The Basics of Pressure Injuries

Pressure injuries, also known as bed sores and pressure ulcers, are an injury to the skin and underlying tissue caused by staying in one position too long. They tend to occur on boney prominences, which are areas where bones are close to your skin, like your ankles, back, elbows, heels, and hips. Bedsores are frequently an issue for patients who are bedridden or use a wheelchair, like many of those in nursing homes. If left untreated, bedsores can become more severe, causing serious infections and even death. The National Pressure Ulcer Advisory Panel has categorized pressure injuries into four stages:

  • Stage 1- Non-blanchable erythema of intact skin
    In this stage, the skin appears reddened and does not “blanch” (or lose color when you press your finger on it and remove), and is often warmer than other areas of the skin. In Stage 1, the skin is still intact and chances of a full recovery are high.
  • Stage 2- Partial-thickness skin loss with exposed dermis
    The second stage involves the skin breaking open, wearing away, or forming an ulcer. This stage is marked by pain and visible blisters, and means the sore is expanding into deeper layers of the skin.
  • Stage 3- Full-thickness skin loss
    Stage 3 pressure injuries are marked by small craters in the skin where the sore is extending into the tissue beneath the skin. Some fat may be visible in the crater, but the sore has not exposed muscles, tendons, or bones at this stage.
  • Stage 4- Full-thickness skin and tissue loss
    The most advanced stage of pressure injuries means the sore has become very deep. At this stage, the sore has reached into muscle and bone and means severe and permanent damage has taken place.

Warning Signs

The Norton Scale has been developed to help predict the likelihood a patient will develop pressure injuries. The scale (shown below) rates patients on five risk factors (Physical Condition, Mental State, Activity, Mobility, and Incontinence) on a scale of 1-4. If a patient has an overall score of < 14, they are at risk for pressure injuries. A similar scale, the Braden scale, evaluates based on six factors: Sensory Perception, Moisture, Activity, Mobility, Nutrition, and Friction and Shear.

Norton Risk Scale

Physical Condition

Mental State




Good 4 Alert 4 Ambulatory 4 Full 4 Not Incontinent 4
Fair 3 Apathetic 3 Walks with help 3 Slightly limited 3 Occasionally 3
Poor 2 Confused 2 Chairbound 2 Very limited 2 Usually urinary 2
Very Bad 1 Stuporous 1 Bedfast 1 Immobile 1 Double 1

It is important to diagnose a bedsore early on, as chances of infection that could lead to death, increase after a bed sore becomes Stage 2. Pressure injuries can pose a serious threat to health and, no matter the stage, can be a sign of possible neglect in a nursing home. If you notice that a loved one is suffering from bed sores, contact an experienced attorney today. The attorneys at Powers Taylor have experience with all types of nursing home abuse and neglect cases and pride themselves on fighting for those without a voice. Contact Powers Taylor today for a free consultation.




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