Which hygiene guideline helps prevent skin injury on patients with bony prominences?

• A. Do not massage reddened skin over bony prominences; avoid friction and shear
• B. Massage reddened skin to improve circulation
• C. Rub vigorously
• D. Ignore reddened areas

Answer: (A)

The main idea here is preventing skin injury from pressure and shear on bony prominences by avoiding any massage of reddened skin. When skin over a bone becomes reddened, it’s a sign the tissue is being stressed and is more vulnerable to damage. Massaging that area can push deeper into the tissue, disrupt tiny blood vessels, and aggravate the injury. Friction and shear from rubbing or sliding patients across a surface can further injure fragile skin, peel away protective layers, and lead to ulcers.

So the best approach is to avoid massage in reddened areas and instead focus on relieving pressure, protecting the skin, and promoting healing. This means regularly repositioning the patient to offload pressure, using pressure-relieving surfaces or cushions, keeping the skin clean and dry, applying barrier products if incontinence is an issue, and inspecting the area frequently for changes.

The other choices aren’t appropriate because massaging reddened skin or rubbing it vigorously increases the risk of tissue damage, and ignoring the reddened area delays appropriate care and can allow a larger injury to develop.