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Recognizing skin breakdown

What is a Bedsore or Pressure Ulcer?

     You might have heard a pressure ulcer referred to as bedsores or decubitus ulcers-different terms but basically the same thing.  A bedsore is a wound of the skin caused by prolonged, unrelieved pressure to one area, often seen around a bony area such as the tailbone, hips, heels, ankles or elbows.


     The constant pressure causes damage by decreasing the blood flow to the skin and traumatizing the area.  As the traumatized area rubs against the surface it touches (sheets, wheelchair cushion, etc.,), the friction starts tearing away surface cells and tissue is damaged. Often, other contributing factors interfere such as moisture from fecal or urinary incontinence, poor nutrition or hydration, and generally poor health.


     If you see damaged tissue and want to tell your healthcare provider about a pressure ulcer, you want to describe the ulcer in terms that match what the healthcare provider understands.  Pressure ulcers are separated into four types. Whenever you believe you are dealing with one that needs treatment to compare what you see to the chart below, take accurate measurements, and be prepared to describe it to your healthcare provider in detail. I recommend placing a tape measure beside the wound and taking a picture of it.  The doctor then has an accurate picture for comparison.

What does it mean when a doctor asks if the skin is still "blanching"?

     The skin is still blanching if you push on it and it gets lighter in color and then returns to its regular color once the pressure is released. That change in color indicates there is still enough blood flow to that area that tissue death is not occurring yet.

What are Signs of Inflammation?

       Inflammation is like an infection but has no pus.  You see redness, heat, swelling, pain, and fever. (Pus is a thick, yellowish-white or green liquid made of dead white blood cells, bacteria, and tissue debris and often has a foul odor.)

Preventing Skin Breakdown

     Failure to quickly and successfully treat pressure ulcers frequently leads to full-body infection (sepsis) and eventual death.


  • Relieve pressure by repositioning the person every two hours while in bed and every 15 minutes in a wheelchair.
  • Remove damaged tissue per doctor’s order using the prescribed method of removal.
  • Clean and dress the wound using saline, keeping the wound moist. Cover with a barrier that allows moisture to remain intact.
  • Check for signs of skin breakdown daily during bath time.
  • If a wound is found, measure the width, length, and depth of the wound in centimeters. Depth can be measured using a clean Q-tip. Take the Q-tip and guide it carefully into the hole. Mark the distance on the Q-tip and measure against a ruler.  Also take a picture for comparison.

How Bad Can the Ulcers Get?

There are Four Stages to the Pressure Ulcers.

Stage I: Pre-Open Wound

The skin is still attached but appears red and discolored (greyish, ashen). It doesn’t blanch (i.e., lighten) when you push on it.  It may also be painful, firm or soft, warm, or cool.

Stage II: Open Wound

The pressure ulcer looks like a shallow, pinkish-red bowl-like wound or may appear to be a blister that hasn’t popped yet or maybe has deflated.

Stage III: Deep Wound

Stage III Ulcers are deeper wounds and look like a crater in appearance, often exposing the fat layer of tissue. The bottom of the wound may have yellow deed tissue called slough present.

Stage IV: Large Scale Tissue Loss

Substantial scare tissue loss has occurred by this point in time. The wound exposes bone, muscle, and tendons. The bottom of the ulcer contains slough, and dark, crusty dead tissue (eschar). The deep damage is extensive and takes a long time to heal.

What are Signs of Infection?

    Good question.  Infection is different from inflammation, which meaning the area is damaged in some way but not always infected. With infection, you usually see pus, fever, swelling, and pain.

Four stages of pressure ulcers

YouTube Video Resources

Pressure Ulcers, Prevention, Assessment, and Stages 1,2,3,4  

Published on Mar 7, 2018 by RegisteredNurseRN. This video provides education on pressure injuries (formerly called pressure ulcers) to include stages, prevention, nursing interventions, and common pressure ulcer sites.  Stage 1, 2, 3, 4 pressure injuries along with unstageable pressure injuries and deep-tissue injuries are reviewed. 


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