The Five Stages of Bedsores

Bedsores, pressure sores and decubitus ulcers are break downs in skin that create flesh type wounds. They are caused by prolonged periods of pressure which usually occurs when immobile, bedridden, or wheelchair-bound nursing home residents stay in the same position for extended periods of time. This makes pressure ulcers especially problematic for residents of nursing homes who may be forced to be bedridden for long periods of time or find themselves permanently wheelchair bound. Bedsores can be deadly and occur in four different stages.

Stage 1 Bedsores

The sore just begins developing during during a Stage 1 Pressure Sore. The skin has not been a break down in the skin and there are no open sores. Instead, certain areas of the skin may be painful and will not turn white when you push on them. Depending on skin tone, the initial sore may appear as a different color from the surrounding skin. You may also find the skin in the area where the sore is developing to be slightly warmer and of different texture than skin surrounding it. With proper treatment it can take 2-3 days for a Stage One decubitus Ulcer to heal

Stage 2 Bedsores

During a Stage 2 Pressure Sore, the outer layer of the skin, known as the epidermis, breaks open and wears away. The layer of skin beneath the epidermis, known as the dermis, begins to break down. As the sore expands into the deeper layers of a patient’s skin it can look like a blister filled with clear liquid. From this stage on, skin may become irreparably damaged. Immediate medical attention is needed. With proper treatment it can take anywhere from 3 days to 3 weeks for a Stage Two decubitus Ulcer to heal.

Stage 3 Bedsores

When left untreated, a Stage 3 Pressure Sore will begin to expand deep beneath the skin into the fatty subcutaneous tissue. The wound starts to look like a crater. At the skin dies off and the wound gets deeper the patient’s fat will be seen within the crater. The patient will develop yellowish dead skin tissue near to bottom of the wound. Signs of infections like pus, odor or greenish liquid secretions may be present. There could be signs of necrosis which is dead and black tissue. With proper treatment it can take anywhere from 1 to 4 weeks for a Stage Three decubitus Ulcer to heal.

Stage 4 Bedsores

During the Stage 4 Pressure Sore, the wound becomes very deep and may reach into a patient’s muscle and bones. There is fluid drainage secretions and dead necrotic tissue. During this advanced stages of a bedsore, a patient may not feel pain because the surrounding nerves may have been severely damaged. It is also possible for these sores to develop beneath the skin, where they are known as a deep tissue injury. There is a high likelihood that infection will result which can lead to death or amputations which compounds the issue. Up to 70% of residents with Stage 4 pressure sores die within 180 days and most die within 50 days. With proper treatment it can take 3 months to 2 years for a Stage Four Democritus Ulcer to heal.

Unstageable Bedsores

An Unstageable Pressure Sore occurs when there is significant tissue loss but the base/depth of the wound cannot be determined because the crater-like wound is filled with dead tissue. The dead tissue/slough needs to be surgically removed using a debridement procedure. Once the dead tissue is removed the depth of the wound base can be determined and the wound can then be assigned the proper stage.

What Can You Do if You Have Bedsores from Pressure Sores?

It is essential that nursing home staff monitor patients’ health at all times. Bedsores are preventable. Many precautions can be taken to prevent these sores, such as ensuring a patient changes positions as frequently as health will allow. Proper hydration and nutrition are also important defenses to pressure sores. When a bedsore does form, it is a serious issue that must be addressed quickly and correctly by the nursing home. Contact our nursing home bedsore lawyers today to schedule a consultation to determine if a nursing home is liable for the development and/or progression of bedsores.

Nursing Home Responsibilities

Most bedsores show improvement in two to four weeks. In some cases though bedsores get worse over time or simply fail to improve. Nursing homes need to monitor existing pressure sores in order to determine if they are getting better or worse. Documenting the status of the bedsore on a consistent basis allows nursing home staff to accurately determine bedsore progress and adjust treatment accordingly.

Many assessment tools exist to monitor and document the status of the pressure sore. One is the PUSH tool, which classifies the pressure ulcer by length and width, tissue type and exudate amount. These three classifications are then used to assign the bedsore a rating score. A nursing home resident’s chart should show the bedsore’s rating score is improving over time.

The PSST (Pressure Sore Status Tool) is another test nursing homes use to monitor the status of bedsores. This test uses 13 items to determine a rating score. Nursing homes need to know if the pressure sore is getting better because if it fails to get better within 2 to 4 weeks the Nursing home is required to reassess the resident’s pressure sore and overall condition. A lack of consistent and accurate documentation by the nursing home staff raises concerns that the nursing home is providing negligent care.

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