Pressure ulcers, also known as bedsores, often develop when someone has to spend a great deal of time in one position, such as when a person is confined to bed or in a wheelchair. This, in turn, only happens when caregivers, including nurses, fail to adequately move and otherwise care for their patients. Thus, they need to learn to identify pressure sores—in particular, who is likely to develop them and who requires the attention and actions to prevent them.
Failing that, prompt treatment of pressure ulcers can help prevent further problems and complications, decrease pain, and increase the odds that the patient will make a full recovery.
What Is a Stage Two Pressure Ulcer?
Pressure ulcers and other pressure injuries are categorized into four stages for identification and treatment.
At stage one of a pressure injury, the skin has not yet broken. Often, stage one pressure ulcers are identified because of patient discomfort: a feeling of pain or tenderness in the affected area, especially when pressure is applied. The skin may appear reddened or darker than the skin around it. In a dark-skinned individual, the pressure injury may appear as a blue or purple patch, and may be difficult to identify through color alone.
Stage one pressure ulcers can often resolve simply by removing pressure from the affected area and assistance changing position more often. Patients who do not have sensation in the area where the pressure ulcer occurs, including spinal cord injury victims, may need regular exams by qualified nursing staff to help identify early signs of pressure ulcers and reduce the risk of further injury.
As a pressure ulcer develops to stage two, it may cause more substantial pain for the victim. At stage two, the skin breaks. Sores may appear as an intact blister or as a shallow, open sore. Stage two pressure sores extend into the layers of skin, but you cannot see fat, muscle, or bone through the injury. Stage two pressure ulcers may include reddened or broken skin, an obvious blister, or pus.
Stage two pressure ulcers may, in some cases, occur before nursing staff or victims notice any other obvious signs of injury. Often, patients note some discomfort before a pressure ulcer reaching stage two, but they may not readily identify its source or may not change position often enough to reduce the risk of further injury. At stage two, pressure ulcers need prompt treatment to help reduce the risk of infection or other complications. Even at this stage, pressure ulcers can cause permanent damage to the skin, resulting in scarring.
At stage three, the pressure sore has extended into the fatty layers of tissue on the body. Stage three pressure sores may not cause as much pain for the victim because of damage to the surrounding nerves, which can prevent pain signals from transmitting. Stage three pressure sores may show fat, but do not show muscle or bone.
Stage four pressure injuries go deep into the muscle and/or bone. By the time pressure injuries reach stage four, the patient may be facing substantial, long-term complications, including damage to muscle, tendons, and joints. In the case of a stage four pressure injury, patients may note blackened, dead tissue, a foul smell, and other signs of spreading infection. Nursing staff should exercise immense care to prevent patients from developing a stage four pressure injury.
What Do Nursing Staff Members Look for in Identifying a Stage Two Pressure Injury?
To identify a stage two pressure injury, nursing staff members and caregivers will look for several obvious signs.
The patient complains of discomfort or pain when lying in a certain position or experiencing pressure on a specific area of the body.
Often, a patient’s complaint will start the investigation into potential bedsores or pressure ulcers. Often, pressure sores develop in a matter of hours or days, and nursing staff may miss the signs unless the patient complains of discomfort. Sometimes, a patient will settle into a position that seems comfortable, only to later discover that the specific position increases the risk of pressure injuries.
If a patient complains of discomfort or soreness, an attending staff member should carefully evaluate the patient’s skin for any sign of pressure injuries.
The nurse notices a blister over a bony part of the body.
Most often, pressure sores occur over bony areas of the body, including the spinal cord or tailbone, the neck, the heels, or the shoulder blades. If a nurse notices any signs of redness or blistering over a specific area of the body, the nurse may suspect a pressure sore is developing and begin treatment as soon as possible. The blister may appear intact or ruptured, depending on how long the patient has had the sore and what previous treatment the patient has received.
The nurse notices signs of pus or drainage from a sore.
If a patient has pus or clear fluid draining from a sore, it is often a pressure ulcer. If the fluid has a foul smell or dark color, an infection may have set in, which requires immediate medical treatment.
Patients who are at high risk of developing bedsores or who have developed them in the past should have regular skin checks to determine whether they have developed any new bedsores. Identifying a pressure ulcer at stage one or two, before it becomes more severe, is important to give a patient the best chance of healing.
How to Treat a Stage Two Pressure Ulcer
Prompt treatment of any type of injury that breaks the skin, including a pressure ulcer, can help improve the patient’s overall outcomes and decrease the risk of substantial infection.
