Your instructor's master guide for Modules 4-6 — safety, mobility, wound care and hygiene. Section 9 at the bottom is her own list of what she expected on the exam.
1 · Pressure injuries
Braden Scale predicts risk, it does not stage. Six subscales: sensory perception, moisture, activity, mobility, nutrition, friction/shear.
19-23 no risk · 15-18 mild · 13-14 moderate · 10-12 high · ≤9 very high.
Prevention: reposition q2h · pillow under the CALVES, not the knees · HOB ≤30° · clean and dry skin · barrier cream · lift sheets ·
no donut cushions · never massage bony prominences · inspect sacrum and heels daily.
Highest risk: immobility, incontinence, poor nutrition, diabetes, older age, edema, sensory deficit, obesity.
2 · Wound healing & drainage
Primary — closed surgically, minimal scar. Secondary — left open, granulates bottom-up, more scarring. Tertiary — left open 5-10 days, infection treated, then closed.
Report immediately: purulent drainage · increasing redness or swelling · fever · severe pain · signs of DVT or PE · non-blanchable purple areas.
3 · DVT & PE
DVT signs: unilateral swelling, warm and tender calf, redness, heaviness, difference in leg circumference.
Risks: immobility, post-op, paralysis, obesity, prior clots, smoking, age, pregnancy, estrogen.
NEVER MASSAGE A CALF. Stop activity · elevate · notify the provider · measure calf circumference · prepare for ultrasound and anticoagulation.
PE: sudden SOB, chest pain, tachypnea, tachycardia, anxiety or a feeling of doom, cyanosis → rapid response, oxygen, raise the HOB, stay with the client.
4 · Immobility
Interventions: ambulate · ROM (goal = prevent contractures) · SCDs · hydration · cough and deep breathe · incentive spirometer · reposition q2h · high-protein high-calorie diet · gait belt · fall precautions.
5 · Falls
Intrinsic (the client): age, fall history, weakness, sedatives/antihypertensives/diuretics, sensory deficits, confusion, incontinence, orthostatic hypotension.
Extrinsic (the environment): clutter, wet floors, poor lighting, cords, high bed, bad footwear, call light out of reach.
After a fall: ASSESS the client first → notify the provider → complete the incident report.
Prevention: bed in lowest position · non-slip socks · call light in reach · lighting · remove clutter · gait belt · hourly rounding · bed/chair alarms · scheduled toileting · regular exercise is the best long-term teaching.
6 · Hygiene
Bed bath order — clean to dirty: FACE first → neck → chest → arms → abdomen → legs/feet → back → perineum LAST. Warm, not hot, water.
Perineal care: female — front to back, hand mitt, dry thoroughly. Male — retract the foreskin, clean in a circle from the meatus outward, and REPLACE the foreskin (critical — prevents constriction and swelling).
Oral care: soft toothbrush · never put your fingers in an unconscious client's mouth · suction available · semi-Fowler's or lateral · dentures in a labeled cup, never on the meal tray · electric toothbrush for a weak grip.
Diabetic foot care: no soaking · dry between the toes · no lotion between the toes · inspect daily · cotton socks · well-fitting shoes · cut nails straight across · podiatry referral.
Culture: ask about preferred caregiver gender, bathing time and method, religious considerations, and family participation. If a client refuses a caregiver on gender grounds — reassign and document the preference. If they bathe after prayers — reschedule. Accommodate, don't override.
7 · Her list of most-likely exam topics
Pressure injury stages · Braden interpretation · healing intentions · drainage types · DVT/PE · effects of immobility · intrinsic vs extrinsic fall risk ·
safe handling (gait belts, bed height) · CHG baths · oral care for aspiration risk · diabetic foot care · perineal technique · skin assessment during hygiene ·
cultural considerations · bed bath order · mobility and respiratory exercises · ADPIE in practice.
Her rapid-fire answers: bed bath first → face · female peri → front to back · DVT risk → immobility · most concerning statement → "I feel like a burden to my family" ·
limited dexterity → electric toothbrush · DVT don't → massage the calf · best fall teaching → regular exercise · sutured after 10 days → tertiary · adipose visible → Stage 3 · most at risk → obese and bed-bound 2 weeks.