Registered Nurses' Association of Ontario

Head-to-Toe Skin Assessment

  • Skin inspection should be based on a head-to-toe assessment of those areas known to be vulnerable for each patient
  • Locations of pressure ulcer development:
    •  Prone positioning and non-invasive facemask ventilation
    • Anterior weight bearing sites including the face, thorax, iliac crest, breast and knee
    • Temporal region and occiput of the skull, ears, scapulae, spinous processes, shoulders, elbows, sacrum, coccyx, ischial tuberosities, trochanters, knees, malleoli, metatarsal areas, heels, and the toes
    • Areas of the body covered by anti-embolic stockings or restrictive clothing
    • Areas where pressure, friction and shear are exerted during activities of daily living
    • Parts of the body in contact with equipment
    • Intensive Care Unit patients à sacrum, coccyx and heels
  • Additional areas should be inspected as determined by the individual’s condition
  • The following notes the timeline for when pressure ulcers can develop in specific clinical settings:
    • Acute Care: Within the first two weeks of hospitalization
    • Intensive Care Unit: 72 hours from admission
    • Home Health Care: First four weeks of admission to agency
    • Long Term Care: First four weeks of admission
    • Palliative Care: Within two weeks prior to death
    • Elderly Clients: First week of hospitalization
    • Critically Ill Children: First day of admission to hospital
Clinical Management
Risk Assessment and Prevention of Pressure Ulcers
Point of Care Resources