Stage IV Pressure Ulcer

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What is a Pressure Ulcer?

A pressure ulcer is a wound that occurs as a result of prolonged pressure on a specific area of the body. This usually occurs when individuals stay in one position for a long period of time. Commonly known as bed sores, these wounds afflict bedridden individuals and people in wheelchairs.

Usually, the lack of blood flowing to the affected area, due to the constant pressure, causes the tissue to die. The most common places for this to occur are areas of the body where the bone is close to the skin, including the hips, ankles, back, and shoulder.

Staging Pressure Ulcers

There are four stages that pressure ulcers progress through. Stage I pressure ulcers are developing and generally appear as a reddish area on the skin. The area doesn’t turn white when pressure is applied to the skin. When the area becomes a blister and open sore, it is classified as a stage II pressure ulcer. As the sore deepens and becomes a crater, the ulcer is labeled as a stage III pressure ulcer. A stage IV pressure ulcer is a wound which extends into the underlying bone and muscle.

Preventing Stage IV Pressure Ulcer

To reduce the chances of a wound degrading to a stage IV pressure ulcer, an adequate screening of bedridden individuals should be done by the medical staff at hospitals and nursing homes. Patients should be routinely moved into different positions to alleviate pressure on the wound. The use of pillows, cushions, and other pressure reducing material should be utilized as well.

Maintaining an adequate diet that is rich in nutrients is important for wound healing. Nutritional supplements which improve healing of pressure ulcers include vitamin c, arginine, and zinc. Increased protein intake also promotes wound healing.

Treating Stage IV Pressure Ulcer

Treatment of stage IV pressure ulcers begin with the removal of dead tissue. If there is a minimal amount of tissue that needs to be removed, it can occur at the patients bedside. If the damage is extensive, surgery is usually required. The next step is to prevent contamination of the wound from bodily fluids. The wound is then cleaned and dressed.

Alginate dressings are usually used for stage IV pressure ulcers. It consists of sheets of fibrous material that absorb fluid from the ulcer. If the wound consists of little to no fluid drainage, this type of dressing can dehydrate the wound tissue and slow the healing process.

Hydrocolloid dressings are used to protect stage IV pressure ulcers that feature little fluid drainage. It provides a protective layer that prevents bacterial infection and a moist environment to promote wound healing. This type of dressing reduces stress on the skin and underlying tissue to establish a more stable healing environment.

Reference

1. https://www.nlm.nih.gov/medlineplus/ency/article/007071.htm

2. https://emedicine.medscape.com/article/1293614-treatment