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Bed Sore Stages
Bedsores (pressure sores, pressure ulcers, and decubitus ulcers) are localized skin or underlying muscle or tissue injuries, usually occurring over a bony area.
The bedsore is often caused by pressure on the skin, friction, or soft tissue shearing on the body, resulting in partial or complete blood flow obstruction. Shearing can stretch and tear blood vessels feeding the skin.
If your loved one has a Stage III or Stage IV pressure ulcer, you may be entitled to pursue a bed sore claim against the nursing home facility for negligence. Contact the bedsore lawyers at (800) 926-7565 (toll-free phone number) for more information. Nursing Home Law Center offers free legal case reviews.
Stages of Pressure Ulcer Development
Common areas for developing pressure ulcers include the buttocks, sacrum, tailbone, ankles, knees, hips, heels, shoulders, shoulder blades, and the back and sides of the head, where there is constant pressure on bony areas.
People most susceptible to developing pressure injuries and sores are the elderly, disabled, bed-bound, individuals who use wheelchairs, and those who cannot reposition themselves without assistance.
Risk factors for developing pressure sores include:
- Poor nutrition
- Fragile skin, especially shoulder blades and ankles
- Lack of proper skin care - keeping skin clean and dry
- Bowel incontinence
- Urinary incontinence
- Alzheimer's disease
Decubitus ulcers can be severe and debilitating, but they are highly treatable, especially in the preliminary stages (Stage 1). Recovery can be complete with the correct risk assessment, diagnosis, and skin care treatment.
The National Pressure Ulcer Advisory Panel developed the staging process for skin injury to assist family physicians and healthcare providers when giving medical advice on the treatment of pressure sores.
Below is information and a complete list of bedsore clinical staging and development.
Stage One Bed Sores
- The skin is intact (unbroken) but discolored. A reddened area will appear on individuals with light skin color and purple, bluish or white on people with darker skin.
- There is a detectable change in temperature – either cool or warm compared to surrounding skin areas.
Stage Two Bedsores
Stage II pressure ulcers are advancing sores from Stage 1, where the condition is significantly worse than in stage one. Common indicators include:
- The skin appears warm to the touch and indicates signs of stage one.
- The uppermost layer (epidermis) is broken, which creates an open, shallow sore
- Drainage of clear fluid of pus
Stage Three Pressure Sores
There is considerable progress in severe pressure ulcers, and proper medical treatment using proven methods, devices, and dressings is required. Indicators include:
- The skin shows signs of ulceration extending through the second layer (dermis) into fat and subcutaneous tissue.
- The sore is significantly deeper than a stage two ulcer
Stage Four Pressure Ulcers
Stage four pressure sores are often life-threatening, where signs of infection are likely to occur. Common indicators of pressure-induced injury include:
- Ulcerated tissue breakdown now extends deep into the muscle and the bone.
- A significant amount of necrotic (dead) tissue
- Sores are open
At this stage, the wound is usually draining. It is imperative to seek immediate medical care. Surgery or debridement will likely be required to manage the injury. Most stage four bedsores take up to one year to heal when healing is possible.
Recognizing and Treating Pressure Ulcers
The National Quality Forum claims that skin ulcers are "never events" and that a facility allowing a developing bed sore to develop is unacceptable.
According to the Centers for Medicare and Medicaid Services (CMS), every pressure sore is preventable if the nursing staff and medical team follow established protocols and procedures.
Early detection is vital to minimize complications with the patient's complex medical conditions. Skin damage is caused by prolonged pressure, shear force, or friction in the area that restricts the flow of blood needed for healthy tissue.
At any stage of pressure sore development, the skin may have a darkening color on the skin surface. In the wound's advanced stage, deeper tissue, ligaments, tendons, bone, and muscle might be exposed deep into the wound sores.
The medical team might identify the presence of infection, including foul odor, pus, blood-filled blister, reddened edges, heat, or wound drainage.
Effective Pressure Ulcer Treatments
The National Pressure Ulcer Advisory Panel (NPIAP) provides guidelines to every wound care specialist, doctor, and health care provider treating skin sores.
- Ensure that the patient is adequately hydrated and receiving the nutrients necessary to promote healthy skin
- Remove all dead or infected skin in the wound bed.
