Pain and a Red Mark
Mrs. T., 88, is two weeks post repair of a left hip fracture and is on a restorative program: passive range of motion to the right arm, ankle pumps, and repositioning every two hours. While assisting with left-leg exercises, Mrs. T. says "ow" and the aide feels resistance against her hand. The aide also notices a palm-sized reddened area over the sacrum that does not blanch when pressed. The care plan lists hip flexion no more than 90 degrees and an abduction pillow at night. Mrs. T. is alert and can answer questions about her pain.
1. What does the aide do when she meets resistance and the resident says "ow" during the left-leg exercise?
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Stop.
"Passive" means the resident is not doing the work - but it does not mean the resident has no say. Resistance and pain are the body's report that something is wrong, and pushing through them can cause harm.
Do:
- Stop the movement at the point of resistance, not past it. Range joint by joint to the point of comfort only.
- Ask her to describe the pain - where, how sharp, whether it started today, whether it travels into the calf or groin. Report her words, not your interpretation of them.
- Report to the nurse promptly. New or sharp pain in a post-operative hip can signal a problem that range of motion will not fix - a clot, a hardware issue, a new fracture. You are not the person who decides which; you are the person who makes sure the nurse knows now.
- Document the time, what movement you were performing, what she said, and who you notified.
Also check the plan: hip precautions mean no flexion past 90 degrees, no crossing the legs, no turning the operative leg inward, and the abduction pillow at night. If any exercise seems to conflict with those limits, ask before doing it.
2. The aide sees a palm-sized reddened area over the sacrum that does not blanch. What does she do - and what must she not do?
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A non-blanching red area is not a cosmetic finding. Skin that stays red when pressed is skin whose blood supply has already been compromised - early pressure injury. Report it, do not treat it.
Do:
- Report to the nurse the same shift, describing location, approximate size, color, and that it does not blanch, plus whether the skin is intact.
- Keep the area off the mattress: follow and reinforce the two-hour repositioning schedule, use positioning devices per the plan, and keep the head of the bed as low as she tolerates to reduce shear.
- Keep the skin clean and dry; change soiled briefs promptly; check the heels, elbows, ears, and under any device.
- Look at the rest of the skin while you are there - the sacrum is often not the only site.
Do not: massage the reddened area. Massage increases friction and shear over tissue that is already injured. Do not apply powders, don't rub with a washcloth, don't place a doughnut-shaped ring, and don't wait to see whether it "goes away by tomorrow."
Document what you saw and who you told.
3. Write what the aide would actually report and record for this shift. What belongs in the report and what does not?
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A useful report is specific, objective, and timed. A vague one is functionally silent.
Report to the nurse, verbally and promptly - not at end of shift:
- "Palm-sized area over the sacrum, red, does not blanch when pressed, skin intact."
- "Said 'ow' during left-leg exercise; felt resistance; stopped the exercise. Pain is new today."
- What you did in response and what you need the nurse to do.
Record in the chart: time, what you observed, what the resident said in her own words, what you did, and who you notified. Use measurements and plain description - "approximately 8 cm, red, non-blanching" - not conclusions.
What does not belong: "looks like a bedsore," "probably a stage 2," "she's being difficult," or anything about the daughter's attitude. Staging and diagnosis are not the aide's role, and opinions in a medical record follow the resident for years.
Also report the pattern, not just the moment: refusals, pain with movement, skin changes, and changes in eating or output mean more when they are tracked across shifts than when each one is treated as an isolated event.