Stages of Pressure Ulcers

Nursing Knowledge

Stages of Pressure Ulcers

Pressure ulcers are a common and serious problem in clinical practice, particularly for clients who are bedridden or use a wheelchair. These injuries to the skin and underlying tissue can cause significant pain and discomfort, and can even lead to life-threatening infections, sepsis, abscesses, necrotizing fasciitis, and osteomyelitis. Nurses play a critical role in preventing and managing pressure ulcers, and understanding how to stage these wounds is an essential part of their practice.
Last updated: December 4, 2023

Table of contents

What are pressure ulcers? 

Pressure ulcers are injuries to the skin and underlying tissue caused by prolonged pressure restricting blood flow. 

Nursing tip: Always do a full head-to-toe skin assessment upon admission or transfer to your unit, and document appropriately.

What causes pressure ulcers?

Pressure ulcers (older terms: bed sores, decubitus) are usually caused by prolonged pressure on the skin. Other causes include friction, shear, moisture, and contributing factors include poor nutrition, poor blood flow, lack of mobility, old age, or decreased sensation. 

Individuals who spend long periods of time in bed or seated in a wheelchair are most at risk.

What are common locations of pressure ulcers?

Pressure ulcers most often affect the tissue over bony parts of the body.

When lying on the back: 

  • Toes
  • Heels
  • Lower back bone
  • Spine
  • Elbows
  • Shoulder blades
  • Back of the head

When lying on the side: 

  • Ankle
  • Knee
  • Hip
  • Shoulder
  • Ear

When sitting: 

  • Heels
  • Sitting bones
  • Lower back bone
  • Elbows
  • Back bone
  • Shoulder blades

What are the 4 stages of pressure ulcers? 

Table: Stages of pressure ulcers

Stage 1Non-blanching erythema with intact epidermis
Stage 2Partial-thickness ulcer, involving epidermis and dermis
Stage 3Full-thickness ulcer extending through dermis into subcutaneous tissue
Stage 4Deep tissue destruction extending through fascia; may involve muscle, bone, tendon
UnstageableDepth of injury unknown due to presence of necrotic tissue or eschar; surgical debridement required for staging

How to prevent pressure ulcers

Measures that can be taken to help prevent pressure ulcers include: 

  • Encourage or assist with position changes, at least every 1–2 hours.
  • Avoid prolonged moisture; protect skin from urine, stool or wound drainage.
  • Utilize specialized mattresses, pads or cushions to relieve and redistribute pressure.
  • Maintain tissue integrity with a well-balanced, protein-rich diet

How are pressure ulcers treated?

Treatment depends on the stage and severity. General approaches include:

  • Relieving pressure on the affected area
  • Cleaning and dressing wounds using appropriate dressings
  • Debridement (removal of dead tissue)
  • Providing proper nutrition to support healing
  • Administering antibiotics if there’s an infection


Stages of Pressure Ulcers

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An overview of how to stage a pressure ulcer

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