- Cover the sore using medicated moisture pads and gauzes
- Offload the affected area using cushions, foam pads, air mattresses, and other devices
Advancing pressure sores can lead to skin calcification caused by a buildup of hardening calcium. Debride the compromised skin injury by cutting necrotic tissue and skin away to allow a new growth on the skin surface and around the sore.
Pressure Sore Bacterial Infection Complications
In the final stages of a possible debilitating pressure injury, the patient may acquire a bacterial infection in the bloodstream (sepsis) or bones (osteomyelitis). Without immediate intervention, the patient could die.
Other patients suffer bacterial cellulitis, which causes extreme pain, swelling, and skin color changes in the area affected. If cellulitis is allowed to spread, it can enter the lymph nodes and bloodstream causing metastatic or systemic infections, including meningitis, endocarditis, and bacteremia.
What to Do If Your Loved One Has Advanced Stage Pressure Ulcers
On the first sign of a bed sore, attempt to relieve pressure for 30 minutes at a time to allow blood flow to be restored to the area. Movement from a wheelchair or static position will alleviate the stress on the surface and areas of the body affected.
The pressure injury may look small, but tissue damage often starts below the top layers. In addition to treating pressure sores, typical steps to prevent pressure injuries include:
- Moving (change positions) every two hours
- Maintaining good hygiene in the area with mild soap.
- Improving diet and hydration
- Minimizing friction when moving or repositioning
- Seeking medical care from a wound care expert
Even if the pressure-induced injury only appears on the surface, keeping the sore covered and seeking immediate medical attention is required to prevent the further development of pressure sores.
A competent health care provider can assess the clinical staging of the wound to determine the injury's extent and provide immediate treatment to minimize further damage.
Bed Sore Development Complications FAQ
Our personal injury attorneys understand that families need more information regarding the development and treatment of bedsores and have answered a few of your online questions below.
A degrading skin wound can quickly advance to a stage IV bedsore that exposes bone and muscle. Typically, the wound at this stage shows signs of infection of the bone (osteomyelitis) or bloodstream (sepsis).
Without immediate intervention, the patient could quickly die, especially if there is a significant infected injury or other condition, including vascular disease, diabetes, or respiratory illness.
If the patient is under the care of a competent wound care specialist, the prognosis could be good, even if they develop a Stage IV decubitus ulcer. Treatment might involve debridement, where the surgeon removes any deep tissue injury or necrotic tissue at the wound's edge.
If the patient survives, the wound might take many months to heal completely. There may be extensive damage to the bone and muscles in the area affected that caused an infection.
Initially, a newly developing skin wound can appear in less than ninety minutes if the patient in a bed, chair, or wheelchair does not move or shift their body weight. Most bed sores appear dark and warm to the touch.
The nursing staff can use a blanching technique by pressing their finger on the damaged area until it turns white. Releasing the finger should restore blood flow if there is no significant tissue damage at the sore site.
Advancing decubitus ulcers typically form an open wound deep into the underlying tissue, muscle, and bone. The open wound makes the area highly susceptible to bacterial infections, leading to a deep tissue injury and necrotic tissue around the sore.
Untreated sepsis could quickly become septic shock, claiming the patient's life. Some skin ulcers are challenging to treat due to the bacteria's high resistance to popular antibiotics.
Patients most at risk for developing debilitating skin ulcers include individuals suffering from:
- Diminished mental awareness
- Compromised skin integrity
- Diabetes and other diseases that restrict blood circulation
- Hypoxemia (low blood oxygen levels)
- Signs of infection
- Nerve damage or other neuropathies leading to weakness, pain, or numbness
- Restricted blood flow (ischemia)
- Neurological conditions
- Spinal cord injury
- Fecal or urinary incontinence
Hiring an Attorney to Prosecute an Advanced Pressure Sore Claim
Stages III and IV pressure sores are severe conditions that can take an individual's life. These pressure sores are challenging to heal and restore health. A doctor or healthcare provider recognizes that advancing bedsore stages never need to occur and are often the result of caregivers' negligence.
Many families will hire an attorney to provide their loved one's health information and to stop caregivers from neglecting their loved ones suffering from advancing pressure sores.
Nursing Home Law Center, LLC at (800) 926-7565 or through the contact form can help you recover damages if a loved one has been neglected in a nursing home, hospital, assisted living facility, residential home, group home, or another medical center.