| Course | NUR-3220 Fundamentals of Nursing |
|---|---|
| Module | Module 3 |
| Paper type | Nursing paper: skin integrity and pressure injury |
| Length | About 1,068 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | B.S.N., Accelerated Second Degree |
| Updated | October 2026 |
Free sample paper for NUR 3220 Module 3
A Score Is Not a Plan: Assessing and Preventing Pressure Injury for an 84-Year-Old in Edison
Student Name
B.S.N., Accelerated Second Degree, Thomas Edison State University
NUR-3220: Fundamentals of Nursing
Mentor Name
Month Day, Year
A Score Is Not a Plan: Assessing and Preventing Pressure Injury for an 84-Year-Old in Edison
The Patient
The patient and hospital are invented. Mrs. Kowalski is 84, lives in an assisted living apartment and was admitted with pneumonia two days ago. She is drowsy from fever, eats about a quarter of her meals, is incontinent of urine at night and spends most of the day in bed with the head raised to help her breathe. On the morning of day two, the student assisting with her bath notices a red patch about 3 centimeters wide on the sacrum that stays red under gentle finger pressure. The admission Braden score was recorded as 14, but nothing in the care plan addressed it.
The Braden Scale
Bergstrom et al. (1987) developed the Braden Scale to predict pressure sore risk. Its six subscales score how well the patient can feel and respond to discomfort, how wet the skin stays, how much the patient moves about and changes position, how well they eat and how much friction and shear the skin meets. Five subscales run from 1 to 4 and friction and shear runs from 1 to 3, for a total of 6 to 23, with lower scores indicating higher risk. In their testing, the scale predicted which patients developed pressure sores, and the authors identified a cutoff below which patients should receive preventive measures. The value of the scale lies partly in its subscales, which point to specific causes of risk.
Staging the Injury
Edsberg et al. (2016) described the National Pressure Ulcer Advisory Panel's revised staging system, which changed the term pressure ulcer to pressure injury and defined stages as follows. At stage 1, the skin is unbroken but a red area does not fade when pressed. At stage 2, the top layers are lost and the dermis shows. Stage 3 is full-thickness skin loss, with fat visible. At stage 4, skin and deeper tissue are lost and structures such as muscle, tendon or bone can be seen or felt. Unstageable injuries are obscured by slough or eschar. A deep tissue pressure injury is persistent non-blanchable deep red, maroon or purple discoloration. The revision also added medical device related pressure injuries and mucosal membrane pressure injuries.
Mrs. Kowalski's sacrum therefore shows a stage 1 injury.
Do Risk Tools Prevent Injuries?
Moore and Patton (2019) reviewed randomized trials comparing structured risk assessment tools with clinical judgment alone or with other tools. They found it uncertain whether using a structured tool, such as the Braden Scale, reduces the incidence of pressure injuries compared with clinical judgment, because the evidence was limited and of low certainty. The review suggests that the benefit of a risk tool depends on what nurses do with the result.
| Source | Key point | Implication for care |
|---|---|---|
| Bergstrom et al. (1987) | Six subscales predict risk; lower scores mean higher risk | Plan for each low subscale |
| Edsberg et al. (2016) | Revised staging; stage 1 is intact non-blanchable redness | Stage and document accurately |
| Moore and Patton (2019) | Uncertain benefit from tools alone | A score must lead to action |
Reassessing Risk
The student and her nurse rescored the Braden Scale on day two: 3 for sensory perception, 2 each for moisture, activity, mobility and nutrition, and 1 for friction and shear, for a total of 12. The subscale scores pointed to four specific problems: moisture from incontinence, limited mobility and activity, poor nutrition and friction and shear from sliding down in bed with the head raised.
The Prevention Plan
Each part of the plan answers a low subscale. For moisture, the team uses a moisture barrier cream, checks for incontinence every two hours and at night uses absorbent pads that wick moisture rather than briefs. For mobility and activity, Mrs. Kowalski is turned every two hours, with pillows to offload the sacrum, and gets up to a chair at mealtimes when she can manage it. For friction and shear, the bed's head stays no higher than 30 degrees whenever her breathing allows, the team uses a lift sheet rather than pulling her up and her heels are floated. For nutrition, the student asks for a dietitian consult; the dietitian adds a protein supplement and the student records intake at each meal. A pressure-redistributing mattress replaces the standard mattress.
Documenting the Injury
Accurate documentation protects the patient and the team. The student and nurse recorded the stage, location, size, color, whether the area blanched, the condition of surrounding skin and the time it was found. They noted that the injury was not present on admission, which matters for the hospital's quality reporting and for understanding where prevention failed. The admission Braden score of 14, recorded without a plan, prompted the student to ask her instructor how the unit could link scores to actions; the unit's electronic record allowed a prompt to appear when a score fell below the hospital's threshold, which the nurse manager agreed to turn on.
Teaching and Communication
The student explains to Mrs. Kowalski and her son why turning matters and asks him to help with meals during visits. At handoff, she reports the stage 1 injury, the new Braden score and the plan, so the night nurse continues it.
