Patient Needs
Maintain healthy skin, prevent breakdown, and promote comfort.
Healthy skin:
- Provides a protective barrier against infection and injury.
- Helps regulate body temperature and moisture.
- Supports sensation and overall health.
Higher-Risk Residents: - Limited mobility or prolonged bed rest.
- Incontinence or excess moisture.
- Reduced sensation or consciousness.
- Poor nutrition, dehydration, or fragile skin.
What Should I Assess?
Observe for:
- Redness, discoloration, or nonblanchable areas.
- Open skin, blisters, or excoriation.
- Rashes, itching, or irritation.
- Moisture damage, especially in skin folds.
- Pain, swelling, unusual warmth, or skin firmness.
Common Types of Skin Damage:
| Type | Description |
|---|---|
| Pressure Injuries | Localized tissue damage from pressure, often combined with shear |
| Friction | Superficial injury caused by rubbing against surfaces |
| Shear | Damage caused when skin and underlying tissues move differently |
| Moisture Damage | Irritation or breakdown from prolonged exposure to moisture |
| Intertrigo | Inflammation in skin folds associated with friction and trapped moisture; sometimes complicated by fungal infection |
High-Risk Areas:
- Heels, ankles, hips, elbows, and sacrum.
- Sitting bones and areas under medical devices.
- Skin folds, especially when moisture accumulates.
- Perineal area in residents with incontinence.
How Do I Provide Care?
Skin Hygiene:
- Inspect skin during routine bathing, dressing, and repositioning.
- Use mild or approved skin cleansers.
- Clean and gently pat skin dry, especially skin folds.
- Change soiled clothing and incontinence products promptly.
- Apply approved moisturizers or barrier products as directed.
- Avoid using powders unless specifically approved.
Pressure Injury Prevention: - Follow the individualized repositioning schedule.
- Use pillows, positioning devices, and approved pressure-relieving surfaces.
- Offload heels and other vulnerable areas as directed.
- Encourage independent movement when appropriate.
- Minimize friction and shear during transfers.
Nutrition & Hydration: - Encourage adequate food and fluid intake within the care plan.
- Support prescribed nutritional interventions.
- Report poor intake or signs of dehydration.
Nonsterile Dressings & Topical Products
California CNA training includes applying certain nonsterile dressings and nonprescription topical products.
Possible Authorized Tasks:
- Applying designated nonsterile dressings.
- Applying approved nonprescription topical ointments, creams, or lotions.
- Observing and reporting changes in skin condition.
Safety Requirements:
- Follow the licensed nurse’s direction and the resident’s care plan.
- Perform tasks only when permitted by the applicable setting, training, competency, supervision requirements, and facility policy.
- Confirm the correct product, site, and instructions before application.
- Use appropriate infection-prevention precautions.
- Do not independently select medications, treatments, or wound-care products.
- Do not assume authorization for sterile wound care, invasive wound treatment, or treatment of open wounds.
- Report unexpected redness, drainage, bleeding, pain, or skin breakdown.
Important: A product being available without a prescription does not automatically authorize a CNA to administer it.
Source: CDPH Nurse Assistant Training Program Skills Checklist (CDPH 276A)
Safety & Precautions
- Never massage reddened or injured pressure areas.
- Avoid dragging residents across bed linens.
- Use appropriate slide sheets or mechanical assistance.
- Do not independently apply wound treatments.
- Wear gloves when contact with blood, body fluids, mucous membranes, or nonintact skin is anticipated.
- Change gloves and perform hand hygiene to prevent cross-contamination.
- Follow individualized care plans rather than assuming fixed repositioning intervals.
- Avoid unnecessary head-of-bed elevation when it increases shear, while honoring respiratory and other medical needs.
What Should I Report?
- New or worsening redness, discoloration, or nonblanchable areas.
- Blisters, open wounds, or skin tears.
- Persistent rashes or moisture-related damage.
- Pain, swelling, unusual warmth, or drainage.
- Changes in skin condition near medical devices.
- Inability to follow prescribed repositioning or skin-care plans.
Related
- Pressure Injuries
- Skin Findings & Terminology
- Repositioning in Bed
- Routine Bathing
- Perineal Care
- Incontinence Care
- Limited Mobility
- Standard Precautions
Sources
- CNA Module 8 — Skin Integrity
- NPIAP — Pressure Injury Prevention
- Facility skin-care and repositioning procedures
- CNA Module 7 — Skin Care and Personal Hygiene (confirm module number against your course)
- NPIAP — International Pressure Injury Prevention and Treatment Guidelines
- NPIAP — Pressure Injury Prevention Points
- NPIAP — Standardized Pressure Injury Prevention Protocol
- CDPH — Nurse Assistant Training Program Skills Checklist (CDPH 276A)
- Facility skin-care, pressure-injury prevention, and topical-product procedures (verify at clinical site)
Flashcards
Why must reddened pressure areas not be massaged?03-application / patient-care
Answer
Massage may worsen tissue damage.
What contributes to pressure or moisture-related skin breakdown?02-mechanisms / patient-care
Answer
Immobility, pressure, shear, moisture, and friction.