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Try to recall Pressure Ulcers as the various Pressure-cooker Ulcer-volcanos arranged as a string of islands, like Hawaii. Ulcers which are Stage 1 show Non-blanchable Redness when pressure is placed on the wound, the stage with (1) wand and nun-bleach. Those that are Stage 2 are Partial Thickness skin loss or blistering, the stage with (2) tutu and partial-thickness skin loss, while Stage 3 shows Full Thickness Skin loss, where subcutaneous fat is visible, the stage with (3) tree showing full thickness skin loss. Stage 4 pressure ulcers, on the other hand,&nbsp;show Full Thickness Tissue Loss, leading to visible muscle or bone, the stage with (4) fork showing full thickness tissue loss. Unstageable pressure ulcers, the hidden-stage of ulcer-volcano, are those which are the full thickness of the skin or of the tissue, but the depth is unknown. Possible deep tissue injury, the deep-diver causing tissue injury, is a purple or maroon area of damaged tissue under intact skin, which may resemble a deep bruise. Nursing considerations include Skin Color Alterations, the skin-suit-man with color alterations, as blanching is not always apparent in darker pigmented patients. It is important to&nbsp;Remove Necrotic Tissue Before Staging, removing the necrosis-crow with tissues, as this can cover the true depth of the wound. Let's quickly review Pressure Ulcers. Stage 1 is considered non-blanchable redness, while Stage 2 is a partial thickness of the skin wound. Stage 3 is full thickness skin loss, while Stage 4 is full thickness tissue loss, which exposes bone. Unstageable wounds occur when the depth cannot be determined, and possible deep tissue injury should be considered when the skin looks like a deep bruise. Other considerations include skin color alterations and removing necrotic tissue before staging a pressure ulcer.

educational

story

pressure cooker ulcer.png

pressure uclers.png

Pressure-cooker Ulcer-volcanoes

Pressure Ulcers

Leg Ulcers

Pressure Ulcers/Pressure injuries (Braden scale)

Nursing Care Plan for Pressure Ulcer / Decubitus Ulcer (Pressure Injury)

Types

stage with one wand and nun bleach.png 

red mountain.png

Stage with (1) Wand and Nun-bleach

Stage 1 - Non-Blanchable Redness

What best describes a stage 1 pressure ulcer?

Stage 1 - Skin intact but with non-blanchable redness

stage with 2 tutu and partial thickness skin loss.png

volcano.png

Stage with (2) Tutu and Partial-thickness skin loss

Stage 2 - Partial Thickness

What best describes a stage 2 pressure ulcer?

Stage 2 - Partial thickness loss of skin with exposed dermis

stage 3 tree and showing full thickness tissue loss.png

Stage with (3) Tree showing Full Thickness Skin Loss

Stage 3 - Full Thickness Skin Loss

What best describes a stage 3 pressure ulcer?

Well-demarcated crateriform ulcer with full-thickness skin loss extending down to fascia over greater trochanteric region

Stage 3 - Full-thickness loss of skin, in which adipose is visible in the ulcer and granulation tissue and epibole (rolled wound edges) are often present

Stage 4 with four fork.png

Stage with (4) Fork showing Full Thickness Tissue Loss

Stage 4 - Full Thickness Tissue Loss

What best describes a stage 4 pressure ulcer?

Black necrosis extending into the calcaneal bone, requires debridement.

hidden stage of ulcer volcano.png

Hidden-stage of Ulcer-volcano

Unstageable

What best describes a pressure ulcer that has dead tissue obscuring it like a scab?

deep diver causing tissue injury.png

Deep-diver causing Tissue Injury

Possible Deep Tissue Injury

What should you be concerned about when finding a pressure ulcer that looks like a deep bruise?

Considerations

skin suit man with color alterations.png

Skin-suit-man with Color Alterations

Skin Color Alterations

Regarding pressure ulcers, what clinical finding cannot be relied upon necessarily in assessing severity?

removing necrosis crow with tissues.png

Removing Necrosis-crow with Tissues

Remove Necrotic Tissue Before Staging

What is an important diagnostic consideration regarding pressure ulcers?

Brunner & Suddarth's Textbook of Medical-Surgical Nursing, 13th Edition

Hockenberry, Wong's Nursing Care of Infants and Children, 10th Ed.

Ignatavicius Medical-Surgical Nursing, 9th Edition

Medical-Surgical Nursing, 10th Ed, Lewis, Dirksen, Heitkemper, & Bucher

Medical-Surgical Nursing, 9th Ed, Lewis, Dirksen, Heitkemper, & Bucher

NP - Certification Examination and Practice Preparation 4th Edition, Fitzgerald

PANCE Prep Pearls: 1st Ed, 2014

PANCE Prep Pearls: 2nd Ed, 2017

Potter, Perry, Stockert & Hall, 2017, Fundamentals of Nursing, 9th Ed.

For hundreds of years man has wondered "what causes these Pressure-cooker Ulcer-volcanos to form". &nbsp;Through edge cutting technology and years unproven research we have figured out there are various stages and types&nbsp;of these volcanos. &nbsp;Begining with Stage 1, During this stage a Non-blanchable redness appears that not even a nun with bleach can get out. &nbsp;Perplexed she chaulks it up to the sourcery of a (1)&nbsp;wand... a remarkable deduction, and we agree. Next, in&nbsp;stage 2&nbsp; a tiny&nbsp;tutu dancer interpitates what partial thickness skin loss must feel like, with unfallable scientific accuracy, whatever shes doing it twerks for us. To catagorize stage 3 scientist put a (3) tree in the shoes of a full thickness skin loss and... ureka! thats kind of what it looks like... uncomfortable to say the least. &nbsp;Years ago we sent a scientist to study the dangerous Stage 4 volcano... and last week we remembered he was there. &nbsp;But by the time we got there it was too late. The Ulcer had gone down into the bone, crushing his poor skeleton body causing full thickness tissue loss... which seems to have been last meal and just out of reach of his (4) fork. &nbsp; Then there are the unstagable ulcer-volcanos, who hidden stages extend past the waterline and into the briny deep where you will find the Deep-diver, causing tissue injuries from below, and leaving his trademark bruising at the surface. &nbsp;And lighting up that dance floor our skin-suit-man, who has done a few of his own experiments causing&nbsp;skin color alteration, and though he's no Micheal Jackson it looks as if hes telling that crow to "just beat it", removing the Necrosis-crow with tissues. &nbsp;Join us next time, on ulcer-volcano discovery. &nbsp;Discovery!

Use a finger to apply pressure to the reddened area.

Apply a dressing to the area for cushioning.

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A 82-year-old lady has been admitted to the hospital with pneumonia and a UTI. She has been too weak to get out of bed for the past three days. As you are giving her a bed bath, you notice some new redness over her sacrum. What should be the nurses priority?

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