Page 173 - Clinical Managers Orientation Binder

4/11/2019

The Skin Assessment / Pressure

Ulcers/Injuries

Incorporate your skin assessment and Braden scoring as
part of the functional assessment activities on the
SOC

 Is there a risk for friction / shear injury when
transferring from bed to chair?
 Can the patient turn from side to side?
 Ask the patient if they have had pressure ulcers or
if their heels or other boney prominences are sore
or numb - this can be evidence of stage 1 ulcer
especially if it is difficult to visualize
 Look/Touch/Ask Questions
 Check the patients feet/ toes thoroughly

Braden Scale

3