Question

First, read the question carefully to understand what is being asked: 'Causes of bed sores'.
Next, evaluate each option independently. Is friction a cause? Yes. Is moisture a cause? Yes. Is the presence of pathogenic organisms a contributing factor? Yes, they cause infection in broken skin.
Recognize that multiple options (A, B, and C) are all factually correct contributing factors to the development or worsening of bed sores.
When you identify that several individual options are correct, look for an 'All of the above' or 'None of the above' option.
In this case, since A, B, and C are all valid, 'All of the above' (Option D) is the most complete and therefore the best answer.

Concept Tested & Keywords

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E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 68-70

E6 Nursing Fundamentals Taylor p. 555-557