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Bed Sore Stages & Development

A bedsore also referred to as a pressure sore, pressure ulcer, and decubitus ulcer, is a localized injury on skin or underlying tissue, usually occurring over a bony area.

The bedsore is often caused by pressure, 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 sore, you may be entitled to pursue a bed sore claim against the nursing home facility for negligence. Contact an attorney for more information. Nursing Home Law Center offers free legal case reviews.

Bed Sore Development

Common areas for bedsore development include the buttocks, sacrum, tailbone, ankles, knees, hips, heels, shoulders, shoulder blades, and the back and sides of the head.

People most susceptible to developing pressure ulcers and sores are the elderly, disabled, bed-bound, individuals who use wheelchairs, and those who cannot reposition themselves without assistance.

Those who are malnourished, dehydrated or with fragile skin, bowel incontinence, urinary incontinence, or suffering from Alzheimer's disease have an increased potential to develop a pressure ulcer.

Though decubitus ulcers can be severe and life-threatening, they are highly treatable, especially in the early stages (Stage 1), and recovery can be complete with proper diagnosis and care.

The National Pressure Ulcer Advisory Panel developed the staging process for skin injury to assist a doctor, practitioner, and healthcare provider in adequately diagnosing and treating pressure sores. Below is information and a complete list of pressure sore stages and development.

Stage One Bed Sores

Recognizing an early-onset Stage 1 bedsore allows the caregiver to intervene and take quick action as early as possible to prevent the condition from becoming worse.

Indicators of a stage one pressure sore include:

  • The skin is intact (unbroken) but discolored. A reddened area will appear on individuals with a light complexion and purple, bluish or white on people with darker complexions.
  • There is a detectable change in skin 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 stage one. Common indicators include:

  • The skin appears warm to the touch and has the indicating signs of stage one in addition to,
  • The skin is broken at the uppermost layer (epidermis), which creates an open, shallow sore
  • At this stage, drainage could be present
Stage Three Pressure Sores

There is significant progress in a severe pressure ulcer, and proper medical treatment using proven methods, devices, and dressings is required. Indicators include:

  • The skin show signs of ulceration extending through the second skin layer (dermis) into fat and subcutaneous tissue
  • The sore is significantly deeper as compared to 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 include:

  • The ulcerated tissue breakdown now extends deep into the muscle and possibly the bone
  • There is typically a significant amount of necrotic (dead) tissue
  • The sores are open

At this stage, the wound is usually draining. It is imperative to seek immediate medical care. More than likely, surgery or debridement will be required to manage the wound. Most stage four pressure wounds 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 pressure wound to decline 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.

Years ago, the CMS changed its regulations, denying nursing homes Medicare payments for any facility-acquired (never event" including developing pressure sores. Every health care provider, doctor, nurse, and wound care specialist working in a nursing home is trained to identify developing pressure sores quickly.

Early detection is vital to minimize complications with the patient's existing complex medical conditions. The 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 in the area 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 provides guidelines to every wound care specialist, doctor, and health care provider treating skin sores. Typically, the attending physician will ensure that the patient is adequately hydrated and receiving nutrients necessary to promote healing.

The wound care specialist will cover the sore using medicated moisture pads and causes after removing dead or infected skin in the wound bed. Next, the nursing team will off-load the affected area using cushions, foam pads, air mattresses, and other devices that prevent pressure on the wound.

Advancing pressure sores can lead to skin calcification caused by a buildup of hardening calcium that can significantly diminish the healing process. The treating surgeon may need to debride the compromised skin injury by cutting necrotic (dead) 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 life-threatening pressure injury, the patient may acquire a bacterial infection in the bloodstream (sepsis) or bones (osteomyelitis). Without immediate intervention, the patient could die.

Many bacteria are now highly resistant to routinely prescribed antibiotic medicine, creating additional damage to the wound that now may never heal. Advanced infections are often challenging to treat.

Other patients suffer bacterial cellulitis infection, which causes extreme pain, swelling, and skin color changes in the affected area. If cellulitis is allowed to spread, it can enter the lymph nodes and bloodstream causing metastatic or systemic infections, including meningitis, endocarditis, and bacteremia.

Bed Sore Development Complications FAQ

Our personal injury attorneys understand that families need more health information about how bedsores develop, and the medicine and treatment required to avoid a severe tissue injury. Our legal team has answered some questions below that some family members are searching for online.

What Happens When a Bedsore Goes to the Bone?

A degrading skin wound can quickly advance to a stage IV bedsore that reaches muscle and bone. Typically at this stage, the wound shows signs of infection of the bone (osteomyelitis) or bloodstream (sepsis).

Without immediate intervention, the patient could quickly die, especially if there is significant infected skin injury or other condition, including vascular disease, diabetes, or respiratory illness.

How Long Can You Live with a Stage 4 Bedsore?

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 cuts away any deep tissue injury or necrotic (dead) tissue at the wound's edge.

If the patient survives, the wound might take three months to many years to heal completely, if possible. There may be extensive damage to the bone and muscles at the affected area caused by tissue compromised by an infection.

How Long Does It Take for a Pressure Sore to Develop?

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 to alleviate pressure to the area. Most 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 weight. Releasing the finger should restore blood flow if there is no significant tissue damage at the sore site.

Can Bedsores Lead to Sepsis?

Advancing decubitus ulcers typically form an open wound deep into the underlying tissue down to muscle and bone. The open wound makes the area highly susceptible to bacterial infections, leading to a deep tissue injury and necrotic (dead) tissue around the sore.

Untreated sepsis could quickly turn into septic shock, claiming the patient's life. Some skin ulcers are challenging to treat due to the bacteria's high resistance to popular antibiotics.

Which Individuals Are More at Risk for Developing Stage IV Pressure Sores?

Patients most at risk for developing life-threatening skin ulcers include individual suffering from:

  • Anemia
  • Diminished mental awareness
  • Fevers
  • Compromised skin integrity
  • Diabetes and other diseases that restricts blood circulation
  • Hypoxemia
  • Hypoxemia (low blood oxygen levels)
  • Signs of infection
  • Nerve damage or other neuropathies leading to weakness, pain, or numbness
  • Restricted blood flow (ischemia)
  • Obesity
  • Neurological conditions
  • Spinal cord injury
  • Dehydration
  • Malnutrition
  • Fecal or urinary incontinence
What to Do If Your Loved One Has Advanced Stage Pressure Ulcers

On the first sign of a skin sore, relieving the pressure for up to 30 minutes is crucial to allow blood flow to be restored to the area. Movement from a wheelchair or static position will relieve the stress on the surface and areas of the body affected.

Note that just because the sore appears small in size, it may not present a little problem. Tissue damage often starts below the top layers.

In addition to treatment, typical steps to avoid or minimize the progression of the condition to advancing stages of pressure sores include:

  • Keep the pressure off the area
  • Maintain good hygiene in the area
  • Improve diet and hydration
  • Minimize friction when moving or repositioning
  • Seek medical care from a wound care expert

Even if the damage appears to be on the service alone, declining pressure sores require immediate medical attention.

A competent health care provider can assess the wound to determine the injury's extent and provide immediate treatment to minimize further damage and begin the healing process.

Hiring an Attorney to Prosecute an Advanced Pressure Sore Claim

Stages III and IV pressure sores are severe conditions that can take the life of the individual. 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 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.

Our attorneys' network specializes in medical malpractice and elder abuse cases and has assisted many victims seeking information, justice, and financial compensation. We offer a free initial consultation to discuss your claim and provide valuable legal options for proceeding with your case.

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