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Discuss the reasons why patients and residents
develop pressure ulcers
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Discuss implications of patient disease process
at end of life such as: anxiety, anger;
depression, and how this processes impact
CNA care modalities

Incorporate preventive/intervention measures
into one’s role as a CNA
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Age
Lack of mobility
Poor diet
Moisture
Mental, neurological and other physical disease
processes
Friction and shearing
Bed sheets and chairs with wrinkled sheet or
hard objects
Previous hx of pressure ulcers

1st warning sign:
› Pink skin on bony prominence that turns white
(blanching)
Further progresses to red/irritated
area…may be warm to the touch…patient
may feel “burning” sensation at ulcer site
 Top layers of the skin will break
down/away…becoming an “open sore” which
may exposure bone, muscle or joint

Prevent skin breakdown and discomfort
through proper positioning in bed
 Thoroughly clean patient after any soiling
 Apply moisturizing lotion as directed by
nurse
 Place padding between knees or other bony
prominence areas
 Anticipate need for special pressure
mattresses and other devices
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Anxiety
› Feelings of apprehension, worry, uneasiness or
dread
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Causes:
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Medication side effects
Fear of the unknown
Inability to perform tasks at hand
Financial concerns
Family conflicts
Spiritual distress
Listen with empathy
 Provide reassurance
 Decrease environmental stimuli (turn lights
down, turn off TV, remove from crowded or
loud areas)
 Offer to engage in distraction activities
 Engage other team members –
multidisciplinary approaches to care

Disorientation to time, place or person
 STM loss
 Unusual or inappropriate communication
 Talking nonsensical
 Yelling
 Searing
 Rudeness
 Hallucinations
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Gently reorient to person, place and time
› Provide calendar, clock, etc. if appropriate)
Ensure use of hearing aides and eyeglasses
Decrease clutter, keep environment organized
and simple
 Pace patient activities, provide rest periods
 Use simple, brief instructions
 Provide emotional support
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Reassurance of safety
Calm tone of voice
Avoid arguing
Be patient
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Depression: Extreme and ongoing cluster of
feelings that may include: sadness,
hopelessness; helplessness; lack of selfworth; anger;
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History of depression
DM; Thyroid disease
Dementia
ETOH
Brain METS
Pain; nausea, diarrhea
Radiation/chemo side effects
Profound loss of control; fear; grief
Spiritual grief; family dysfunction or lack of
support
Provide emotional support to patient – be
present and be a good listener…
 Avoid trying to “cheer” patient; maintain
normal level of social conversation
 Encourage as much independence and
control as possible; particularly ADL’s
 Provide opportunity for talking about and
remembering significant life events
 Encourage use of previous helpful coping
mechanisms – prayer, family/friend visits..
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High fowlers
 Semi-Fowlers
 Supine
 Prone
 Lateral or side lying position
 Right lateral position
 Sim’s position
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Heels
Pelvis
Spine
Sacrum
 Heels
 Sacrum
 Elbows
 Scapulae
 Occipital
region (back of head)
 Ankle
bone
 Knees
 Hip bone
 Shoulder
 Side of the head (parietal region) and
ears
 Toes
 Knees
 Male
genitals
 Breasts
 Shoulder
 Cheek and ears
 Ears
 Cheek
 Shoulder
 Hip
 Feet
 Toes
Providing good skin care
 Keep skin clean and dry
 Turn and position patients at least every 2
hours (educate your patient,
family/caregivers)
 Observe condition of skin and report to nurse
(bathing is an excellent time to do this)
 Encourage mobility
 Empower patients in the plan of care
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 Provide
for toileting needs
 Encourage and provide nutrition and
fluids (as appropriate)
 Use pressure ulcer reducing
cushions, mattresses, beds, booties,
elbow pads, etc.)
 Be cognizant of disease process
progression / intervention modalities

Berman, A., Snyder., S., Kozier, B., and Erb,
G. (2010)

Fundamentals of Nursing: Concepts,
Process and Practice. 8th edition.; Pearson
Prentice Hall

Presentation adapted for in-house training
only