How is nursing care for a patient who has a stage IV pressure ulcer different from that for a patient who has a stage I pressure ulcer?

• A. Stage IV requires the use of a low-air-loss, alternating pressure, or air-fluidized support surface.
• B. Stage IV requires the patient to remain in bed with the head of bed elevated at 90 degrees continuously.
• C. Stage IV requires no special surface and can be treated the same as Stage I.
• D. Stage IV requires frequent turning every 2 hours regardless of surface type.

Answer: (A)

Stage IV wounds involve full-thickness tissue loss with exposed bone, tendon, or muscle, and they require substantial offloading to protect the wound and promote healing. The most effective way to achieve this is with a specialized support surface—such as a low-air-loss, alternating-pressure, or air-fluidized bed or overlay—that redistributes pressure, reduces shear, manages moisture, and helps keep the wound bed clean. This direct offloading approach addresses the deep, extensive nature of stage IV wounds and is why this level of care differs from stage I, where the focus is on preventing progression through basic pressure relief and skin protection on standard surfaces. Other ideas, like keeping the head of the bed at 90 degrees continuously, can increase pressure on vulnerable areas and aren’t a standard requirement for stage IV. While turning is important, frequency should be guided by the wound’s status and the surface used, rather than applying a fixed interval across all stages.