Stage 2 Pressure Ulcers: Symptoms, Causes, and Solutions

A pressure ulcer is defined as damage to the skin or underlying soft tissue, often located over a bony prominence. This damage is typically caused by prolonged or intense pressure, or a combination of pressure and shear forces. Early diagnosis of pressure ulcers, including stage 2 pressure ulcers, is crucial to prevent worsening and complications such as infections, which can be life-threatening.

What Is a Stage 2 Pressure Ulcer?

A stage 2 pressure ulcer involves damage to the skin that results in the loss of the outermost layer (epidermis) and exposure of the dermis, which is the middle layer of skin. This type of ulcer presents as a shallow, open wound with a pink or red wound bed. The wound bed may contain granulation tissue or necrotic material such as slough or eschar, which may appear yellow, white, black, or brown. A stage 2 pressure ulcer may also present as an intact or ruptured serum-filled blister.

Case Example: An 84-year-old male is admitted to a long-term care facility after a hospitalization for exacerbation of congestive heart failure. During his hospitalization, he developed a stage 1 pressure ulcer on his left heel. He is very weak and mostly stays in bed for several weeks after his admission to the facility. He complains of pain in his left heel, and staff find that the stage 1 pressure ulcer on his left heel is now an open ulcer with a red wound bed. He is diagnosed with a stage 2 pressure ulcer on his left heel.

Early Warning Signs of Stage 2 Pressure Ulcers

Stage 1 pressure ulcers can progress to stage 2 pressure ulcers if not treated promptly and properly. Early warning signs of a stage 2 pressure ulcer include persistent skin color changes (red, blue, or purple) that does not fade when pressure is removed. The skin may also be warm to the touch, swollen, or unusually firm. Affected individuals may complain of pain, tenderness, or itchiness in the area. The skin may also feel boggy or have a spongy texture before the ulcer visibly opens.Steps for Treating a Stage 2

Pressure Ulcer

It is important to prevent pressure ulcers from developing, but once a stage 2 pressure ulcer is diagnosed there are a few key steps to follow to allow for optimal healing.

Step 1: Relieve pressure from the affected area by repositioning the resident and using supportive devices such as pillows or bolsters.

Step 2: Use dressings and padding to protect the wound and reduce additional pressure.

Step 3: Keep the affected area clean and moisturized to support optimal healing.

Step 4: Assess for the presence of slough or eschar, which may indicate the need for wound debridement.

Step 5: If slough or eschar is present, perform debridement to remove nonviable tissue and promote a clean wound bed.

Step 6: Monitor for exudate (drainage), which could be a sign of infection requiring antibiotic treatment.

Step 7: If the drainage is not due to infection, manage moisture with absorptive dressings.

Step 8: Consult with a certified wound care nurse or physician if the pressure ulcer does not improve or shows signs of worsening.

Timely, consistent care is key to healing stage 2 pressure ulcers and preventing further complications.

Preventing Stage 2 Pressure Ulcers

Facilities should prioritize implementing strategies to prevent pressure ulcers from developing.

• Reposition at-risk residents according to scheduled protocols.
• Conduct weekly skin assessments for all residents.
• Perform frequent risk assessments to identify residents at risk of developing pressure ulcers.
• Monitor all residents' weight regularly to ensure they are receiving adequate nutrition.
• Ensure residents are adequately hydrated through ongoing monitoring.
• Utilize pressure-relieving cushions and mattresses as needed for at-risk residents.

By consistently applying these preventive measures, facilities can significantly reduce the incidence of stage 2 pressure ulcers and improve resident outcomes.

Building a Facility-Wide Culture of Skin Integrity

Facility leadership should help develop a culture in which skin integrity is a priority for all staff. The entire interdisciplinary team should work together to implement measures to prevent pressure ulcers and heal those ulcers that are present.

• Provide staff with regular education on all aspects of pressure ulcer prevention, identification, and treatment.
• Conduct routine competency assessments to ensure staff are applying best practices consistently.
• Have nursing leadership track and monitor the facility’s pressure ulcer rate.
• Share pressure ulcer data with the full interdisciplinary team during QAPI meetings to guide quality improvement initiatives.
• Encourage open communication between staff and leadership regarding skin integrity concerns.

Pressure ulcer quality measure improvement should be celebrated in the facility as well as any pressure ulcer that has been healed

Conclusion

Stage 2 pressure ulcers are characterized by the loss of the outer skin layer and exposure of the dermis, often appearing as open sores or ruptured blisters. Because stage 1 ulcers can progress into stage 2 pressure ulcers if left untreated, early prevention is essential. Many nursing home residents are at increased risk due to chronic health conditions, immobility, or malnutrition. Treatment includes offloading pressure, protecting the wound with appropriate dressings, and monitoring for infection. If slough or eschar is present, debridement may be necessary to facilitate healing. Regular risk assessments and skin checks should be part of routine care to prevent stage 2 pressure ulcers and other skin integrity issues.

Frequently Asked Questions (FAQ)

• Can stage 2 pressure ulcers heal on their own? Stage 2 pressure ulcers can heal on their own, but they are considered open wounds, so they require appropriate care to allow healing and to prevent worsening.
• How long does it typically take for a stage 2 ulcer to heal in a long-term care resident? Stage 2 pressure ulcers heal in a few weeks to a month on average. Larger stage 2 pressure ulcers can take longer to heal, and the presence of infection will also delay healing. Residents with poor nutritional status or multiple chronic medical conditions may also have delayed healing of their stage 2 pressure ulcers.
• What is the difference between stage 2 and stage 3 pressure ulcers? Stage 2 pressure ulcers result from an injury that causes the first layer of skin to be lost, exposing the dermis (the middle layer of skin). It appears as a pink or red open wound. Stage 3 pressure ulcers result from full loss of all skin layers and subcutaneous fat may be visible.
• What role do CNAs play in preventing pressure ulcers? CNAs play an essential role in preventing pressure ulcers by repositioning at risk residents and alerting nursing staff to any skin changes as well as worsening of pressure ulcers. CNAs can also ensure that residents receive adequate nutrition and hydration.
• How can leadership support better pressure ulcer outcomes? Facility leadership can play a role in creating a culture that prioritizes skin integrity. Leadership should ensure that policies and procedures are in place for resident screenings that determine pressure ulcer risk as well as regular skin assessments. Leadership should also ensure that success stories and improvement in pressure ulcer rates are highlighted.