Chart — Wound Care

NPIAP Pressure Injury Staging Chart

All 6 NPIAP pressure injury categories at a glance: skin findings, tissue involvement, key characteristics, and primary nursing action.

Data Source: NPIAP (National Pressure Injury Advisory Panel) Staging Definitions

Educational use only. This material supports nursing education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional policy, or medical direction. Always follow facility protocols and current provider orders.

Complete Staging Chart

Stage	Skin Intact?	Skin Findings	Tissue Involved	Key Characteristic	Priority
Stage 1	Yes — intact	Non-blanchable erythema; warmth, firmness, or edema at site; may be purple/blue in dark skin	Epidermis only	Blanch test NEGATIVE. No skin breakdown. Reversible with prompt pressure relief.	urgent
Stage 2	No — partial thickness	Shallow open wound (red/pink wound bed) OR intact/ruptured serum-filled blister	Epidermis + partial dermis. No adipose visible.	NO slough, NO eschar, NO adipose visible. Clean wound bed. Serum blister (not blood-filled).	priority
Stage 3	No — full thickness	Deep wound with adipose visible; possible slough or eschar; possible undermining/tunneling	Epidermis + dermis + subcutaneous fat. Fascia NOT exposed.	Adipose visible — fascia, muscle, bone NOT exposed. Depth varies by body location.	critical
Stage 4	No — full thickness	Deep wound with bone, muscle, tendon, or ligament visible or palpable; slough/eschar often present	Epidermis + dermis + fat + fascia + muscle/bone/tendon exposed	Bone, tendon, or muscle VISIBLE or PALPABLE. High osteomyelitis risk. Probe-to-bone test.	critical
Unstageable	Variable — surface may be intact under eschar	Wound bed completely or partially covered by slough (yellow/tan) and/or eschar (dark brown/black)	Unknown — cannot assess depth until debrided	TRUE STAGE UNKNOWN. Is a Stage 3 or 4 underneath. Heel exception: do NOT debride dry, stable heel eschar.	priority
DTPI	Intact OR intact with thin blister	Persistent deep red, maroon, or purple discoloration OR blood-filled blister; pain and firmness preceding visible change	Deep tissue (muscle/fat at bone-muscle interface) — inside-out injury with potentially intact surface	INSIDE-OUT INJURY. May evolve into Stage 3 or 4 rapidly. Warn family of potential worsening despite good care.	critical

Stage Detail Cards

Stage 1

Yes — intact

Tissue: Epidermis only

Findings: Non-blanchable erythema; warmth, firmness, or edema at site; may be purple/blue in dark skin

Key: Blanch test NEGATIVE. No skin breakdown. Reversible with prompt pressure relief.

Action: Relieve pressure IMMEDIATELY. Reposition.

Stage 2

No — partial thickness

Tissue: Epidermis + partial dermis. No adipose visible.

Findings: Shallow open wound (red/pink wound bed) OR intact/ruptured serum-filled blister

Key: NO slough, NO eschar, NO adipose visible. Clean wound bed. Serum blister (not blood-filled).

Action: Moist wound healing (hydrocolloid or foam). Do NOT debride.

Stage 3

No — full thickness

Tissue: Epidermis + dermis + subcutaneous fat. Fascia NOT exposed.

Findings: Deep wound with adipose visible; possible slough or eschar; possible undermining/tunneling

Key: Adipose visible — fascia, muscle, bone NOT exposed. Depth varies by body location.

Action: Wound care specialist consult. Debridement, packing if undermining.

Stage 4

No — full thickness

Tissue: Epidermis + dermis + fat + fascia + muscle/bone/tendon exposed

Findings: Deep wound with bone, muscle, tendon, or ligament visible or palpable; slough/eschar often present

Key: Bone, tendon, or muscle VISIBLE or PALPABLE. High osteomyelitis risk. Probe-to-bone test.

Action: URGENT surgical consult. Rule out osteomyelitis. NPWT consideration.

Unstageable

Variable — surface may be intact under eschar

Tissue: Unknown — cannot assess depth until debrided

Findings: Wound bed completely or partially covered by slough (yellow/tan) and/or eschar (dark brown/black)

Key: TRUE STAGE UNKNOWN. Is a Stage 3 or 4 underneath. Heel exception: do NOT debride dry, stable heel eschar.

Action: Wound care consult for debridement plan. Reassess staging after debridement.

DTPI

Intact OR intact with thin blister

Tissue: Deep tissue (muscle/fat at bone-muscle interface) — inside-out injury with potentially intact surface

Findings: Persistent deep red, maroon, or purple discoloration OR blood-filled blister; pain and firmness preceding visible change

Key: INSIDE-OUT INJURY. May evolve into Stage 3 or 4 rapidly. Warn family of potential worsening despite good care.

Action: Relieve pressure IMMEDIATELY. Notify provider. Close monitoring for rapid evolution.

NCLEX Pearls

✦Stages 1 and 2 involve partial damage — Stage 1 is intact skin, Stage 2 is partial thickness
✦Stages 3 and 4 are full-thickness — adipose visible in Stage 3; bone/muscle/tendon visible in Stage 4
✦Unstageable = Stage 3 or 4 covered by slough/eschar — you CANNOT determine the stage
✦DTPI = inside-out injury — the visible area understates the damage. May look like Stage 1 but be Stage 4 underneath
✦Pressure injuries do NOT backstage — a healing Stage 4 remains 'Stage 4' in documentation
✦Only pressure injuries are staged using NPIAP criteria — venous, arterial, and diabetic ulcers are NOT staged this way
✦Heel eschar exception: dry, stable, intact heel eschar without infection signs = leave intact
✦Stage 1 in dark-skinned patients: look for warmth, edema, firmness, color change (purple, blue) — not just redness

Prevention — SSKIN Bundle

The SSKIN bundle is an evidence-based framework for preventing pressure injuries:

S — Surface: use an appropriate pressure-redistributing mattress or cushion.
S — Skin inspection: inspect skin at every care opportunity; document findings.
K — Keep moving: reposition every 2 hours (in a chair, every hour); use the 30° tilt; offload heels.
I — Incontinence / moisture: manage moisture, use barrier creams, and change pads promptly.
N — Nutrition / hydration: ensure adequate protein, calories, fluid, and micronutrients; refer to a dietitian if at risk.

Related Resources

Pressure Injury Stages ReferenceDetailed staging definitions, full assessment findings, and nursing interventions

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Pressure Injury Prevention GuideRisk factors, repositioning schedules, support surfaces, nursing assessment

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Wound Assessment BasicsHow to assess wound characteristics and match to staging criteria

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Braden Scale ChartPressure injury risk scoring for identifying at-risk patients

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Skin Integrity Risk Factors ChartImmobility, malnutrition, moisture, and the other drivers of skin breakdown

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Standards & sources

Fact-checked Jun 21, 2026

This page is written to align with NPIAP (National Pressure Injury Advisory Panel) Staging Definitions. It is an educational summary, not a citation of any single document — always verify specific doses, values, and protocols against current guidelines and your facility policy. How we source content →