In second degree bedsore, there is an involvement of:

Appeared in: Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)

Explanation

A second-degree bedsore is synonymous with a Stage 2 pressure injury.
This stage is defined as partial-thickness loss of the dermis, meaning the damage extends through the epidermis and into the dermis.
Clinically, it appears as a shallow open ulcer with a red-pink wound bed or as an intact or ruptured serum-filled blister.
Deeper tissues like subcutaneous fat, muscle, or bone are not visible in a Stage 2 injury.

Option B: Involvement of the dermis and subcutaneous tissues describes a Stage 3 pressure injury, which is a full-thickness skin loss, more severe than a second-degree bedsore.
Option C: Involvement of subcutaneous tissues and muscles characterizes a Stage 4 pressure injury, the most severe stage with full-thickness tissue loss and exposed deep structures.
Option D: This option is incorrect because the different stages of bedsores involve distinct layers of tissue, not all layers simultaneously in a second-degree injury.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Staging of pressure ulcers (bedsores) based on tissue involvement as background academic context rather than a clinical decision trigger.
Accurate staging of pressure injuries is critical for nurses to select appropriate interventions, dressings, and support surfaces to promote healing and prevent the wound from worsening.
A Stage 2 injury signals a breach in the skin's primary defense barrier, increasing the risk of infection. Nursing care focuses on keeping the area clean, moist, and protected.
What if? If a Stage 2 ulcer shows signs of slough (yellow, non-viable tissue), it can no longer be staged as a 2. It would be considered at least a Stage 3 injury, as slough indicates full-thickness tissue loss, requiring debridement and a change in the treatment plan.

How to Approach the Question

First, identify the key term in the question: 'second degree bedsore'. Recognize that this is equivalent to a 'Stage 2 pressure injury'.
Recall the layers of the skin in order: Epidermis (top), Dermis, Subcutaneous tissue, Muscle, and Bone.
Mentally review the definitions for each stage of pressure injury, focusing on the depth of tissue involvement.
Stage 1: Intact skin, redness.
Stage 2: Partial-thickness loss, involves epidermis and dermis.
Stage 3: Full-thickness loss, involves subcutaneous tissue.

Concept Tested & Keywords

Concept Tested: Staging of pressure ulcers (bedsores) based on tissue involvement.
Stem keywords: second degree bedsore, involvement
Lead-in keywords: BEST, MOST RELEVANT CLUE
Negative lead-in flag: false

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E6 Nursing Fundamentals Potter Perry 12e Part 6 p. 69-71

E6 Nursing Fundamentals Taylor pp. 556-558, 581-583

Practise the full Combined AIIMS - 2020 (Jodhpur, Bhopal, Patna, Raipur)

Attempt every question from this paper in a timed mock, then review the full solution for each one.