Introduction:
Pressure ulcers, bedsores, or decubitus ulcers, are injuries to the skin and its underlying tissue caused by continued pressure on the skin. In stage 1 pressure ulcer, the ulcer is a red, blue, or purple tint and feels warm to the touch, burning, and itchy. If a stage 1 pressure ulcer is not treated correctly on time, it may develop into a stage 2 pressure ulcer. At this stage, the pressure ulcer breaks the superficial skin layers resembling an open blister, causing pain and discoloration.
Pressure ulcers are common in patients with limited mobility or underlying medical problems. Untreated stage 2 pressure ulcers can worsen, causing severe medical problems or may be fatal. Proper medical care can help elders to recover. Stage 2 pressure ulcers may indicate nursing care abuse or neglect.
What Are the Symptoms of Stage 2 Pressure Ulcers?
Stage 2 pressure ulcers are open, shallow, broken wounds with a red base. Intact or incompletely ruptured blisters may also be present with clear fluid or pus seeping from the affected area, and the skin to it adjacent may be discolored. It may involve both the dermis and epidermis of the skin.
Stage 2 bedsores are common in ankles and heels, back of the head, hip, shoulder blades, and tailbone. However, it can develop in any part of the body under constant pressure. Still, areas near bones are at a higher risk.
There is more significant pain in stage 2 bedsores than in stage 1 bedsores. The pain decreases as the sore worsens but becomes harder to treat, leading to fatal complications.
What Are the Causes of Stage 2 Pressure Ulcers?
Pressure ulcers can occur mainly due to three different forces:
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Prolonged Pressurev - When a person applies constant pressure against the bony surface for a long time, it can result in a pressure ulcer. When this pressure goes beyond the tissue capillary pressure, the surrounding tissues deprive oxygen, leading to tissue necrosis.
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Shearv - Shear happens when the deep fascia slides over the skeletal muscle, which can compress the blood vessels leading to ischemia and tissue necrosis.
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Frictionv - Friction is the opposite of shear force. Friction causes microscopic and macroscopic tissue trauma when the patient moves through the support surface.
Further, moisture from incontinence, wetness, or exudate increases the friction between the surface and the skin. It weakens the epithelial bonds making the skin more liable to pressure, shear, and friction damage.
Stage 1 pressure ulcers do not cause skin breaks, but disposing of the same area to any forces after an ulcer is formed can tear the skin, developing stage 2 pressure ulcers.
Who Is at Risk for Stage 2 Pressure Ulcers?
Patients with limited mobility, immobility, and bedridden patients. Elders with medical conditions like circulatory diseases and diabetes, atherosclerosis, spinal cord injury, neuropathy, infections. Patients who lack control over urination and defecation moisten the adjacent skin and damage the skin. Additionally, adult diapers trap waste, thus damaging skin if they are not changed frequently. Malnourishment causes anemia that can decrease a person's health and weight, which results in bedsores.
How Is a Stage 2 Pressure Ulcer Treated?
Dressing over the ulcer keeps the ulcer dry and decreases the risk of infection.
Different dressings available in the market are:
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Topical antimicrobials including Bacitracin, Bactroban, Cadexomer iodine, nanocrystalline silver, polysporin powder, silver sulfadiazine cream, silver impregnated hydrofiber, silver gel, sodium hypochlorite.
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Alginates dressing.
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Barrier dressings.
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Activated charcoal dressings.
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Collagen dressing.
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Composite products.
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Compression wraps.
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Hydrophilic polyurethane foams.
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Cotton, rayon, or polyester gauze packs.
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Carboxymethylcellulose (CMC) combined with pectin hydrocolloids.
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Carboxymethylcellulose hydrofiber.
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Hydrogels.
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Sodium chloride impregnated dressings.
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Petrolatum impregnated dressings.
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Polyurethane or synthetic polymer sheets transparent films.
Aggressive irrigation with saline solution is done to clean the open wound. The damaged and dead tissues are debrided from the ulcer to promote healing. Nutritious Vitamin A and C, protein, zinc, and iron-rich diets should be given. Enough water intakes also play an essential role in healing. Reducing pressure on the ulcer area will prevent it from worsening and allow the skin to repair. Negative pressure wound therapy uses sub-atmospheric pressure to stimulate wound contraction, remove discharges, reduce swelling and increase blood flow.
How to Prevent Stage 2 Pressure Ulcers?
Stage 2 pressure ulcers can be prevented when stage 1 pressure ulcers are treated early. Treatment includes removing pressure from the ulcer and keeping it clean and dry. Consult a physician if the ulcer does not fade in two to three days.
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The patient should be repositioned every two hours.
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Maintain the skin clean and dry.
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Do not massage the bony prominences.
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Use positioning devices to avoid continued pressure over the bony prominences.
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Keep the bed head as low as possible to decrease the risk of shearing.
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Keep bedspreads dry and without fold.
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Use a pillow between legs when lying on the sides.
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Do not directly position the trochanter.
What Is the Prognosis of a Stage 2 Pressure Ulcer?
Stage 2 pressure ulcers have a relatively good prognosis when treated on time. They usually heal in three days to three weeks when appropriately treated.
What Are the Complications From Stage 2 Pressure Ulcers?
Stage 2 pressure ulcers, when left untreated, can advance into deeper skin tissues, resulting in stage 3 and 4 ulcers which are harder to treat and may be fatal. Infection in pressure ulcers can spread to the blood and bones, resulting in sepsis and osteomyelitis. When deeper tissues are involved, it may cause permanent tissue damage that may never heal completely even with treatment. Pressure ulcers increase the risk of urinary tract infections (UTIs), amputations, and autonomic dysreflexia.
Conclusion:
Stage 2 pressure ulcers are open wounds on the epidermis of the skin. Proper care given when the stage 1 pressure ulcer is diagnosed can prevent progressing to stage 2 pressure ulcers. Frontline caregivers play an essential role in screening, assessing, and managing pressure ulcers. Healing and prevention of pressure ulcers in critically ill patients are crucial. Early referral and treatment improve the outcome of the risk of pressure ulcers.
