10.3 Elastic Stockings and Common Comfort Procedures (Skill 2)

10.3 Elastic Stockings and Common Comfort Procedures (Skill 2)

Quick Answer: Skill 2 is tested on a candidate volunteer with a clean, unused stocking. Explain; privacy; client supine; turn the stocking inside-out at least to the heel; place the foot of the stocking over toes, foot, and heel; pull over foot, heel, and leg; no force or over-extension. Critical element: no twists or wrinkles; heel of the stocking over the heel; toe opening over or under the toe; on a mannequin you may state the stocking needs to be wrinkle-free. Call light in reach, bed low, wash hands. TED / anti-embolism stockings go on before getting out of bed if ordered; remove on schedule to check skin; report redness or numbness. Comfort: note the skin before a back rub; make an occupied or unoccupied bed wrinkle-free to prevent pressure; apply heat or cold only if ordered — you check skin and report, you do not independently order therapy.

Why stockings and comfort are I.B.3

Elastic stockings are a technical procedure. Bedmaking, back rubs, and heat or cold are comfort procedures that also prevent harm: clots, pressure injuries, and burns. Written I.B.3 items mix these. Skill 2 is the performance card.

Skill 2 — Applies One Knee-High Elastic Stocking is one of the 23 Colorado skills. It is not a measurement skill, but it has a bold critical element. Miss the wrinkle-free heel-over-heel finish and the skill is not satisfactory — and you must still pass all five assigned skills.

/practice/co-cnaPractice questions with detailed explanations

Skill 2 — Applies One Knee-High Elastic Stocking

The Colorado handbook states this skill is tested on the candidate volunteer with a clean, unused stocking. You do not recycle a stretched, inside-out practice hose from your bag. You may not bring your own equipment to the test site.

Handbook steps:

1. Explains the procedure, speaking clearly, slowly, and directly, maintaining face-to-face contact whenever possible.
2. Provides privacy with a curtain, screen, or door.
3. Client is in supine position (lying down in bed) while the stocking is applied.
4. Turns the stocking inside-out, at least to the heel.
5. Places the foot of the stocking over toes, foot, and heel.
6. Pulls the top of the stocking over the foot, heel, and leg.
7. Moves the foot and leg gently and naturally, avoiding force and over-extension of limb and joints.
8. Critical element: Finishes with no twists or wrinkles and the heel of the stocking, if present, is over the heel and the opening in the toe area (if present) is either over or under the toe area; if using a mannequin, the candidate may state the stocking needs to be wrinkle-free.
9. Signaling device is within reach and the bed is in low position.
10. After completing the skill, washes hands.

Why inside-out to the heel

Turning the stocking inside-out to the heel lets you seat the foot pocket on the toes, foot, and heel before you pull the fabric up the calf. If you try to fight a closed tube up from the toes, the heel pocket lands on the instep and the calf twists. That is how candidates fail the critical element.

The person is supine. Sitting dangling on the side of the bed lets the stocking roll and wrinkle and is not the card. Standing application is also wrong on test day. TED stockings are applied in bed on the unit so the legs are not already dependent and swollen.

No yanking. A forced pull can injure a joint and still leave wrinkles. Gather, ease, smooth. Smooth upward so wrinkles do not remain at the ankle or the back of the knee.

The toe opening may sit over or under the toes — both are acceptable on the Colorado card. What is not acceptable is a twist, a wrinkle, or a heel pocket sitting on the top of the foot.

On a mannequin, you may state that the stocking needs to be wrinkle-free. On a volunteer, you must make it wrinkle-free. Colorado tests Skill 2 on the volunteer with a clean unused stocking, so plan to finish the critical element with your hands, not a speech.

Leave the call light in reach and the bed low. Then wash.

TED / anti-embolism stockings on the unit

Anti-embolism stockings (often called TED hose) apply graduated compression to help venous return and reduce clot risk. They are ordered. You do not decide a person needs them because the roommate has a pair.

• Apply before the person gets out of bed when ordered for daytime wear — legs are least swollen then.
• Use the correct size. A stocking that is too small binds. One that is too large wrinkles and does not compress.
• Remove on the schedule the nurse or care plan lists so you can inspect the skin: toes, heels, calves, and the top band.
• Report redness, blisters, cool or blue toes, numbness, tingling, increased swelling, or pain. Remove only as the order and the nurse direct if the skin is in trouble — then report immediately.
• Stockings are not rolled down at the top. A tight roll is a tourniquet.

