How would you stage this pressure ulcer is and why?

Nice work everyone and thank you for posting. This pressure ulcer would be staged as a suspected deep tissue injury (STDI). According to NPUAP, the definition of a SDTI is: "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."

For more information about staging view the video.

Tags: pressure ulcer

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Permalink Reply by amy glenn on April 21, 2011 at 4:09pm

Are we talking staging or coding?? This is definately a Suspected DTI, however if you were coding this it would be coded at a Stage I because it is not open yet. Not fair in my opinion. When it does open, it will be a Stage III or Stage IV.

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Permalink Reply by Laurie Swezey RN, BSN, CWS,CWOCN on April 22, 2011 at 5:57pm

Great answer!

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Permalink Reply by E Lee Krieg Lowery RN on April 22, 2011 at 12:06am

Unstagable. At this point cannot determine the extent of the wound.

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Permalink Reply by Laurie Swezey RN, BSN, CWS,CWOCN on April 22, 2011 at 6:01pm

For more information about staging view the video.

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Permalink Reply by Kathi Karp, RN, BSN on April 23, 2011 at 10:04am

This would be classified as unstageable as there is no way to determine what is underneath the intact skin and how deep it will be when it does open.

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Permalink Reply by Tiffany Brown on April 24, 2011 at 2:41pm

I wouldn't define this as a pressure ulcer unless patient was on their knees or lying in a fetal position knees against kness for a long period of time, which would make it a DTI. I would find out if there was an contributing device. Inferior to the patella is a blood blister. Skin turgor is poor and very thin in body mass.