Bedsores fall into one of four stages based on their severity. The National Pressure Ulcer Advisory Panel, a professional organization that promotes the prevention and treatment of pressure ulcers, has defined each stage as follows.
The beginning stage of a pressure sore has the following characteristics:
- The skin is intact.
- The skin appears red on people with lighter skin color, and the skin doesn't briefly lighten (blanch) when touched.
- On people with darker skin, there may be no change in the color of the skin, and the skin doesn't blanch when touched. Or the skin may appear ashen, bluish or purple.
- The site may be painful, firm, soft, warmer or cooler compared with the surrounding skin.
The stage II ulcer is an open wound:
- The outer layer of skin (epidermis) and part of the underlying layer of skin (dermis) is damaged or lost.
- The pressure ulcer may appear as a shallow, pinkish-red, basin-like wound.
- It may also appear as an intact or ruptured fluid-filled blister.
At this stage, the ulcer is a deep wound:
- The loss of skin usually exposes some amount of fat.
- The ulcer has a crater-like appearance.
- The bottom of the wound may have some yellowish dead tissue (slough).
- The damage may extend beyond the primary wound below layers of healthy skin.
A stage IV ulcer exhibits large-scale loss of tissue:
- The wound may expose muscle, bone and tendons.
- The bottom of the wound likely contains slough or dark, crusty dead tissue (eschar).
- The damage often extends beyond the primary wound below layers of healthy skin.
Common sites of pressure sores
For people who use a wheelchair, pressure sores often occur on skin over the following sites:
- Tailbone or buttocks
- Shoulder blades and spine
- Backs of arms and legs where they rest against the chair
For people who are confined to a bed, common sites include the following:
- Back or sides of the head
- Rim of the ears
- Shoulders or shoulder blades
- Hip, lower back or tailbone
- Heels, ankles and skin behind the knees
When to see a doctor
Inspection of the skin should be a part of routine nursing or home care for anyone who is confined for a long time to a wheelchair or bed or for anyone who has limited ability to reposition himself or herself. Contact your doctor right away if you notice any signs or symptoms of a pressure ulcer. Get immediate medical care if a person under your care shows signs of infection, such as fever, drainage or foul odor from a sore, or increased heat and redness in the surrounding skin.
Mar. 19, 2011
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