Test your Pressure Ulcer Staging Skills

+227

No comments posted yet

Comments

BillyEverett (1 year ago)

Didn't even know what the title meant before watching this

Slide 1

Test your Pressure ulcer staging skills Advance slides for answers. Note: Beware this presentation contains Graphic photos

Slide 2

What Stage?

Slide 3

Deep Tissue Injury NPUAP Definition - Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.

Slide 4

What Stage?

Slide 5

Stage II NPUAP Definition - 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 blister. Presents as a shiny or dry shallow ulcer without slough or bruising.

Slide 6

What Stage?

Slide 7

Unstageable NPUAP Definition - Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed. Further description: Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as “the body’s natural (biological) cover” and should not be removed.

Slide 8

What Stage?

Slide 9

Stage III NPUAP Definition - 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.

Slide 10

What Stage?

Slide 11

Unstageable NPUAP Definition - Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed. Further description: Until enough slough and/or eschar is removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as “the body’s natural (biological) cover” and should not be removed.

Slide 12

What Stage?

Slide 13

Stage IV NPUAP Definition - Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.

Slide 14

What Stage?

Slide 15

Stage II NPUAP Definition - 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 blister. Presents as a shiny or dry shallow ulcer without slough or bruising.

Slide 16

What Stage?

Slide 17

Stage I: NPUAP Definition - 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.   Further description: The area may be painful, firm, soft, warmer or cooler as compared to adjacent tissue. Stage I may be difficult to detect in individuals with dark skin tones. May indicate “at risk” persons (a heralding sign of risk)

Slide 18

What Stage?

Slide 19

Stage III NPUAP Definition - 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.

Slide 20

What Stage?

Slide 21

Deep Tissue Injury NPUAP Definition - Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.

Slide 22

What Stage?

Slide 23

Stage IV NPUAP Definition - Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed. Often include undermining and tunneling.

Slide 24

Resources Wound Care Education - www.wcei.net Training tools – www.woundcentral.com NPUAP Website – www.npuap.org Pressure Ulcer Staging - http://tr.im/sNRx

Summary: For Licensed Healthcare professionals. Photo quiz: Identify stages of pressure ulcers. Medical Nursing Education; very graphic photos.

Tags: wound care pressure ulcer staging nursing skills

URL: