Wound Types
An injury that breaks down the skin and underlying tissue due to lack of circulation to the area for periods of time.
Partial growth of blood vessels and connective tissue. Beefy/bumpy in appearance.
Early/partial granulation
Rolled over epithelial cells caused by the body attempting to heal a wound.
Epiboly
Intact nonblanchable erythema over a bony prominence or under a medical device
Stage 1
Name the PU stages that do not have a depth.
Stage 1
A wound caused by vein or blood flow issues.
Stasis Ulcer/Venous Ulcer
Granulation tissue covering entire wound bed
Fully granulated
Overhydration of wound edges. May appear white and pruney.
Maceration
Full thickness ulceration over a bony prominence or under a medical device. Will see subcutaneous fat (adipose) and/or some slough.
Stage 3
When does a stage 2 PU not have a depth?
Blister
Damage caused by scraping.
Abrasion.
Excess growth of granulation above skin level. Usually occurs with wet wounds.
Hypergranulation
Linear scratches on the skin
Excoriation
Full thickness skin loss over a bony prominence or under a medical device. Will see bone, muscle, or tendon in the wound bed.
Stage 4
Non-blanchable, purple discoloration over a bony prominence or under a medical device
Stage I pressure ulcer
A cut or tear.
Laceration
Thick, leathery, necrotic (dead), black tissue
Eschar
Redness around wound edges. Can be blanchable or nonblanchable.
Erythema
Wound bed is obscured by slough or eschar
Unstageable
Scattered partial thickness skin loss. Likely found to the buttocks/groin with urine/fecal incontinence. Periwound skin is denuded.
Stage II - Partial Thickness Loss
An injury caused by the layers of the skin separating or peeling back.
Skin Tear
Yellow, soft, moist, avascular tissue. Can also appear tan and stringy
Slough
Hard, firm, or thickened area around wound
Induration
Partial thickness skin loss over a bony prominence or under a medical device
Stage 2
If you're going to mess up anything...
Don't mess up wounds!