Stage 4 Pressure Ulcer

Stage 4 pressure ulcer is the most severe. Pressure ulcers are commonly known as bedsores. They form after sitting or lying for a long time without changing position. Pressure ulcers can affect anybody. They appear in various forms ranging from closed wounds to open ones.

Prolonged pressure on the skin, particularly in bony areas, makes pressure ulcers develop quickly. These ulcers are common in people with frailty, paralysis, severe illness, or old age. Bedsores develop in stages based on the depth of the wounds.

What is stage 4 pressure ulcer?

A stage 4 bedsore has progressed through stage 1, 2, and 3 of pressure ulcer development without any treatment. This stage is the most severe. Stage 4 pressure ulcers may occur simultaneously with various other medical skin conditions. However, sores at this stage happen due to negligence of nurses and caretakers taking care of the sick or patients waiting until it’s too late to seek medical treatment.

Malpractice or inexperience in handling immobile individuals can also result in the stage 4 bedsores development. Incorrect treatments of earlier stages of this condition also cause the ulcers to develop to this potentially terminal stage. Bedsores at this stage develop around bony parts of the body with minimal fat tissues protecting underlying tissues.

These bedsores are life-threatening. They can also cause other multiple infections. These ulcers break below subcutaneous fat layer. They result in extensive loss of tendons, fat, skin, muscle, and ligaments. In some cases, they extend to the cartilage or bone. Some of the tissues can get damaged or die beneath a seemingly healthy skin that surrounds the pressure ulcers.

What are symptoms of stage 4 ulcers?

  • Bedsores at this stage appear as large, gaping areas of damaged and dead tissues.
  • Patient’s muscle fibers, bones, joints, ligaments, and tendons in the affected areas are in most cases visible and dying.
  • The skin has turned black and shows signs of infection -- red edges, pus, odor, heat, and or drainage.
  • Crusty dead tissues that have not been removed from the wounds are present.

A patient who has developed bedsores at this stage is battling a variety of infections. In cases where medical care is not given as early as possible, they may never recover. Diseases associated with the stage 4 pressure ulcers include sepsis and cellulitis. The sores are upsetting in appearance. Therefore, most individuals without medical expertise may find it quite challenging to examine the ulcers visually.

Stage 4 Therapy

Treatment of stage 4 bedsores is precisely described as pressure ulcers management. Although treatment is aimed primarily at healing open wounds, many of the affected patients are not healthy enough to recover from stage 4 pressure ulcer conditions.
Therefore, several medical processes are required to focus majorly on minimizing discomfort and pain for the patients.

Therapy also enables the doctor to determine the extent of damage to the surrounding tissues. Also, these procedures allow physicians to recommend perfect treatment strategies that will increase the rate of healing of stage 4 bedsores.

Stage 4 Management

Management of this health condition involves several processes. First, changing the position of a patient is necessary. It is a part of both prevention and treatment of pressure ulcers. Remaining immobile for extended periods is what causes bedsores to develop.

Pressure applied on bony areas of the patient’s body causes inconsistent and eventual cut off of blood circulation to the involved parts. Changing positions and eliminating pressure on a stage 4 bedsore reduces pain. Consequently, the wound gets an opportunity to heal.

Advancement in the medical field has enabled development of new medications to help patients heal their bedsore wounds. Although some of the medicines are still in trial stages, a patient with severe bedsores opts to try them out. Furthermore, pain relievers and antibiotics may be used in the treatment of infections while simultaneously alleviating pain.

Debridement of the bedsores focuses primarily on the removal of all dead tissues in the affected parts. Elimination of dead tissues minimizes further risk of infection. Doctors may debride using ultrasounds, biological debriding procedures, debriding dressings, and natural or man-made enzymes. Furthermore, surgical removal of dead and damaged tissues can also get used for debridement processes. Some physicians and doctors may use a saline rinse to clean the stage 4 bedsores.

Air fluidized therapy manages bedsores using air-fluidized beds. This strategy is proven to offer the most effective results for suspected deep tissue injuries. Additionally, the treatment can be used as a form of bedsore prevention process.

Negative pressure therapy relies extensively on the combined use of several other bedsore treatment procedures. Nonetheless, its effectiveness varies from one patient to the next. Some patients experience successful healing using this management method after surgical debridement. Negative pressure therapy eliminates the remaining dead tissues and enhances the formation of new, healthy ones.

What causes pressure ulcers?

Pressure ulcers arise from constant force on the skin that limits normal blood flow to other body parts. Primary factors that cause these sores are:

  • Pressure: Constant pressure decrease blood flow to various body parts. The inconsistent blood circulation makes nearby skin and tissues to get damaged and also die. People with restricted mobility tend to develop these sores.
  • Friction: Whenever skin rubs against clothing or bedding for a long time, bedsores develop. The skin gets vulnerable to injury particularly when the skin is moist.
  • Shear: This condition arises when two surfaces in contact move in opposite directions. For instance, a patient sliding down a bed that is raised at the head.

What are risk factors of pressure ulcers?

Immobility while seated or in bed caused by poor health and old age increases the risk of developing bedsores. Other risk factors include:

  • Lack of sensory perception
  • Poor nutrition
  • Inadequate hydration
  • Medical conditions affecting blood flow

What are other Stages?

Bedsores get categorized in different stages depends on the degree of tissue damage. Doctors implement the best treatments to assure quick recovery subject to the stage involved. The pressure ulcers can get healed within a few days if they are treated correctly in their early stages.

Stage 1

Stage 1 is the mildest causing the upper skin layer to discolor into a reddish color. The condition extends more in-depth than the skin’s surface even though although the wound is yet to open. The affected areas get sore with no appearance of surface tears or breaks. Mild itching and burning sensations are a common occurrence.

Stage 2

Stage 2 features some pain in the bedsores. The pressure ulcers break through the top layer of the skin and the layer below it. The wounds are open and shallow. They may or may not a discharge. However, the bedsores resemble a serum-filled blister that may have ruptured. The surrounding skin gets red, swollen, or sore signifying tissue damage or death.

Stage 3

Stage 3 ulcers have entirely broken through the top two skin layers and entrenched into fatty tissue below. Pressure ulcers resemble a crater and may produce foul smells since surrounding tissues have started to rot. It is advisable to look out for signs of infections such as foul odor, pus and redness.

Stage 4 pressure ulcers cause pain, discomfort, and limited mobility. Other underlying conditions or illnesses contribute to high mortality rate. Sepsis and other infections are common resulting in death or extended treatment for the bedsore patients. Most patients with pressure ulcers are already getting treatment for severe conditions. It’s advisable to seek early treatment whenever one develops any skin condition.