Stages of Bed Sores

According to the Centers for Disease Control and Prevention (CDC), nearly 1 in 10 nursing home residents in the United States will have some type of bed sore at any given time. Signs of a possible bed sore or pressure ulcer include odd changes in skin color and/or texture, tenderness, swelling, pus, and changes in temperature. An extreme bed sore may be deep enough to where the victim’s bone can be seen. If you notice any of these signs on your loved one in a nursing home in Memphis or elsewhere in the South, consult with a medical professional immediately.

In all states, including Tennessee, nursing homes owe residents a legal duty of care when accepting them into the facility. Nursing homes must provide reasonable care and a safe environment. Nurses, Certified Nursing Assistants (CNAs), and other staff members should competently perform their duties. Falling below the appropriate standard of care could result in liability if a resident suffers injuries or passes away as a result.

The National Pressure Ulcer Advisory Panel (NPUAP) made determinations in 2016 as to the stages and level of severity of bed sores as symptoms progress and worsen. The NPUAP has indicated the following distinct levels of bed sore injuries, the specific symptoms of which are described below.

• Stage I: A patient with Stage I bed sores will exhibit intact skin that is reddened or discolored. Changes in skin color may be preceded by changes in temperature, firmness, or other sensation.
• Stage II: The second stage of bed sores results in the partial loss of skin, and the wound will appear pink or red, moist, and may also appear as an open wound with a broken or unbroken fluid-filled blister. Fat layers and deeper tissues are not yet visible.
• Stage III: A Stage III bed sore exists when a there is full-thickness loss of skin, which may cause fat layers to be visible in the ulcer. The amount of damage present in this stage can vary by location, and bed sores in areas where more fat is commonly stored can mean deep wounds. The appearance at this stage is often crater-like, but muscles, tendon, and bone are not yet exposed.
• Stage IV: In the most severe stage, there is full-thickness loss of skin, coupled with tissue loss. It is often hard to determine the amount of tissue damage within the sore itself due to dead skin and/or tissue blocking the wound. Muscle, bone, and tendons may be exposed.

The NPUAP has also published a set of pressure injury prevention points for medical professionals and caregivers, so those who work with the elderly can be proactive about preventing bed sores from occurring. The guidelines cover identifying at-risk patients, as well as instructions for skin-care, nutrition, and repositioning and mobilization. Nursing home staff and caregivers play an instrumental role in ensuring that residents are closely monitored, cared for, and treated with respect and dignity. State and federal laws require nursing home staff to use reasonable care when caring for nursing home residents. Unfortunately, staffing shortages present in nursing homes have led to some patients not receiving the level of care they require and deserve. In the end, nursing home administrators are responsible for ensuring that their staff receives proper training on how to prevent and identify bed sores, in order to prevent minor injuries from becoming major injuries, or even from occurring at all.