Quiz____?
Pressure Ulcer? -
Answer✓✓
localized injury to the skin and/or underlying tissue usually over a bony prominence, as a
result of pressure, or pressure in combination with shear.
Quiz____?
Pressure -
Answer✓✓
the force per unit surface area that is applied vertically or perpendicular to the surface of
the skin. It deforms underlying tissue and compresses small blood vessels hindering blood
flow and nutrient supply. Tissues become ischemic and are damaged or die.
Quiz____?
ischemic -
Answer✓✓
Disruption of the blood supply due to an obstruction, usually a thrombus or embolism, that
causes infarction of brain tissue
Quiz____?
Shear -
Answer✓✓
1
, the force per unit surface area applied parallel to the skin surface. It occurs when one layer
of tissue slides horizontally over another, deforming adipose and muscle tissue, and
disrupting blood flow.
Quiz____?
classification system for pressure ulcers -
Answer✓✓
includes four numerical categories/stages with two additional categories/stages for use in the
United States.
Category/Stage I
Category/Stage II
Category/Stage III
Category/Stage IV
Unstageable/Unclassified
Suspected Deep Tissue Injury
Quiz____?
Category/Stage I Pressure Ulcer -
Answer✓✓
-Intact skin with non-blanchable redness (erythema) of a localized area usually over a bony
prominence.
-Darkly pigmented skin may not have visible blanching; its color may differ from the
surrounding area.
-The area may be painful, firm, soft, warmer, or cooler as compared to adjacent tissue.
2
, -may be difficult to detect in individuals with dark skin tones.
May indicate "at risk" persons.
Quiz____?
Blanchable -
Answer✓✓
apply fingertip and slight pressure to red area; if skin turn a lighter shade of of red or whitish
color,injury is not severe
Quiz____?
NonBlanchable Erythema -
Answer✓✓
a defined area of redness that persists (does not blanch/become pale) when pressure is
applied to the area.
Quiz____?
Category/Stage II Pressure Ulcer -
Answer✓✓
-Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound
bed, without slough.
-may also present as an intact or open/ruptured serum-filled or serosangineous-filled blister.
-Presents as a shiny or dry shallow ulcer without slough or bruising.
-This stage should not be used to describe skin tears, tape burns, incontinence- associated
dermatitis, maceration, or excoriation.
3