When & Why?
Dressings protect wounds, absorb drainage, and support wound healing.
CNAs may assist with certain dressing-related activities when authorized by the care plan, facility policy, and applicable scope-of-practice rules.
CNA Responsibilities:
- Observe the skin and condition of existing dressings.
- Follow the resident’s care plan and nursing instructions.
- Assist with specifically authorized nonsterile tasks.
- Report new redness, open areas, drainage, bleeding, odor, or pain.
- Ask the nurse for clarification when instructions or permissions are uncertain.
Important: Do not independently select wound dressings, treat open wounds, perform debridement, or apply medicated ointments.
Common Types of Dressings
| Dressing | Purpose | Important Considerations |
|---|---|---|
| Gauze sponges (2×2, 4×4) | Cover wounds and absorb some drainage | May adhere to wounds; sometimes used with gauze rolls or tape |
| Non-adherent pads | Protect wounds while minimizing adherence | May require additional absorbent layers |
| Foam dressings | Absorb moderate to heavy drainage and provide cushioning | Commonly used for certain pressure injuries |
| Calcium alginates | Absorb moderate to heavy drainage | Form a gel when exposed to wound fluid; generally unsuitable for dry wounds |
| Hydrogels | Add moisture to relatively dry wounds | Generally have limited absorption capacity |
| Transparent films | Provide a thin protective covering | Appropriate for selected superficial, minimally draining wounds; limited absorbency |
Wet-to-Dry Dressings
Wet-to-dry dressings involve applying moistened gauze that dries and is subsequently removed.
The removal process may pull away wound tissue, making it a form of mechanical debridement.
Important:
- Debridement is not an independent CNA responsibility.
- Wet-to-dry dressings can damage healthy tissue and are not appropriate for every wound.
- Follow the nurse’s instructions and wound-care plan.
Before You Start
- Review the assigned task and resident’s care plan.
- Confirm with the nurse that the activity is permitted within your role and training.
- Identify any precautions related to the wound, dressing, or resident.
- Explain the activity and obtain permission.
- Perform hand hygiene and use appropriate PPE.
- Gather only the supplies required for the authorized task.
- Provide privacy and position the resident comfortably.
Steps
Observation & Authorized Assistance
- Identify the resident and explain the care being provided.
- Perform hand hygiene and follow Standard Precautions.
- Observe the existing dressing for:
- Looseness or displacement.
- Wetness or saturation.
- Visible drainage or bleeding.
- Unusual odor.
- Resident-reported pain or discomfort.
- Observe surrounding skin during authorized care for redness, irritation, swelling, or breakdown.
- Assist with permitted activities according to the nurse’s instructions and facility procedure.
- Do not remove or replace a wound dressing unless the specific task is authorized and within your scope.
- Ensure the resident is comfortable and safely positioned.
- Dispose of used supplies according to infection-prevention procedures.
- Remove PPE and perform hand hygiene.
- Report and document observations according to facility policy.
Safety & Observations
Signs of Possible Wound Complications
- Increased redness, warmth, or swelling.
- New or worsening pain.
- Increased or unusual drainage.
- Thick, cloudy, or pus-like drainage.
- New unpleasant odor.
- Bleeding.
- Skin breakdown or wound enlargement.
- New dark or discolored tissue.
Urgent Concerns:
- Significant or uncontrolled bleeding.
- Rapidly spreading redness with systemic symptoms.
- Sudden severe pain or rapid deterioration.
- Other signs of acute illness or instability.
Promptly notify the nurse and activate emergency response when indicated.
Scope & Safety
- Do not independently determine which dressing a wound needs.
- Do not perform wound debridement.
- Do not probe, pack, or manipulate an open wound.
- Do not apply topical medications or ointments without appropriate authorization.
- Do not remove or alter surgical dressings outside assigned and permitted duties.
- Do not perform sterile wound procedures as routine CNA care.
- Follow the resident’s care plan and facility infection-control procedures.
What Should I Remember?
- Observe, protect, report.
- Dressing choice depends on wound characteristics and the treatment plan.
- Highly absorbent dressings are generally intended for more heavily draining wounds.
- Hydrogels add moisture; alginates absorb moisture.
- Wet-to-dry dressing removal may debride tissue.
- A change in drainage, pain, odor, or surrounding skin may indicate a complication.
- Knowing a dressing’s purpose does not authorize independently using it.
Related
- Skin Integrity & Breakdown Prevention
- Postsurgical Resident Care
- Standard Precautions
- Pressure Injuries
- Standard Precautions
Practice
- Studied
- Observed
- Practiced
- Passed checkoff
Sources
- CNA coursework — Nonsterile Dressings and Wound Care
- AHRQ — Pressure Ulcer Assessment
- Wound Dressings — StatPearls, NCBI Bookshelf
- AHRQ — Chronic Venous Ulcers: Treatment Modalities
- Facility wound-care procedures and nursing instructions
Flashcards
What is the primary purpose of a wound dressing?01-foundations / clinical-skills
Answer
Protect the wound, manage drainage, and support healing.
What type of dressing is commonly used for moderate to heavy drainage?03-application / clinical-skills
Answer
Foam or calcium alginate, depending on the wound.
What is the main purpose of a hydrogel dressing?01-foundations / clinical-skills
Answer
Add moisture to relatively dry wounds.
What happens when calcium alginate contacts wound drainage?03-application / clinical-skills
Answer
It absorbs fluid and forms a gel.
What type of wound is a transparent film generally suited for?03-application / clinical-skills
Answer
A superficial wound with little drainage.
What is wet-to-dry dressing removal?01-foundations / clinical-skills
Answer
A form of mechanical debridement.
May a CNA independently perform wound debridement?03-application / clinical-skills
Answer
No. It requires appropriately authorized clinical personnel.
Should a CNA independently choose a wound dressing?03-application / clinical-skills
Answer
No. Follow the prescribed wound-care plan.
What wound changes should a CNA report?03-application / clinical-skills
Answer
New pain, redness, swelling, bleeding, unusual drainage, or odor.
Can a CNA independently apply an over-the-counter ointment to an open wound?03-application / clinical-skills
Answer
No. Appropriate authorization and care-plan instructions are required.
A wound is relatively dry and needs moisture added. Which dressing?03-application / clinical-skills
Answer
Hydrogel dressing.
A wound produces moderate to heavy drainage and needs cushioning. Which dressing?03-application / clinical-skills
Answer
Foam dressing.
A wound produces heavy drainage and needs highly absorbent material. Which dressing?03-application / clinical-skills
Answer
Calcium alginate dressing.
A superficial wound has minimal drainage and needs a protective covering that can be checked on. Which dressing?03-application / clinical-skills
Answer
Transparent film dressing.
A wound has delicate new tissue, and the dressing must not stick. Which dressing?03-application / clinical-skills
Answer
Non-adherent pad.
A wound needs basic coverage and absorption of light drainage. Which dressing?03-application / clinical-skills
Answer
Gauze sponge.
A wound has nonviable tissue, and mechanical debridement has been specifically ordered. Which traditional dressing method?03-application / clinical-skills
Answer
Wet-to-dry gauze dressing.