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Four Stages of Bedsores

Posted On August 05, 2020

Bedsores are a preventable injury that can have potentially fatal consequences for elderly residents of nursing home facilities. Caregivers and healthcare professionals within nursing homes have a duty of care to properly care for residents so they do not develop these injuries. When they are negligent in their duties, these injuries can cause severe discomfort and can complicate treatment regimens which is why prevention and early recognition are crucial.

Understanding Bedsores

Bedsores can occur when individuals are bedridden or rendered immobile. They often occur in residents who are unconscious or otherwise unable to sense or communicate pain. They are ulcers that occur when an area of skin is placed under pressure. They can occur when patients are bedridden for a prolonged period of time. While this period differs based on the individual’s age and overall health, they can occur in as little as 2-3 hours of immobility as the blood supply is cut off and the skin dies.

Bedsores are common on the buttocks, heels, shoulder blades, back, and knees. Once they develop, bedsores heal slowly. While minor sores can heal in a few days to a couple weeks, more severe sores can take months and even years to fully heal. Thus, it is crucial for caregivers within nursing facilities to properly monitor residents and to take special care with patients who have known health conditions such as diabetes, heart disease, or poor diet which make the individual more prone to developing bedsores.

Stages of Bedsores

Stage 1 bedsores are often red in appearance and warm to the touch. If the individual has dark skin, the sore will appear blue or purple. Stage 1 bedsores often feel as if they are burning or itching, and may be accompanied by muscle pain in the region. They can feel firm, soft, warm, or cool to the touch and will often have a different feel than surrounding skin. These types of sores impact only the upper layer of skin. Treatment for these types of bedsores starts with removing pressure from the affected skin through the use of foam pads and pillows to keep pressure away from the affected region.

Stage 2 bedsores often cause significant pain and open wounds. These will appear much like an open sore, blister, or scraped skin. Stage 2 blisters go past the first layer of skin and into the second. They usually involve discoloration and swelling of the skin. Often, the wound will fill with pus and generate significant pain to the individual. Treatment for Stage 2 bedsores requires cleaning and thoroughly disinfecting the wound. Individuals are also usually given a pain reliever and will regular changes of the dressing to prevent infection. Often, individuals are prescribed antibiotics to help guard against potential infection. Healthy individuals can recover from Stage 2 bedsores in as little as a few days, but many will take three weeks or longer to heal.

Stage 3 bedsores have appear like small craters in the skin. At this stage, the sore has progressed through the second layer of skin and into the fat tissue beneath. These bedsores are usually infected and will have a red edge, visible pus, and an obvious odor. They will also feel warm to the touch. As the sore worsens, the tissue around the sore will die and turn black. These types of wounds require significant care that often involves debriding the dead tissue and prescription of antibiotics ot fight the active infection. Even with prompt and proper treatment of an individual in good health, Stage 3 bedsores can take months to properly heal.  

Stage 4 bedsores are the most serious type of bedsore. These can affect the bones, joints, muscles, and ligaments. Infection is a common factor in Stage 4 bedsores and will require the administration of strong antibiotics. Stage 4 bedsores are deep and will generate symptoms similar to Stage 3 bedsores. In some cases, the wound may be so deep that it is possible to see tendons, muscles, and bones within the sore. Often, Stage 4 bedsores will require surgical intervention to treat. With prompt and proper treatment, Stage 4 pressure sores can heal within a few months, however, it is not uncommon for these types of wounds to take years to properly heal.

Documenting and Monitoring Treatment 

Nursing home personnel must properly treat and monitor the healing process. This involves removing pressure from the affected area, applying the appropriate dressings, and wound cleaning. It also involves close monitoring of nutrition, and continued removal of damaged, infected, and dead tissue. If the wound is Stage 3 or Stage 4, it may also involve skin transplants. Caregivers in nursing home facilities are required to properly document the size of the wound, the wound’s depth, and the individual’s response to treatment. Any negligence during this process can result in uncontrolled infection and potential loss of life.

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