3.5 Common Resident Injuries, Safety Devices, and Acute Emergencies
Key Takeaways
Prevent skin tears by lifting with a draw sheet instead of sliding, padding equipment when ordered, keeping nails short, and avoiding tape on fragile skin; report any tear to the nurse without trimming the flap.
A bruise with no known cause, in an unusual place, or shaped like fingers is an injury of unknown source that must be reported immediately as possible abuse.
If a resident falls, keep the resident still, stay with the resident, and call the nurse; no one helps the resident up until the nurse has checked for injury.
Wander bracelets, bed and chair alarms, low beds, and floor mats help prevent injury, but they must be kept working and every alarm must be answered at once.
For a resident who is vomiting, turn the head to the side or sit the resident up to prevent aspiration, and report coffee-ground or bloody vomit immediately.
3.5 Common Resident Injuries, Safety Devices, and Acute Emergencies
Prometric's Alabama outline lists common injuries of residents (skin tears and shearing, falls, spills, burns, and bruises), safety devices such as wander alarms, and a long list of acute emergency situations that a nurse aide must recognize and report. Credentia's NNAAP outline tests the same material under "Safety/Emergency" and "Data Collection and Reporting." This section pulls those items together. Your job in every case follows the same pattern: keep the resident safe, stay with the resident, call for the nurse, and report exactly what you saw.
Common Injuries and How to Prevent Them
Skin Tears and Shearing
Older skin is thin and dry and tears easily. A skin tear is a wound in which the top layer of skin is separated from the layer beneath, often leaving a flap.
- Common causes: pulling a resident across the sheets, bumping arms or legs against wheelchair parts or bed rails, removing adhesive tape, rough handling during dressing, and long or jagged fingernails (yours or the resident's).
- Prevention: lift with a draw sheet instead of sliding; pad wheelchair arms, leg rests, and bed rails when the care plan calls for it; keep nails short and smooth; dress the resident gently and use long sleeves or protective sleeves if ordered; use paper tape or no tape on fragile skin; keep skin moisturized; and keep pathways clear.
- Response: stop the activity, protect the area with a clean dressing or towel, and report to the nurse right away. The nurse assesses and treats the tear; do not try to trim or pull off the skin flap.
Bruises
A bruise with a known, documented cause (for example, a resident who bumped a table) is still reported and recorded. A bruise with no known cause, in an unusual place (inner arms, thighs, face, neck), or in the shape of fingers or an object must be reported immediately as a possible sign of abuse. Federal rules call this an "injury of unknown source," and the facility must report it to ADPH within the required time (Section 1.2).
Burns
Older adults feel heat less and burn faster. Prevent burns by checking bath and shower water temperature before use and asking the resident whether it feels comfortable, serving hot drinks with care (never over the resident's lap or within reach of a confused resident), using heating pads or warm applications only when ordered and as directed, and keeping residents away from hot equipment. If a burn happens, stop the source of heat, cool the area with cool (not ice-cold) running water, do not break blisters or apply butter or ointments, and get the nurse.
Spills and Falls
Wipe up spills immediately and post a wet-floor sign. If a resident falls, do not move the resident. Stay with the resident, call for the nurse, keep the resident warm and calm, and let the nurse check for injury before anyone helps the resident up. Report the fall even if the resident says they are fine, and note the time, location, what the resident was doing, and what you observed.
Safety Devices
| Device | Purpose | Nurse aide responsibilities |
|---|---|---|
| Wander or exit alarm bracelet (for example, WanderGuard) | Sounds an alarm or locks a door when a resident at risk for elopement approaches an exit | Check that the bracelet is on and working as directed; respond to every alarm at once; never disable an alarm for convenience |
| Bed and chair pressure alarms | Alert staff when a resident at high fall risk begins to get up alone | Keep the alarm turned on and in place; answer it immediately; report residents who are repeatedly getting up |
| Low bed and floor mats | Reduce injury if a resident rolls or climbs out of bed | Return the bed to its lowest position; keep mats flat so they do not become a tripping hazard when the resident walks |
| Call light (signaling device) | Lets the resident ask for help | Place it within reach, on the resident's stronger side, before you leave the room; answer all call lights promptly |
| Grab bars, nonskid footwear, and locked wheels | Prevent slips and rolling equipment | Check footwear before standing; lock bed, wheelchair, and commode wheels before transfers |
Alarms and low beds are alternatives to restraints, not substitutes for watching residents. Any device that keeps a resident from moving freely, or from reaching their own body, may be a restraint and needs the nurse's direction.
