Introduction: Why Stage 3 Pressure Ulcers Demand Immediate Attention
Stage 3 pressure ulcers—also called stage 3 bedsores or decubitus ulcers—are serious skin injuries that involve full-thickness skin loss and exposure of the fatty tissue beneath. These wounds can be painful, slow to heal, and prone to infection. They commonly affect elderly or immobile individuals in nursing homes, hospitals, or long-term care settings.
Preventing and properly treating stage 3 pressure ulcers is essential to protect patient safety and maintain skin integrity. Below, we’ll explore a real-life case, followed by key facts on symptoms, causes, treatments, and facility-wide prevention strategies.
Case Study: How a Stage 3 Pressure Ulcer Developed in a Long-Term Care Resident
An 89-year-old female long-term resident in a nursing home developed fever, chills, and cough. Diagnosed with pneumonia but not requiring oxygen, she was treated in the facility with IV antibiotics. One month later, she reported ongoing fatigue, shortness of breath, and depression. These symptoms continued for two more months, and she eventually became bedbound.
Four months after her initial illness, she was found to have a stage 3 pressure ulcer (or stage 3 decubitus) on her sacrum—a serious skin breakdown likely related to immobility and prolonged pressure on vulnerable areas.
What Is a Stage 3 Pressure Ulcer?
A stage 3 pressure ulcer is tissue damage that results in full-thickness loss of skin and the layer of fat under the skin may be visible. The ulcer may present with:
- Rolled wound edges
- Granulation tissue (new connective tissue)
- Slough or eschar (yellow, white, black, or brown dead tissue)
- Tunneling (a narrow passage deeper into the tissue)
- Undermining (a pocket beneath the skin surrounding the wound)
At this stage, the ulcer is deep but does not expose muscle, tendon, or bone, which would classify it as a stage 4 pressure ulcer.
Early Warning Signs: How Pressure Ulcers Progress to Stage 3
Pressure ulcers typically begin as stage 1 (red, non-blanching skin) or stage 2 (partial skin loss or blistering). Without proper care, they can worsen into stage 3 ulcers. Warning signs include:
- Open wounds with a red or pink wound bed
- Signs of tissue breakdown or slough
- Development of pain or foul odor
- Blisters that rupture and expose deeper tissue
Recognizing and addressing early stages is key to preventing severe wounds.
How to Treat a Stage 3 Pressure Ulcer
It is important to prevent pressure ulcers from developing, but once a stage 3 pressure ulcer is diagnosed there are a few key steps to follow to allow for optimal healing. Treating a stage 3 pressure ulcer involves a multi-step wound care plan, including:
- Pressure relief: Repositioning the patient regularly, using pillows, bolsters, or specialized mattresses.
- Wound dressing: Using appropriate moisture-balancing or absorptive dressings based on the amount of exudate.
- Cleaning: Keeping the wound clean and moist to promote healing.
- Debridement: Removing dead tissue (slough or eschar) if present, either surgically or with wound care products.
- Infection control: Monitoring for signs of infection (odor, pus, redness, warmth) and initiating antibiotics if needed.
- Clinical oversight: Consulting a wound care nurse or physician if the ulcer worsens or does not improve.
How to Prevent Stage 3 Pressure Ulcers in Long-Term Care Settings
Facilities should prioritize implementing strategies to prevent pressure ulcers from developing. Preventing pressure ulcers is a team effort that includes:
- Regular repositioning of at-risk residents (every 2 hours or per protocol)
- Weekly skin assessments and routine risk evaluations
- Monitoring nutrition and hydration
- Using pressure-relieving devices, like cushions or alternating pressure mattresses
- Staff education on pressure ulcer risk factors and prevention strategies
Creating a Culture of Skin Integrity
Facility leadership plays a crucial role in reducing pressure ulcer rates. To support better outcomes:
- Make skin integrity a facility-wide priority
- Educate all staff on pressure ulcer staging, prevention, and care
- Track and share pressure ulcer rates with interdisciplinary teams
- Celebrate healing and quality improvement success stories
- Encourage open communication between frontline staff and leadership
Conclusion: Protecting Residents from Stage 3 Pressure Ulcers
Stage 3 pressure ulcers are a significant health concern for older adults, especially in long-term care. With full-thickness skin loss and exposure of fatty tissue, they require immediate and consistent care. Preventing pressure ulcers through regular assessment, proper positioning, good nutrition, and staff training can drastically reduce complications.
When ulcers do occur, a team-based, evidence-informed approach is essential for healing and avoiding progression to stage 4 wounds.
FAQs About Stage 3 Pressure Ulcers
Q: Can stage 3 pressure ulcers heal on their own?
A: Not usually. These open wounds require clinical care, including pressure relief, moisture control, and sometimes antibiotics or debridement.
Q: How long does it take to heal a stage 3 pressure ulcer?
A: Healing can take several weeks to months, depending on wound size, infection, and the resident’s overall health.
Q: What’s the difference between stage 3 and stage 4 pressure ulcers?
A: Stage 3 ulcers expose fat tissue but not bone, tendon, or muscle. Stage 4 ulcers extend deeper, exposing these critical structures.
Q: What role do CNAs play in prevention?
A: CNAs are essential in repositioning residents, noticing early skin changes, and ensuring nutrition and hydration needs are met.
Q: How can leadership support pressure ulcer prevention?
A: 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.
