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Different Ulcers

This document describes the four categories or stages of ulcers. Stage I involves non-blanchable erythema of intact skin. Stage II is a partial thickness skin loss presenting as a shallow ulcer or blister. Stage III shows full thickness skin loss with exposed subcutaneous fat. Stage IV is the most severe, showing full thickness tissue loss down to bone, tendon or muscle.

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Ronilyn Mae Alvarez
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134 views

Different Ulcers

This document describes the four categories or stages of ulcers. Stage I involves non-blanchable erythema of intact skin. Stage II is a partial thickness skin loss presenting as a shallow ulcer or blister. Stage III shows full thickness skin loss with exposed subcutaneous fat. Stage IV is the most severe, showing full thickness tissue loss down to bone, tendon or muscle.

Uploaded by

Ronilyn Mae Alvarez
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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ALVAREZ, Ronilyn A

BSN I-B

DIFFERENT STAGES OF
ULCERS

Category/Stage I: Non-blanchable
erythema: Intact skin with non-blanchable
redness of a localized area usually over a
bony prominence. Darkly pigmented skin
may not have visible blanching; its color may
differ from the surrounding area. The area
may be painful, firm, soft, warmer or cooler
as compared to adjacent tissue. Category I
may be difficult to detect in individuals with

Category/Stage II: Partial thickness


Partial thickness loss of dermis presenting as
a shallow open ulcer with a red pink wound
bed, without slough. May also present as an
intact or open/ruptured serum-filled or serosanginous filled blister. Presents as a shiny
or dry shallow ulcer without slough or
bruising.

Category/Stage III: Full thickness skin


loss:
Full thickness tissue loss. Subcutaneous fat
may be visible but bone, tendon or muscle
are not exposed. Slough may be present
but does not obscure the depth of tissue
loss. May include undermining and
tunneling. The depth of a Category/Stage

Category/Stage IV: Full thickness tissue


loss:Full thickness tissue loss with exposed
bone, tendon or muscle. Slough or eschar
may be present. Often includes undermining
and tunneling. The depth of a
Category/Stage IV pressure ulcer varies by
anatomical location.

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