1. Reposition the patient.
Bedsores often occur because of prolonged pressure on a specific area of the body. If a patient can move without help, the patient should take care to move into different positions regularly. If necessary, the patient can use positioning devices to help keep pressure off of the affected area and reduce the risk of further injuries. If the patient cannot move on their own, a nurse or other caregiver can help reposition the patient to take pressure off of the affected area. Reducing pressure on that area, especially while the patient recovers, provides an important first line of defense in treating the injury and preventing it from worsening.
2. Keep the skin clean and dry.
To help reduce the risk of infection, the skin around the pressure sore should remain clean and dry. Often, nursing staff will use a barrier cream or bandage to help protect the affected skin and keep the patient as comfortable as possible, as well as aiding in the healing process. The type of bandage or barrier cream used may depend on the severity of the pressure ulcer and the patient’s overall sensitivity.
3. Inspect the injured area of the skin and other areas of the patient’s body.
Keeping pressure off of one area of the skin may place more pressure on another area, which can increase the risk of additional bedsores or other pressure injuries. Nursing staff should carefully evaluate the patient’s skin and keep an eye on any potential pressure injuries. Nursing staff should also evaluate the pressure sore regularly to make sure that healing progresses properly and that the patient does not show worsening signs of infection. In general, pressure sores develop to stage three or four due to a lack of aggressive treatment or intervention. Prompt treatment and regular observation can help prevent a patient from suffering worse injuries.
4. Remove any potential sources of pressure injuries.
Pressure injuries can occur due to a variety of challenges in a bed-bound patient’s environment. Sometimes, patients suffer pressure injuries because of wrinkled or twisted sheets, a worn mattress with bumps or lumps, or an item that has made its way into the bedding. Other times, pressure sores may occur when a patient is moved around, due to friction or shearing.
Several strategies can help reduce the risk of potential pressure injuries:
- Moving a patient carefully and according to protocol.
- Keeping the head of the patient’s bed lowered, especially when moving the patient.
- Using positioning devices to help keep a patient more comfortable in bed.
- Moving a patient regularly.
- Avoiding massaging over bony areas of the skin.
Carefully evaluating a patient’s room, bedding, and movement can provide clues as to how a pressure sore developed and offer the strategy needed to prevent future pressure injuries to the patient.
5. Keep up with the patient’s nutrition and hydration.
Nutrition and hydration can make a huge overall difference in patient health. Patients with poor nutrition, especially low protein intake, cannot heal as quickly, which may substantially increase the time needed for a patient to recover from a pressure ulcer or even lead to more serious injuries. Hydration also has a large impact on the skin’s elasticity, and patients with poor hydration may be at a much higher risk for developing pressure ulcers. After identifying pressure sores, nursing staff should take care to keep careful track of the patient’s food and water intake.
6. Keep up patient mobility when possible.
Some patients may have little to no mobility, especially while recovering from severe injuries. Maybe they can’t get out of bed much, if at all. Other patients, however, may have the ability to get out of bed and move around a little, especially with help from nursing staff. While recovering from pressure ulcers, patients should move around as much as possible. Increased mobility can decrease the risk of future pressure ulcers and keep a patient more comfortable as well as providing mental stimulation, which can help aid in improving a patient’s overall health.
Take These Four Steps if You or a Loved One Develops a Pressure Ulcer
Pressure ulcers can develop with little or no warning, especially in patients who have serious existing skin conditions or who lack sensation around the site of the injury. A minor pressure injury, treated promptly, may be little cause for long-term concern.
However, any time you or a loved one who needs ongoing care develops a pressure injury, you should take these four steps to help protect the person who suffered the injury.
- Notify nursing staff about the injury. You may notice signs of a pressure injury before the nursing staff has identified it. Sometimes, you may offer care to a loved one, or your loved one may mention a problem to you that they have not mentioned to the nursing staff. As a patient, you may feel pain in certain positions or feel soreness spreading over a bony area, which may be the first signs of an injury. Notify nursing staff about the problem so they can address it promptly.
- Follow instructions for movement and treatment. If your nurse or doctor provides you with instructions for treatment, follow them carefully. If you receive instructions to move regularly, for example, you should make sure that you adjust your position as required. If your doctor tells you to use a specific cream or to make sure that you change your dressings regularly, carefully follow those instructions.
Document the healing or progression of the pressure sore. Take photos or document the progression of your healing. Sometimes, you may notice serious complications, including spreading infection, as you document signs of injury. Documenting the healing process can not only offer you a baseline that can offer a comparison if your pressure injury starts to spread, it can also serve as evidence in a potential medical malpractice claim.
- Contact an attorney. If you do not receive the treatment you need for a pressure sore and your injury becomes serious, you may need an attorney to help you understand your legal rights or pursue compensation for your injuries. Contact an experienced medical malpractice attorney to learn more about your legal right to compensation following serious pressure injuries.