Reassessment
On day four, the redness has faded and blanches when pressed, Mrs. Kowalski is eating half her meals and her Braden score has risen to 15. The plan continues until her mobility returns.
What the Student Learned
The student had learned the Braden Scale as a form to complete on admission. Caring for Mrs. Kowalski showed her that each subscale is a clue to an action, and that a score left in the chart protects no one. She now looks at the subscales before planning care for any patient with limited mobility.
Limits
A single patient's outcome cannot show that the plan caused improvement. The Braden Scale has been tested more in some populations than others, and its cutoffs vary. The Cochrane review found weak evidence either way, not evidence that tools are useless.
Conclusion
A Braden score of 14 on admission had led to no action, and Mrs. Kowalski developed a stage 1 injury within two days. The Braden subscales pointed to specific risks, the revised staging system allowed accurate documentation and the Cochrane review explained why the score alone is not enough. A plan tied to each low subscale, communicated at every handoff, helped the injury resolve.
References
Bergstrom, N., Braden, B. J., Laguzza, A., & Holman, V. (1987). The Braden Scale for predicting pressure sore risk. Nursing Research, 36(4), 205-210. https://doi.org/10.1097/00006199-198707000-00002
Edsberg, L. E., Black, J. M., Goldberg, M., McNichol, L., Moore, L., & Sieggreen, M. (2016). Revised National Pressure Ulcer Advisory Panel pressure injury staging system: Revised pressure injury staging system. Journal of Wound, Ostomy and Continence Nursing, 43(6), 585-597. https://doi.org/10.1097/WON.0000000000000281
Moore, Z. E. H., & Patton, D. (2019). Risk assessment tools for the prevention of pressure ulcers. Cochrane Database of Systematic Reviews, (1), Article CD006471. https://doi.org/10.1002/14651858.CD006471.pub4
What the NUR 3220 Module 3 instructions ask for
Safe and quality basic nursing care is the core of TESU's catalog description of NUR-3220, and since TESU keeps the syllabus private, the third module is planned as a skin integrity paper about one patient. A paper of this kind assesses risk with a validated tool and explains each subscale, stages any injury with current definitions, reviews evidence on what risk tools can and cannot do, builds a prevention plan tied to the specific risks found, addresses teaching and handoff and reassesses. Some sections ask for a wound care paper on an existing injury instead of prevention. Check whether the brief requires a specific staging system and whether photographs of wounds may be used, which most courses prohibit. Plan the reassessment date before you write the plan.
Inside the NUR 3220 Module 3 example
An invented 84-year-old woman with pneumonia at an Edison hospital, a Braden score of 14 with no plan and a new stage 1 injury on the sacrum open the paper. The Braden Scale's six subscales, the 2016 staging system and a Cochrane review on risk tools are explained and linked to care. The rescored Braden subscales point to moisture, mobility, nutrition and shear, and the plan answers each. Teaching, handoff, reassessment on day four, limits and conclusion follow. Annotations note the movement from score to plan and prevention that continues across shifts. Sections on documentation and on the student's own learning show how the score becomes action across the unit and in her practice.
Where the marks sit in the NUR 3220 Module 3 rubric
Skin integrity papers score well when they use the Braden Scale correctly, with correct staging with current definitions, a balanced reading of evidence on risk tools, a plan tied to each low subscale and communication and reassessment. Mentors notice when a student turns a total score into specific actions. Requesting a dietitian consult shows understanding of nutrition's role. Keeping the head of the bed low when possible shows attention to shear. Studies and staging definitions should be cited from their original sources. Documenting whether an injury was present on admission shows awareness of quality reporting. Linking a low score to a prompt in the record shows systems thinking from a student. Asking how to prevent the next missed plan shows growing systems awareness.
NUR 3220 Module 3 help: mistakes that cost marks
Pressure injury papers often report a Braden total and list generic interventions; match an action to each low subscale. Another common gap is staging with outdated terms. Use the 2016 definitions. Address moisture, shear and nutrition, not only turning. Hand off the plan at every shift. Reassess and rescore. A free first draft for your own patient is available with your brief, following the Edison paper. Record stage, size, appearance and whether the injury was present on admission. Ask how your unit links scores to actions.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 3220 Module 3 questions, answered
Where can I find a free NUR 3220 Module 3 sample paper?
The pressure injury paper about an invented 84-year-old in Edison, from the Braden subscales to the prevention plan, is reproduced on this page.
What are the Braden Scale subscales?
Sensation, skin wetness, activity level, ability to change position, eating, and the rubbing and dragging forces called friction and shear.
What is a stage 1 pressure injury?
Intact skin with a localized area of non-blanchable redness.
Do risk assessment tools prevent pressure injuries?
A Cochrane review found it uncertain whether tools alone reduce injuries compared with clinical judgment; the action taken matters.
Why keep the head of the bed at 30 degrees or lower?
Higher angles increase sliding, friction and shear over the sacrum.