Pressure ulcers fall into four stages:
Stage one is the beginning stage in which the pressure ulcer has the following characteristics:
• Skin is not broken
• Skin appears red on lighter skin tones and doesn’t lighten when touched, and on darker skin it shows discoloration and change in color when touched
• Site may be tender, painful, firm, soft, warm or cool compared with the skin surrounding
• Outer layer of skin and part of the underlying layer of skin is damaged or lost
• Wound may be shallow and pink or red
• Ulcer may look like a blister
At stage III the ulcer has progressed into being a deep wound.
• Loss of skin exposes fat
• Appears crater-like
• Bottom of the wound may have yellowish dead tissue
• Damage may extend beyond the primary wound below layers of healthy skin
In this stage the ulcer shows large-scale loss of tissue.
• Ulcer may expose muscle, bone or tendons
• Bottom of the wound likely contains dead tissue that’s yellow or dark and crusty
• Damage extends under healthy skin beyond the primary wound
A pressure ulcer is unstageable if its surface is covered in yellow, brown, black or dead tissue. In this case it isn’t possible to see how deep the wound is.
The most common places for pressure sores in patients confined to a wheelchair are the tailbone and buttocks, shoulder blades and spine and the backs of the arms and legs. For patients who are bedridden, the most common sites tend to be on the back or sides of the head, rim of the ears, shoulders or shoulder blades, hip and lower back or tailbone and the heels, ankles and skin behind the knees.
If you notice early signs or symptoms of a pressure ulcer, change your position to relieve the pressure.
People who are the most at risk for developing a pressure ulcer are patients who are unable to change positions with ease due to generally poor health or weakness, paralysis, injury or illness that requires bed rest, recovery after surgery, sedation and coma. Other factors that increase risk of pressure ulcers are:
• Age – The skin of older adults is more fragile and thinner. Seniors also produce new skin cells more slowly making them more vulnerable to developing sores.
• Lack of sensory perception – People with spinal cord injuries and other neurological disorders may lose sensation. This loss of ability to feel pain or discomfort can result in being unaware of a developing sore or the need to change position.
• Weight loss – When a patient loses weight due to prolonged illness the loss of fat and muscle cushioning can cause a sore because its lessens padding between a patient and a wheelchair or bed.
• Poor nutrition and hydration – People who don’t get enough fluids, calories, protein, vitamins and minerals in their diet are vulnerable to the breakdown of tissue.
• Excess moisture or dryness – Skin that is moist from sweat or lack of bladder control is more vulnerable to sores. Both dry skin and moist skin causes friction between the skin and bedding and clothing.
• Bowel incontinence – Bacteria from feces can cause infection.
• Poor blood flow – Conditions like diabetes and vascular disease increase the risk of tissue damage.
• Smoking – Smoking reduces the flow of oxygen in the blood, which can lead to more severe wounds that heal more slowly.
• Muscle spasms – Patients with muscle spasms may be at increased risk of pressure sores due to frequent friction.