Oral Care, Skin Care & Pressure-Injury Prevention

Quick Answer: Daily oral care; reposition q2h (or per plan); keep skin clean/dry; float heels; report non-blanchable redness—never massage red areas.

Oral Care

Dentures: clean over basin of water (prevent breakage if dropped); brush gums and tongue.

Denture Storage

• Clean water or denture solution per policy
• Label with resident name
• Remove at night unless contraindicated (report sore spots)

Unconscious Resident Oral Care Steps

1. Position resident side-lying with head turned to side
2. Explain even if unresponsive
3. Moisten toothbrush; apply small amount toothpaste or mouthwash per policy
4. Brush teeth and gums gently; suction or wipe excess fluid
5. Turn head to allow drainage; never leave fluid pooled in mouth
6. Document completion

Aspiration pneumonia is a leading complication of poor oral care in dependent residents.

Skin Assessment

Daily and during baths:

Braden Scale (nursing tool)—CNAs implement interventions for low mobility, moisture, poor nutrition.

Blanching Test

Press reddened skin for a few seconds. If redness disappears and returns (blanches), tissue still has blood flow. If redness does not fade, suspect Stage 1 pressure injury—report immediately.

Pressure-Injury Prevention

Never massage bony prominences over redness—increases tissue damage.

Common Pressure Points

Devices

• Pressure-redistribution mattress per orders
• Heel protectors if ordered
• Do not place doughnut rings under sacrum (focuses pressure on rim)

Wheelchair Pressure Relief

Residents in wheelchairs need weight shifts every 15–30 minutes per care plan—lean forward, side-to-side, or push up on arms if able. Report residents who cannot reposition themselves without assistance.

Worked Scenario

After 3 hours in chair, resident complains of buttock pain; skin red and non-blanching.

Reposition immediately; relieve pressure; report to nurse—likely stage 1 pressure injury.

Prometric Oral Care Skills

Critical elements: explain, side-lying for unconscious, hand hygiene, clean mouth/dentures, store dentures safely, lower bed, call light.

Skin Barrier Products

Apply barrier cream or film per order after incontinence care. Too much product can trap moisture—follow thin even application per facility protocol.

NYSDOH Survey Connection

Pressure injuries are a top NYSDOH survey deficiency category. CNAs who reposition, float heels, and report early redness directly protect facility quality measures and resident safety.

Exam Traps

• Dentures left dry on bedside table overnight
• Massaging sacral redness
• Repositioning only at shift change
• Oral care skipped for NPO resident (mouth still needs care unless contraindicated)
• Using doughnut cushion under sacrum

Comprehensive Skin Care in New York Nursing Homes

Skin is the largest organ and the most visible quality indicator on NYSDOH surveys. CNAs perform daily skin surveillance during every care contact.

Lotion Application Rules

Apply lotion to intact skin per care plan. Do not apply between toes (maceration risk). Do not massage over bony prominences with redness. Report resident allergy to scented products.

Heel and Elbow Protection

Turning Schedule Documentation

Many facilities use turn clocks or EMR prompts every 2 hours. Document repositioning even when resident sleeps—use gentle repositioning per plan. Side-lying at 30 degrees reduces sacral pressure compared to 90 degrees.

Oral Care for Dementia Residents

Residents with dementia may resist mouth care. Approach calmly, explain each step, use small motions, try different times of day. Report oral bleeding, loose teeth, or refusal patterns—dental referral may be needed.

Thrush and Oral Infection Signs

White patches on tongue or cheeks that wipe off leaving red area may be oral candidiasis. Report—do not scrape. Denture-related stomatitis requires dental and nursing follow-up.

Unlicensed Assistive Personnel Skin Reporting

Your objective description triggers nursing wound assessment. Photographs may be taken per facility policy—never post wound images on personal devices.

Lip and Corner-of-Mouth Care

Apply moisturizer to cracked lips per order. Angular cheilitis (sores at mouth corners) may indicate nutritional deficiency or candida—report, do not treat with random ointment.

Sacral Mepilex and Dressings

Some residents have foam dressings on sacrum prophylactically. Do not remove unless ordered. Report if dressing rolls, gets wet with urine, or loosens.

Heel Pressure in Wheelchairs

Residents who sit long hours need pressure relief off sacrum and ischium, not only heel floating in bed. Report residents who cannot shift weight independently—wheelchair cushions alone do not replace repositioning.