While doing field orientation for home health, my preceptor quoted our team leader as follows: When the skin opens over an old, formerly closed, Stage II decubitus, the defining factor as to whether it is defined as a skin tear is if it stings when cleansing solution is applied. According to the preceptor, a skin tear will sting and a decubitus will not.
I am only out of school for a year, but to me, this sounds arbitrary and inaccurate. To my recall, the most current evaluation criteria of decubiti is, they are never reverse staged. Once a lesion, always a lesion, and it is either closed or open.
I have never heard of the "stings or not stings" discriminator.
I can't say with certainty that it is true, but I do know that there are many terminal nerve endings and pain receptors in the layers of the skin, especially the basal layers, that are not found in deeper layers. When I give IM injections, I almost never hear a patient complain that it stings. An intradermal PPD, I can say from personal experience, does sting. With a decubitus, those layers that contain most of the pain receptors may be gone. I'm not saying this means that is the accurate criteria for classifying a wound; I'm just suggesting some rationale behind their statements.
Last edit by mariebailey on Sep 9, '12
: Reason: add'l thoughts