By Jessica Hegg
Pressure ulcers are one of those day-to-day realities many of us face while caregiving. Avoiding pressure ulcers in anyone who is bedridden for an extended period of time – even when you’re vigilant and take precautions, preventative measures, and examine patients early and often, is a difficult task. They’re pernicious that way, so knowing how to recognize and treat every stage of a pressure ulcer is very important.
In this guide, we’ll take you through a step-by-step look at each stage of pressure ulcers, and give you some tips on recognizing them, and knowing what treatment options are available.
STAGE I - LOW RISK
Stage I pressure ulcers generally present rather mildly. Skin is discolored, and some tissue has begun to die, indicated by discoloration – purplish, blue, red, and bruise-like in light-skinned patients, and often a whitish discoloration in darker-skinned patients.
An easy way to recognize these pressure ulcers is with a simple fingertip-pressure method. If you think an area may be affected, simply press down on with one finger to check for both discomfort, and skin blanching. If the skin does not blanch (whiten) in response to light pressure, meaning blood does not get pushed away from the area you press, you likely have a stage I pressure ulcer on your hands.
Treatment of these ulcers generally involves moving the patient so that the affected area is under as little pressure as possible, and simply ensuring the wound is clean and dry, allowing dead skin and tissue to slough off naturally and be restored by healthy tissue. However, these ulcers can progress, and become more dangerous.
STAGE II - MEDIUM-RISK
Stage II ulcers are generally recognized as extant when the skin around the wound is broken, and dead tissue is present around the wound. The area where the skin has broken will be a reddish-pink color, and may blister.
If a stage I ulcer has progressed to where it has broken the skin, it’s stage II. Generally, Stage II ulcers don’t present with pus or drainage – if this is present, the ulcer may have reached into the fatty tissue layers, and already progressed to stage III.
While stage II ulcers are riskier than stage I ulcers, precautions mainly include avoiding infection and allowing the wound to heal by using a light saline rinse to wash away dead slough skin and keep the area clean. They do have a much higher risk of infection, so precautions should be take to avoid contact with infectious substances. They can then progress to Stage III, which presents much higher risks.
STAGE III - HIGH RISK
Stage III occurs when the ulcer reaches beyond the surface skin, and tissue up to and including the fat layer is necrotizing.
These wounds present with a far larger, “cratered” appearance than Stage II ulcers, and generally have a significant amount of pus, drainage, and slough. Eschar – large scabs of dried and dead skin – may also be present in more advanced stage III wounds They are generally quite painful and uncomfortable, and present a serious risk of infection due to the vulnerability and depth of exposed flesh.
Generally, Stage III and above ulcers are monitored and cared for by medical professionals in a clinical setting, as they are quite dangerous, and have a high risk of becoming infected. Treatments include debridement and removal of necrotized flesh, and dressings and antibiotics to help prevent infection. The ulcer can progress further, though.
STAGE IV - HIGHEST RISK
Stage IV ulcers present with tissue loss past the fatty layer of the skin, and through muscle, bone, tendons, and joints. Large quantities of eschar and dead tissue are present, and the injury is often deep enough that you can see bone and muscle layer in the wound.
Stage IV is characterized by visibility of bone, muscle fascia, tendons, ligaments, or cartilage in the wound. If any of these are seen, the wound has progressed past the fatty layer, and is classified as a stage IV ulcer.
Emergency treatment by medical professionals is absolutely required for these ulcers. They are an incredible infection risk, and extremely painful and dangerous for anyone afflicted. Debridement and antibacterial treatments are common until the bacterial load has been reduced, at which time surgery, such as flap reconstruction, can take place to help seal and heal the wound.
Surgery is almost always required for advanced stage IV pressure ulcers, and complete excision of the affected area can be required if the injury is serious enough. These wounds always require the constant care and supervision of medical professionals, and can be life-threatening even if they are not infected.
UNSTAGEABLE PRESSURE ULCERS
Unstageable pressure ulcers present when the extent of a pressure ulcer’s depth and seriousness is unclear due to the base of the wound being completely covered in eschar – a certain type of hard scab that is made entirely out of dead tissue.
Excision and debridement of the eschar is the first step. After this, the extent of the tissue injury (stage III or IV) will become clear, and treatment will continue as appropriate.
PREVENTION IS YOUR BEST OPTION
It’s important to remember that pressure ulcers, while a serious problem, are almost always preventable, and 70 to 90 percent of stage I to II pressure ulcers will heal without serious medical intervention. Being able to recognize when an ulcer has progressed to the point of danger is essential when you are caring for a bedridden loved one at home. Please be sure to consult with your doctor to develop a safe and proper bed sore treatment plan.
Jessica Hegg serves as the Content Manager for Vivehealth.com. The company, based in Naples, Florida, provides a wide array of medical supplies, as well as tips for healthy aging.