6.3 Skin, Pressure Injury Prevention, and Positioning
Key Takeaways
- Pressure injury prevention depends on repositioning, skin observation, nutrition, hydration, hygiene, and pressure relief.
- Report redness, open areas, drainage, odor, warmth, swelling, or complaints of pain.
- Do not massage reddened bony areas.
- Good positioning protects alignment, breathing, comfort, and skin.
- Keep skin clean and dry, especially after incontinence.
Skin Observation
CNAs often see skin changes first during bathing, toileting, dressing, and repositioning. Early reporting can prevent serious pressure injuries.
High-risk areas include:
- Sacrum and coccyx.
- Heels and ankles.
- Hips.
- Elbows.
- Shoulder blades.
- Back of head.
- Ears under oxygen tubing or masks.
Pressure Injury Warning Signs
Report:
- Persistent redness.
- Open skin.
- Blisters.
- Purple or dark discoloration.
- Drainage or odor.
- Warmth or swelling.
- Pain over a bony area.
Do not massage reddened areas. Massage can damage tissue that is already stressed.
Positioning
Positioning supports comfort and safety.
| Position | Use |
|---|---|
| Fowler's | Breathing, eating, tube feeding support |
| Lateral | Side-lying pressure relief |
| Supine | On back; needs alignment and heel protection |
| Prone | On stomach; less common and care-plan directed |
| Sims' | Side-lying variation for some care procedures |
Use pillows, wedges, foot boards, and heel protectors according to the care plan. Keep joints aligned and avoid pulling residents across sheets without help.
Repositioning Routine
Many residents need repositioning at regular intervals. Follow the care plan. During each turn, check skin, smooth linens, remove crumbs, manage moisture, and place the call light within reach.
Exam Tip
If a question includes redness over a bony area, the CNA reports it and relieves pressure. The CNA does not massage it or ignore it because the skin is intact.
What should a CNA do when observing a reddened area over a resident's sacrum?
Which resident is at higher risk for pressure injury?