Stage II Pressure Ulcers

Stage II pressure ulcers are the most common pressure ulcers that we experience.  Everyone at some point in their life has had an injury similar to a stage II pressure ulcer although we may not have called it that.

Stage II pressure ulcers can be blisters.  The same blisters that we have on our heels or toes when our shoes rub, or we get on our hands after doing unusual yard work without wearing appropriate protection. Stage II ulcers are defined as damage to the outermost layer of the skin.  They sometimes appear as open areas that do not involve the deeper layers of skin, muscle, or bone, and other times as the above described blisters.

That's how stage II pressure ulcers form more often than not, from a combination of moisture and rubbing. A patient left in a wet bed a little too long might form a stage II pressure ulcer.

The best part about a stage II ulcer, is like stage I ulcers they require very little treatment to cure them. The stage II pressure ulcer requires a dry surface and some sort of a protective covering to keep excess moisture out. Many times, ensuring the bed and the area around the wound remains clean and free of excess moisture, either from a dry dressing or a barrier product of some sort, is enough to heal the wound.

This wound is easy to spot on all skin types because unlike the stage I and DTI the skin is clearly broken and no longer intact. In fact because of the lack of intact skin for the first time we have an ulcer that can usually be seen more clearly on a patient with non Caucasian skin tones than those with Caucasian skin tones.

The fact that stage II pressure ulcers are easy to heal makes them difficult from a litigation standpoint.  Many times the wounds heal and don't get any worse without any assistance and the same level of care as prior to the wound, or with the simple expedient of more frequent diaper or bed changes, or ensuring the skin is drier than it was previously. If a stage II ulcer is left untreated though, or if the patient is continually left in a damp situation stage II pressure ulcers can quickly decline into stage III or stage IV ulcer. Each ulcer requires a more complex treatment plan, and even more therapy and costs everyone more.  Many times facilities get into trouble because they fail to reassess their patient's needs at the stage II level.

I am going to spend a few lines here discussing nomenclature. Nomenclature (how you express yourself in writing) for pressure ulcers consists of two different choices.  The common/preferred choice for pressure ulcers is to write their stages as Roman Numerals, however I have seen the ulcers, particularly stage 1 and stage 3 expressed as arabic numerals.  There isn't anything wrong with this and its not uncommon, nor is a deviation for the standard of care, and in writing it can be easier to see stage 3 ulcers specifically when written in arabic numerals. I see them interchangeably used all the time and for the purposes of this blog I will attempt to stick with the roman numerals for expression.