Recognizing and Responding to Acute Emergencies
Prometric's outline lists chest pain, cardiac arrest, respiratory distress, difficulty swallowing, choking and aspiration, vomiting, seizures, signs of stroke, diabetic situations, sudden confusion or agitation, changes in level of consciousness, falls, bleeding, and burns. Chest pain, choking, seizures, and stroke are covered in Section 3.4. The others are summarized here.
| Situation | What you may see | What the nurse aide does |
|---|---|---|
| Cardiac arrest | Resident is unresponsive and not breathing, or only gasping | Shout for help and activate the facility's emergency code; check the resident's code status (DNR or full code); if the resident is full code and you are trained, start CPR: push hard and fast in the center of the chest, 100 to 120 compressions per minute, at least 2 inches deep |
| Respiratory distress | Rapid or labored breathing, gasping, blue or gray lips, anxiety, using neck muscles to breathe | Stay with the resident; raise the head of the bed or help the resident sit upright; check that oxygen tubing is connected and not kinked; call the nurse immediately; never adjust the oxygen flow rate |
| Vomiting | Nausea, retching, vomitus | Turn the resident's head to the side or help the resident sit up to prevent aspiration; hold an emesis basin; note the amount, color, and odor (coffee-ground or bloody vomit is reported at once); measure it if the resident is on intake and output; give mouth care afterward |
| Difficulty swallowing | Coughing or choking with meals, wet or gurgling voice, food held in the mouth | Stop feeding; keep the resident upright; report to the nurse; follow the ordered diet texture and liquid thickness exactly |
| Low blood sugar (hypoglycemia) | Shaky, sweaty, pale, cool clammy skin, hunger, confusion, irritability | Report to the nurse immediately; stay with the resident; give a fast-acting sugar only if the nurse or care plan directs |
| High blood sugar (hyperglycemia) | Increased thirst and urination, dry flushed skin, fruity breath, drowsiness | Report to the nurse; record intake and output if ordered |
| Sudden confusion or agitation | New disorientation, restlessness, or hallucinations that were not there yesterday | Treat it as a possible medical problem (such as delirium from infection or dehydration) and report it immediately; keep the resident safe |
| Change in level of consciousness | Harder to wake, very drowsy, unresponsive to voice | Call for the nurse at once; stay with the resident; if the resident vomits, turn the head to the side |
When you report any of these, give the facts: what you saw, when it started, any vital signs you measured, and what the resident said, using the resident's own words.
While helping a resident with fragile skin move up in bed, which technique best prevents a skin tear?
Slide the resident up by pulling under both arms
Apply adhesive tape over the elbows before the move
Ask the resident to dig in their heels and push without help
Lift the resident with a draw sheet and a second staff member
During morning care, a nurse aide notices bruises shaped like fingermarks on a resident's upper arms. No one has reported a fall or other cause. What should the aide do?
Apply a warm compress and check the bruises again the next day
Report the bruises immediately to the charge nurse as an injury of unknown source
Note the bruises on the shift worksheet and mention them at the end of the shift
Ask the resident's roommate whether anyone has been rough with the resident
A resident suddenly vomits while lying in bed. What is the nurse aide's first priority?
Turn the head to the side or sit the resident up
Leave to get clean linens first
Lower the head of the bed flat so the resident can rest quietly
Give the resident a full glass of water to rinse out the stomach
Sections you finish are checked off in the contents.