Lecture on Staging Pressure Injuries

Importance of Staging

• Essential to discern level of tissue destruction in pressure injuries/ulcers.
• Uses grapefruits as visual aids to represent different stages of pressure injuries.

Stage 1 Pressure Injury

• Characteristics: Skin is intact with non-blanchable erythema (redness).
  • Non-blanchable: Pressing does not cause the area to turn white and then back to red.
• Consideration for Non-Caucasian Skin: Look for changes in natural skin tone, such as darkening (dischromia), instead of erythema.

Stage 2 Pressure Injury

• Characteristics: Disruption of skin barrier function, involving partial thickness injury.
  • Epidermis is removed, exposing the papillary layer of the dermis.
  • Considered partial thickness as it only invades the epidermis and the first layer of the dermis (papillary layer).

Stage 3 Pressure Injury

• Characteristics: Full thickness pressure injury.
  • Involves full epidermis and both papillary and reticular layers of the dermis.
  • Does not extend through the subcutaneous tissue.
  • Represented by the fibrous tissue of a grapefruit.

Stage 4 Pressure Injury

• Characteristics: Very deep injury, full thickness with deeper tissue structure involvement.
  • Extends past the subcutaneous tissue into deeper structures like muscle, bone, tendon, ligament, or even metal (post-surgery).
  • Requires immediate protection to maintain tissue viability.

Deep Tissue Injury

• Characteristics: Intact skin with purple or dark purple-red discoloration.
  • Non-blanchable but with notable tissue consistency changes.
  • May feel cooler, warmer, boggy, or hard, differing from normal tissue.
• Pathophysiology: Occurs at the bone-tissue interface due to lack of perfusion, leading to tissue necrosis (muscle, tendon, bone).
  • Described as "cutaneous infarction" as skin is highly resistant to hypoxia.

Conclusion

• Accurate recognition of tissue involvement level is crucial for correct staging and management of pressure injuries.