Pressure Ulcers

This is where things get tricky.  If they weren't tricky before, they get tricky now.  Stage 1 and two pressure ulcers are only at the surface of the skin.

Stage III pressure ulcers are the first pressure ulcer that does not involve intact skin that involves more than damage to the skin surface.  The difference between a stage III and a stage IV ulcer is the not the size (the total area of the ulcer) but the depth of the ulcer.  A stage 3 ulcer involves the fat that lies below the skin, and there is some debate as to whether or not it involves the musculature, but it absolutely does NOT involve bone exposure or that the clinician can feel the bone through the tissue. (sometimes called palpable).

Once you get away from the surface ulcers (stage 1 and stage II) size NO LONGER MATTERS.

Let me repeat that SIZE NO LONGER MATTERS. 

I'll say it one more time SIZE NO LONGER MATTERS.

I'm pretty sure I cannot emphasize this point enough, because its hard to wrap your head around.  The idea that a stage 3 pressure ulcer that is the size of your entire back is actually not worse than a stage 4 pressure ulcer the size of a pencil that goes all the way to the bone on your leg. This is because the one on across your back looks worse than the one on your leg. In truth the one on the back is NOT worse than the one on the leg.

I'll get into the multitude of problems that a stage IV pressure ulcer can cause next week, because that's not our focus, our focus is the stage III ulcer.

Stage III ulcers like stage I ulcers tend not to last terribly long if they're not caught and treated almost immediately.  Its not long before a stage III ulcer without treatment develops into a stage 4 ulcer.

Depending on the depth, treatment usually involves keeping the wound bed moist and clean to promote healthy tissue generation, and the surrounding tissues dry to prevent additional breakdown, and regular turning and repositioning of the client. If the client's nutritional status has not been previously evaluated, it is CRITICAL to get their nutritional status evaluated and start nutritional support if it's needed. This is because the body puts it's energy into healing these wounds, and it has been my finding, as it has been many others, that patients without adequate nutritional support not only take longer to heal but also are at significantly increased risks for developing additional pressure ulcers and infections.

Pressure ulcers are a slippery slope and once started down them if a stop is not put in place immediately it can lead to death.

For all pressure ulcer cases it is important to have at least one nurse evaluate the case, because the first line of prevention is the nurse providing day to day care.  A wound nurse is ONLY called in once a wound has formed.