Definition
Pressure on the skin and tissues close to the bony prominences deprives blood supply to those areas resulting in the formation of pressure ulcers. Caring for these areas is termed care of pressure points.
Purposes
- To assess skin integrity and intactness/early signs of breakdown in the skin.
- To protect the skin and manage wound effectively.
- To prevent the loss of sensation due to prolonged bed-ridden status.
Common Pressure Points
| Position | Bony Prominences |
|---|---|
| Supine | Occiput, scapulae, sacrum, heels, elbows |
| Side-lying | Ear, acromion, greater trochanter, medial/lateral knee, malleoli |
| Prone | Forehead, chin, chest (female), iliac crests, knees, toes |
Indications
Patients with the below-mentioned problems/who are elderly:
- Paralysis.
- Spinal cord injury.
- Reduced level of awareness.
- Unconsciousness.
- Malnourished.
- Heavily sedated.
- Problems with mobility including confinement to bed or wheel chair.
- Incontinence.
Articles
Preparation of Equipment
- Pillows.
- Rolled-up towels or linen.
- Special mattress such as air and water.
- Heel and elbow protectors.
- Sand bag.
- Air cushion.
- Knee rest.
- Foot board/foot rest.
- Rubber or cotton rings.
- Lubricants such as lotions/oil/powder.
Procedure
The care of pressure points includes the following:
| Nursing Action | Rationale | |
| 1. | Keep the skin clean and dry. | Moisture irritates the skin and results in injury. |
| 2. | Avoid products that dry the skin. | Dryness impairs skin integrity. |
| 3. | Use lubricants or moisturizers after bathing the patient. | To prevent dryness. |
| 4. | Observe the skin surface every shift or as per policy for signs of pressure injury. | To identify and treat at the earlier stage. |
| 5. | Change positions once in every 2 hours. | To avoid constant pressure on bony prominences or pressure points. |
| 6. | If permitted, ambulate the patient. | Ambulation promotes blood circulation. |
| 7. | Provide pillows/sand bags/air cushion or others as per the pressure points and need. | To relieve pressure from pressure points. |
| 8. | Massage the pressure points in a circular stroke with a lubricant. | To improve circulation. |
| 9. | Avoid friction between the body and the bed during lifting and transfer. | Friction disrupts skin integrity. |
| 10. | Avoid placing heavy objects (e.g., hot water bottle and beddings) over the body. | To reduce damage. |
| 11. | Ensure that the wound dressings or bandages are not very tight. | Tight dressings occlude blood flow. |
| 12. | Maintain a nutritious and high-protein diet. | To improve oxygen supply and promote tissue healing. |
| 13. | Observe for areas of decreased sensation. | More prone to unintentional injury. |
Skin Care & Moisture Management
- Inspect pressure points at least daily, noting erythema, induration, or breakdown.
- Keep skin clean and dry:
- Use gentle pH-balanced cleansers; avoid harsh soaps that strip oils.
- Pat dry—do not rub—especially in skin folds prone to moisture.
- Apply a moisture barrier (e.g., zinc oxide) for incontinent patients to prevent maceration.
Friction & Shear Reduction
- Avoid dragging when repositioning: use slide sheets or draw-sheets to lift the patient and prevent skin stretching.
- Elevate the head of the bed no more than 30° to minimize shearing forces that pull skin downward over the mattress.
- Maintain wrinkle-free linens and remove debris to reduce friction against the skin.
Nutrition & Hydration
Adequate protein, calories, vitamins (especially A and C), and fluids support skin integrity and wound healing:
- Protein: 1.25–1.5 g/kg/day for patients at high risk or with existing wounds.
- Calories: 30–35 kcal/kg/day, adjusted for activity and metabolic needs.
- Hydration: Encourage 1.5–2 L of fluid daily unless contraindicated.
Optimizing nutrition reduces susceptibility to pressure injuries and accelerates recovery.
Documentation & Education
- Record skin assessments, repositioning times, support surface use, and any signs of breakdown in the care plan.
- Teach patients and caregivers safe transfer techniques, turning schedules, and the importance of daily skin checks.
- Provide written materials on pressure-relieving equipment and proper skincare routines to reinforce learning.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
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