Pressure Injury Prevention, Positioning and Range of Motion

Understanding Pressure Injuries and Skin Care

A pressure injury is localized damage to the skin and/or underlying soft tissue, usually over a bony prominence or related to a medical device. Common bony prominences that are particularly prone to pressure injuries include the sacrum, heels, elbows, hips, and shoulder blades. Pressure injuries can result from intense or prolonged pressure, alone or combined with shear. In addition, friction can damage the skin and increase the risk of breakdown. During daily care, the nurse aide should carefully observe the resident's skin, paying close attention to bony prominences, and report any changes to the nurse.

It is important to understand the difference between friction and shear. Friction occurs when the skin scrapes or rubs against another surface, such as bed linens. For instance, think of how skin can become irritated when rubbed across a rough sheet. Shear occurs when the skin stays in place while underlying tissues move, such as when a resident slides down in bed. To protect fragile skin from these forces, the nurse aide should avoid pulling or sliding a resident across bed sheets. Instead, a lift sheet or draw sheet should be used to move a resident up in bed to reduce friction and shearing. Bed linens must always be kept clean, dry, and free of wrinkles.

Excess moisture significantly weakens the skin barrier. Moisture from perspiration, urine, or feces increases skin breakdown and the risk of pressure injuries. To protect the resident, incontinence care must be provided promptly to prevent skin exposure to moisture and irritants. The nurse aide should apply barrier cream only as directed by the resident's care plan. When caring for dry skin, apply lotion as directed by the care plan, but do not apply it between the toes.

Observation and early reporting are vital responsibilities of the nurse aide. An early pressure injury may appear as persistent redness on lighter skin or as a different color change on darker skin; the nurse aide observes and reports changes rather than testing blanchability or identifying a stage. The nurse aide must promptly report new or persistent skin-color changes, warmth, swelling, or open areas to the nurse. If reddened bony prominences are found, the nurse aide should never massage them, as massaging can damage fragile underlying tissue.