Understanding bed sore stages is important to keeping your loved one safe. Why? depending on the stage, bed sores may be a non-blanchable area of the skin or a massive hole in the body. It all depends on the stage. Using the bed sore stages pictures on this site can help. Please note that this site cannot substitute for proper medical advice.
Bed sores can begin at the skin, or far deeper, and work up until the skin is ulcerated. Because a bed sore can appear drastically different from one stage to another, nursing home staff may misidentify them. That’s why it is important for nursing homes to provide appropriate bed sore stages identification training. Proper training includes providing bed sore stages information with pictures of each.
For more information about bed sore stages, please check out the Nursing Home Abuse Podcast:
Bed sores are a sign of nursing home neglect in most residents. Nursing facilities are required to take steps to prevent bed sores before they occur. This includes a comprehensive assessment of the resident’s skin at admission, creation of a personalized care plan, and consistent updating of the care plan. If a nursing home fails to implement these requirements, they may be liable to the resident.
Because bed sores are so common in nursing homes, families of residents are encouraged to understand bed sore stages and what such wounds look like. We’ve provided this page showing bed sore stage pictures for that purpose.
Typically, bed sores progress through four stages, representing the level of depth to the wound. Stage 1 represents the least amount of damage to the body while Stage 4, represents the most amount of damage. An “unstageable” bed sore is one that cannot be staged because the wound cannot be completely viewed.
Appropriate staging is important. Often, the stage and progression determines the type of treatment the resident received.
Unfortunately, bed sore staging is not an exact science. There is not one uniform staging model across the healthcare industry. So home health nurses have their own staging scale. Many hospitals have their own staging scale. Nursing homes often have their own staging scales. Then, there are academic and advocacy groups, like the National Pressure Ulcer Advisory Panel, that have their own model.
Still, there are many characteristics to bed sore stages that are shared among the many models. In other words, even though there may be different methods for identifying stages, each follows the same basic pattern. For example, one group’s Stage 1 will never be another group’s Stage 4.
Bed sores look different at each of the four stages. Most often, there is not much to see with Stage 1 and Stage 2 bed sores. However, Stage 3 and Stage 4 bed sores can appear as terrible, open wounds.
Also, bed sores may look different depending on the part of the body in which they occur. For example, a bed sore on the sacrum, coccyx, or buttocks will appear differently than a bed sore on the heal. Generally, this is the case because some parts of the body where pressure is applied have more tissue, muscle, and skin that may be deteriorated.
A Stage 1 bed sore is a red patch of skin typically appearing over a bony area like the heel or tailbone that does not blanch. Blanching means the paleness or whiteness that results when pressure is applied to the skin. Skin that does not turn white is called “non-blanchable.”
The skin of a Stage 1 bed sore is non-blanchable because the blood flow to the area has been restricted. The red area on the surface of the skin remains red despite pressure being applied. In most people, when pressure is applied, the blanched skin returns to normal in a few minutes or hours. When the skin does not change is an indicator of a deeper problem.
In African Americans, the area may be purple, bluish, or shiny. Also, blanching in darker skin is difficult to detect. As such, other indicators, like color change and skin hardness compared to the surrounding areas, is necessary to properly assess the wound.
A Stage 1 bed sore may also feel hard or warm to the touch.
Partial Thickness Skin Loss
A Stage 2 bed sore is most often a very shallow opening of the top layers of skin. Wounds extending only to the top two layers of skin are called “partial thickness” wounds. Stage 2 bed sores often look like rug burn, scrapes, blisters, or burns.
Unfortunately, Stage 2 bed sores can be misdiagnosed as moisture associated, like incontinence associated dermatitis, or misidentified as a traumatic wound, like skin tears or abrasions.
Full Thickness Skin Loss
A Stage 3 bed sore occurs when the wound extends below the layers of skin and into the top portions of the “subcutaneous tissue” (underlying fat and muscle). Wounds extending to the subcutaneous tissue are called “full thickness” wounds.
In a Stage 3 wound, fat is visible in the wound bed. However, bone, tendon, and muscle are not yet exposed. The wound bed may appear red or pink and contain slough (dead tissue). Slough can either be wet and appear yellow or stringy, or dry and appear think, leathery, and black.
Undermining may occur in Stage 3 bed sores. Undermining occurs when tissue under the wound edges become eroded. As a result, a pocket forms under the wound’s edge. Tunneling may also occur. Tunneling wounds occur when channels (like a cave or tunnel) extend from the wound into other subcutaneous tissue.
Unfortunately, undermining and tunneling may go undiagnosed because they are not typically visible. Discovery and treatment of undermining and tunneling in Stage 3 of Stage 4 bed sores requires proper probing, measurement, and documentation.
Full Thickness Tissue Loss
A Stage 4 bed sore occurs when the wound extends through the skin layers and into the subcutaneous tissue (underlying fat and muscle) such that bone, tendon, or muscle is exposed. Just like in a Stage 3 wound, a Stage 4 is a “full thickness” wound, meaning the wound bed is within the subcutaneous tissue.
Undermining, tunneling, slough and eschar (dead or dying tissue) may be present. The wound bed may reflect the color of the exposed bone, muscle, tendon, or fat.
Often, the depth of the wound will depend on where the bed sore is located. For example, bed sores of the sacrum can become much deeper and larger than those located on the heel or elbow. As such, depth is not necessarily a factor in differentiating Stage 3 from Stage 4, only whether bone, tendons, or muscles are exposed.
Stage 4 bed sores may be misdiagnosed as Stage 3 because of the presence of slough or eschar in the wound. Eschar may prevent the healthcare provider from observing that the bone is exposed, or prevent an accurate measurement of the wound.
Full Thickness of Unknown Depth
An Unstageable bed sore occurs when the wound bed is covered with eschar and/or slough (dead, dying, and necrotic tissue) such that it is not possible to measure or stage the wound. In short, until the dead tissue is removed, the true extent of the wound is not known.
According to many studies, Stage 4 bed sores can take months or years to heal. Healing times can depend on the resident’s age, comorbidities, cognition, and other factors.
We hope you found our bed sore stages pictures helpful. If your loved one developed bed sores at a Georgia nursing home, please call and speak to one of our nursing home neglect lawyers. Our consultation are always free.