Stages of pressure ulcers pdf

Topic Overview Pressure injuries are described in four stages. Stage 1 sores are not open wounds. The skin may be painful, but it has no breaks or tears. The skin appears reddened and does not blanch lose color briefly when you press your finger on it then remove your finger.

In a dark-skinned person, the area may appear to be a different color than the surrounding skin, but it may not look red. Skin temperature is often warmer. And the stage 1 sore can feel either firmer or softer than the area around it. At stage 2 , the skin usually breaks open, wears away, or forms an ulcer, which is usually tender and painful. The sore expands into deeper layers of the skin. It can look like a scrape abrasion or a shallow crater in the skin.

Sometimes this stage looks like a blister filled with clear fluid. At this stage, some skin may be damaged beyond repair or may die. During stage 3 , the sore gets worse and extends into the tissue beneath the skin, forming a small crater. Fat may show in the sore, but not muscle, tendon, or bone. This Data Brief presents the most recent national estimates of pressure ulcer prevalence, resident characteristics associated with pressure ulcers, and the use of wound care services in U.

Keywords: pressure ulcers, wound care, nursing home residents, quality of care. Of the 1. There was no significant difference between white and nonwhite populations with respect to having pressure ulcers. Various demographic and clinical factors were related to having a pressure ulcer in a nursing home. Residents in a nursing home for a year or less since admission, who had a recent weight loss, or who had high immobility had the highest prevalence of pressure ulcers.

This suggests that a minority of nursing home residents with stage 2 or higher pressure ulcers received wound care in accordance with the clinical practice guidelines.

Pressure ulcers are serious and common medical conditions in U. Information from this Data Brief on pressure ulcer prevalence and service use among nursing home residents with pressure ulcers may provide a foundation for targeting public health efforts. Pressure ulcers : Nursing home providers were asked the highest stage of any pressure ulcer the sampled resident currently had.

This measure had five categories: no pressure ulcer, stage 1, stage 2, stage 3, and stage 4. High Immobility : It is measured using two measures, bed mobility how resident moves to and from lying position, turns side to side, and positions body while in bed and transfer how resident moves between surfaces-to and from: bed, chair, wheelchair, and standing position.

Each measure had five response categories: independent, supervision, limited assistance, extensive assistance, and total dependence. Recent Incontinence : It is measured using five categories: continent, usually continent incontinent episodes less than weekly , occasionally incontinent incontinent episodes once a week , frequently incontinent incontinent 2 to 3 times a week , and total dependence incontinent all or almost all of the time in the last 14 days.

Special programs have one or more specially trained professionals or staff dedicated to the program. This does not include special training and services provided by all staff members. NNHS is a continuous cross-sectional survey of a nationally representative sample of U. It is designed to provide descriptive information on nursing homes, their services, their staff members, and the residents they currently serve. Stage two pressure ulcers will usually be red and warm to the touch. There may also be clear fluid in the broken skin.

To prevent progression to stage three, every effort must be made to pad the sore and alter the body's position frequently. If treated properly, a stage two pressure ulcer can take anywhere from four days to three weeks to resolve. Stage three ulcers are characterized by a lesion that extends well into the dermis and begins to involve the hypodermis also known as the subcutaneous layer. Fat may begin to show in the open sore but not muscle, tendon, or bone.

In some cases, there may be visible pus and a foul smell. This type of ulcer opens the body to infection and leads to serious complications, including osteomyelitis a bone infection and sepsis caused by an infection entering the bloodstream.

With aggressive and sustained treatment, a stage three pressure ulcer can resolve in one to four months depending on its size and depth. Stage four pressure ulcers occur when the hypodermis and underlying fascia are breached, exposing muscle and bone. Damage to deeper tissues, tendons, nerves, and joints may occur, usually with copious amounts of pus and drainage.

Stage four pressure ulcers require aggressive treatment to avoid systemic infection and other potentially life-threatening complications. Even with effective treatment in a care facility, a stage four pressure ulcer can take two to six months or even longer to heal. If a pressure ulcer is deep and mired in overlapping tissue, your healthcare provider may not be able to accurately stage it. This type of ulcer is considered unstageable and may require extensive debridement removal of dead tissue before the stage can be determined.

Some pressure ulcers may appear on first glance to be stage one or stage two, but the underlying tissues may be more extensively damaged.

In this case, the ulcer may be classified as stage one with a suspected deep tissue injury SDTI. Upon further examination, an SDTI can sometimes turn out to be a stage three or four pressure ulcer.

If a loved one is hospitalized and unable to move, you need to be vigilant in recognizing—and ideally preventing—a pressure ulcer. A healthcare provider or physical therapist can work with you and the nursing team to ensure the following preventive measures:. Call your healthcare provider if you notice a sore, redness, warmth, or any other change in the skin that last for more than a few days.

The earlier you treat a pressure ulcer, the better. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Reddy M. Pressure ulcers. BMJ Clin Evid. Bhattacharya S, Mishra RK. Pressure ulcers: Current understanding and newer modalities of treatment. Indian J Plast Surg. Agrawal K, Chauhan N. Pressure ulcers: Back to the basics.

Wake WT. Pressure ulcers: what clinicians need to know. Perm J.