Mobility, Positioning, and Skin Integrity
Reposition and ambulate patients safely, and prevent the pressure injuries that develop when they are not moved.
By the end of this lesson you can
- Reposition patients on a schedule to prevent pressure injury
- Identify pressure points and stage 1 pressure injury
- Assist with ambulation using a gait belt
- Apply range of motion exercises within your scope
Lesson Notes
Read through the key concepts before you try the challenge.
Pressure injuries are preventable and largely your responsibility
You care for an immobile patient at Lakeside Regional.
A patient who cannot reposition themselves is left on their back for four hours during a busy shift. A reddened area develops over the sacrum. Caught now it resolves in days. Missed, it becomes an open wound that takes months, and it was entirely preventable by turning them.
Your task: Reposition on schedule and inspect skin every time, because nobody else is checking.
Pressure injuries develop when sustained pressure cuts off blood supply to tissue over a bony prominence. They begin within hours in a vulnerable patient. Prevention is repositioning, keeping skin clean and dry, adequate nutrition and hydration, and inspecting the skin — and most of that is PCT work.
| Position | At risk |
|---|---|
| Supine | Sacrum, heels, elbows, back of head, shoulder blades |
| Side-lying | Hip (greater trochanter), outer ankle, ear, shoulder, inner knees |
| Prone | Toes, knees, genitals, breasts, cheek, ear |
| Sitting | Ischial tuberosities (sitting bones), sacrum, heels |
| Measure | Detail |
|---|---|
| Reposition at least every 2 hours in bed | More often if skin shows early changes |
| Reposition every 1 hour in a chair | Sitting concentrates pressure on a small area |
| Use a 30-degree side-lying tilt | Avoids direct pressure on the trochanter |
| Float the heels off the bed | Pillows under the calves; heels have almost no padding |
| Keep the head of bed at or below 30 degrees where possible | Higher creates shear on the sacrum |
| Lift rather than drag when moving | Dragging causes shear and friction injury |
| Keep skin clean and dry | Moisture makes skin far more vulnerable |
For ambulation, use a gait belt fitted snugly around the patient's waist over clothing. Stand on their weaker side, slightly behind. Hold the belt underhand, never the patient's arm — an arm can dislocate and gives you no control. If they begin to fall, do not try to hold them up: guide them down, protecting their head, and lower yourself with them.
You find a reddened area over a patient's sacrum. Pressing it does not cause the redness to fade. What does this indicate?
Challenge
Apply what you've learned in this lesson.
Transfers and repositioning require supervised hands-on practice.
- Draw a body outline and mark every pressure point for supine and side-lying positions.
- Research the pressure injury staging system. Describe each stage in one sentence.
- Research the Braden Scale. List the six factors it assesses and what a low score indicates.
- Write out the steps for assisting a weak patient to ambulate with a gait belt, including what you would do if they began to fall.
Finished this lesson?
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