Development of Bedsores

While unstageable bedsores cannot be readily assigned to a development stage, all other bedsores fall into one of four general stages classified by the National Pressure Ulcer Advisory Panel or NPUAP. These stages indicate the severity of the bedsore and there are specific treatments which can prove effective at each stage in order to minimize the time required for a full recovery. The following are descriptions of the four stage of bedsores based upon the NPUAP guidelines:

Stage One:

Stage one bedsores are the least severe, and have the shortest length of recovery time if treated properly and promptly. The symptoms of a stage one bedsore include redness that does not subside when the pressure on the affected area is relieved. This area may be warmer or cooler than surrounding skin and is often tender or painful to the touch. If the affected individual has a dark skin tone, the area may be purple or bluish compared to surrounding skin.

Stage one bedsores indicate only superficial damage, and the condition can usually be resolved in a relatively short amount of time with proper treatment. Stage one bedsores should not be confused with a diagnosis of suspected deep tissue injury, although both may be indicated by discolored skin and the presence of tissue that is painful, has a different texture, or is cooler or warmer than the surrounding areas. Suspected deep tissue injury may also have the presence of a blood blister, and can be caused by pressure or shear factors that may or may not be continual such as is the case with bedsores.

Stage Two:

If proper treatment is not given for a stage one bedsore, then the condition may progress to stage two. Stage two bedsores generally show the first signs of an open wound or crater, and indicate a partial deterioration of the epidermis. Depending upon the area where the bedsore develops, this stage may take some time to heal, and may progress into later stages more quickly. Because of the open nature of the wound, there is an increased risk of infection as well.

Stage Three:

Stage three bedsores are more severe than the first two stages, and comprise full loss of the dermis layer. This means that subcutaneous fat may be clearly visible, and there is a high risk of infection as the bedsore is open to further exposure to potential pathogens. Depending upon where the bedsore is located, this wound may be very deep, or relatively shallow. Generally speaking, any stage three bedsores located where there may be a significant amount of subcutaneous tissue will be deeper than areas that do not, such as the backs of the ears.

Stage Four:

Stage four bedsores represent the most severe injuries possible and there is a loss of epidermis, dermis, subcutaneous tissue, and in some cases muscle or bone may be directly visible. These stage of bedsore is very prone to infection, slow to heal, and can cause significant pain and mobility issues. The depth of stage four bedsores, like those of stage three, is directly determined by the area of the body upon which the bedsore develops.

The more severe the bedsore, the longer it will take to heal. While some stage one bedsores may be healed within only a few days or weeks, stage four bedsores can take a year or longer to fully heal, if in fact they heal at all. During this time, the patient is more vulnerable to infection, and additional bedsores as attempts to alleviate irritation and pressure in one area can divert the pressure to other areas of the body for prolonged periods of time if proper precautions are not taken.