You do not cut a hole, apply lotion and then fight a wet stocking up the leg, or leave wrinkles to air the toes unless the product has a designed toe opening — and that opening still follows the card: over or under the toes.

Comfort procedures

Back rub — look first

A back rub can ease muscle tension and help you look at the skin. The order is observe, then rub only intact skin. Older handbook sample themes treat comfort and observation as the same habit the written test still asks.

• Provide privacy and raise the bed to a safe working height, then lower it when you finish.
• Note redness, warmth, open areas, bruises, and bony prominences (sacrum, hips, shoulder blades, heels).
• Do not massage a red area, a bruise, or an open pressure injury. Massage on reddened skin can add damage. Report the finding.
• Use a small amount of lotion if the care plan allows; warm it in your hands; use gentle strokes. Wipe excess so the gown does not stick.
• Reposition off a red area. Leave the call light in reach.

Occupied vs unoccupied bed

An unoccupied bed is made when the person is out of the bed. An occupied bed is made while the person remains in it — you turn the person, roll soiled linen toward the back, place clean linen, and complete the other side.

Either way:

• Use a barrier for dirty linen. Hold linen away from your uniform.
• Never shake linen in the room — that spreads organisms.
• Finish with a wrinkle-free bottom sheet and a tight, smooth surface under the person.
• Wrinkles cause pressure. A bunched draw sheet under the sacrum is a pressure-injury setup.
• Use a toe pleat or a loose top sheet over the feet so heels are not forced into plantar flexion, per training.
• Call light in reach, bed low, brakes set.

Occupied-bed sequence in brief: privacy; bed flat if the person tolerates it; working height; loosen linen; turn the person toward you or the rail; roll dirty linen under the back; place the clean bottom sheet and draw sheet; turn the person over the linen mound; remove dirty linen; finish and tighten the clean side; replace the top sheet, blanket, and pillowcase; smooth every wrinkle under the body.

Heat and cold — ordered only

Heat and cold are treatments, not CNA hobbies.

• Apply only if ordered and assigned. You do not independently order a heating pad, ice pack, or warm soak because the person always uses one at home.
• Check the device, the skin before, and the skin during and after.
• Typical training time limits are short (often about 15–20 minutes). Follow the order and facility policy — do not leave a pack on for the whole shift.
• Place a cover between the pack and the skin unless the product is designed otherwise.
• Report redness, blisters, numbness, increased pain, or pale or blue skin. Remove the device as trained and tell the nurse.
• Extra caution with people who cannot feel or report pain: diabetes, decreased sensation, confusion, or unconsciousness.

You check and report. You do not write a new therapy on the care plan.

Colorado scenario

You are in a Grand Junction skills room. Skill 2 is on your card. You sit the volunteer on the side of the bed so it is easier, wad a previously used class stocking from your purse over the toes, leave a twist along the shin, and say if this were a mannequin I would say wrinkle-free. The heel pocket sits on the instep. You raise the bed to high and walk away without the call light.

Colorado tests this skill on the volunteer with a clean unused stocking. Supine. Inside-out at least to the heel. Seat toes, foot, and heel. Pull without force. Finish with no twists or wrinkles, heel over heel, toe window over or under the toes. You may use the mannequin wrinkle-free statement only if you are actually using a mannequin. Call light in reach, bed low, wash.

That evening on a Boulder unit, Ms. Chen has ordered knee-high TEDs. You apply them before she stands. At the scheduled removal you find a red groove and she says the top band is numb. You do not roll the stockings down and leave them. You follow the removal schedule, report redness and numbness to the licensed nurse, and document. Her roommate asks you to just throw the heating pad on my back like last winter. There is no order. You do not apply heat. You offer a wrinkle-free occupied-bed straighten and a back-skin check, and you tell the nurse the person is requesting heat. A bright-red sacrum gets a report and a position change — not a massage.

Exam traps

• Applying the stocking with the person sitting or standing.
• Skipping the inside-out-to-heel step.
• Twists, wrinkles, or a heel pocket on the wrong landmark.
• Using a dirty or personal stocking.
• Claiming the mannequin exception on a volunteer.
• Leaving the bed high or the call light out of reach.
• Applying TEDs after the legs have been dependent all morning without checking the order.
• Massaging a red sacrum.
• Making a bed that is full of wrinkles because they will move anyway.
• Starting heat or cold because the family brought a pad from home.