Bedsores Definitions and Stages

Published on April 17, 2012

A bedsore is the common name for a pressure sore or pressure ulcer. Bedsores are caused by prolonged pressure on the skin. Typically they develop on bony areas of the body such as heels, ankles, hips and buttocks. Bedsores are categorized or “staged” based upon severity. The National Pressure Ulcer Advisory Panel defines each stage as follows.

Stage I
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.

Stage II
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.

Stage III
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.

Stage IV
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.

Bedsore Prevention
Bedsore prevention involves a few basic task practiced consistently. These task include relieving pressure by turning or repositioning the elder every 1-2 hours. Use pillows, towels or a pressure relieving mattress to assist in reducing pressure. Keep the skin clean of feces and urine and keep the skin moisturized. Proper hydration and nutrition, especially adequate protein intake, is essential in preventing bedsores.

Treatment of Bedsores
Treating bedsores requires a multidisciplinary approach. This should include:

  • A primary care physician to oversee and modify as needed the treatment plan
  • Treatment nurses specializing in wound care
  • A social worker who educates the resident or family and addresses emotional concerns related to long-term recovery
  • A physical therapist who helps with improving mobility
  • A dietitian who assesses nutritional needs and recommends an appropriate diet
  • A neurosurgeon, orthopedic surgeon or plastic surgeon, depending on whether surgery may be required and what type of surgery is needed

Complications from Bedsores
Serious infections are the most common complication of bedsores. These include:

  • Sepsis. Sepsis occurs when bacteria enters your bloodstream through the broken skin and spreads throughout your body — a rapidly progressing, life-threatening condition that can cause organ failure.
  • Cellulitis. This acute infection of your skin’s connective tissue causes pain, redness and swelling, Proper hydration and nutrition, especially adequate protein intake, is essential in all of which can be severe. Cellulitis can also lead to life-threatening complications, including sepsis and meningitis — an infection of the membrane and fluid surrounding your brain and spinal cord.
  • Bone and joint infections. These develop when the infection from a pressure sore burrows deep into your joints and bones. Joint infections (septic or infectious arthritis) can damage cartilage and tissue, and bone infections (osteomyelitis) may reduce the function of your joints and limbs.

Because of the seriousness of these infections and the compromised medical condition of most nursing home residents, death is not an uncommon result following a stage III or IV bedsore and resulting infection(s).