MICA · CARE LEARNING NOTES
Observe, keep care safe and communicate
Pressure injury prevention centres on actual mobility, skin assessment and sustained offloading of threatened areas. A suitable mattress helps but does not replace individualised repositioning.
Assess risk and skin
Assess immobility, sensory loss, difficulty repositioning, malnutrition, moisture and previous pressure injury. A validated tool supports rather than replaces judgement. With consent and privacy, inspect pressure points and areas compressed by devices. In darker skin, altered colour, warmth, firmness or pain may be more informative than obvious redness.
[1][2]Offload without creating another pressure point
Agree a repositioning plan with the patient and team, considering mobility, skin tolerance, comfort and support surface. Use handling equipment to reduce friction and shear. Check that heels and other threatened points are actually offloaded; reposition devices when safe. No support surface removes every need for repositioning.
[2][1]Address moisture, nutrition and comfort
Use gentle hygiene and manage incontinence according to the care plan, with suitable skin protection. Identify reduced intake and request indicated nutritional assessment. Manage pain as prescribed to enable movement. Do not massage a red or suspicious area to stimulate circulation. Participation depends on understandable explanations and positions compatible with other treatment.
[1][2]Individualise repositioning to mobility, skin, support surface and tolerance; a suitable mattress does not remove the need. Inspect areas beneath devices and look for new pain. Persistent redness on light skin or changes in colour, temperature or consistency on dark skin should be reported.
- Record tolerated positions and areas needing offloading at handover.
Act on early signs and follow up
Persistent non-blanching colour change, local pain, blistering or skin breakdown requires offloading, skilled assessment and plan adjustment. Record site, appearance, pain, support surface, positioning and tolerance. Reassess with deterioration, transfer or reduced mobility. An existing wound needs a specific care plan; choosing a dressing never removes the need to relieve the causal pressure.
[1][2]A learning situation
FICTIONAL SITUATION · REFLECTION WITHOUT A SCORE
Fictional situation: a patient with limited mobility has a painful heel with colour change persisting after pressure is briefly removed. A prevention mattress is already in use.
Is the mattress sufficient, and should the area be massaged?
Read the reasoning
No. Effectively offload the heel, avoid massage and request skilled skin assessment. A mattress replaces neither repositioning nor a heel-specific plan. Document pain and appearance, review the support and individualised assessment frequency, and hand over measures so they continue across shifts and transfers.
References and scope
- Recommendations — Pressure ulcers: prevention and management (CG179) ↗
- Repositioning — International Guideline, fourth edition (2025) ↗
Original documentary teaching summary for adult care. Procedures and medicines depend on professional competence, prescription and institutional procedures. International references do not establish an Algerian protocol. Independent human scientific review remains to be confirmed.