Limit head of bed elevation to 30 degrees or less for stage 1 pressure injuries.

Pressure injuries can feel like a stubborn wall to climb, especially when a patient’s skin just blushes with a reddened patch that hasn’t yet opened into a sore. In clinical care, the way we position a patient and support the skin can make a big difference in healing—and in preventing the injury from getting worse. Here’s a practical look at what to include in the care plan for a client with a stage 1 pressure injury, and why one intervention stands out as the most important.

Stage 1 in plain terms

Stage 1 pressure injuries show up as non-blanchable redness on intact skin. No open wound yet, but that redness signals underlying tissue stress from pressure, friction, or shear. The skin may feel firmer, softer, warmer, or cooler than surrounding areas. The key at this stage is to relieve pressure, protect the skin, and keep it comfortable while monitoring for any changes that might push the injury into a more serious stage.

The head-of-bed question—why it matters

Let me explain the essential reason why a limited elevation of the head of the bed (HOB) is recommended: higher elevations shift more weight onto vulnerable areas, like the sacrum and the heels, and they can increase shear forces when the patient shifts in bed. Think of it like trying to balance a heavy backpack on a sloped chair—the higher up you sit, the more you tilt and press on the same spots. Keeping the HOB at 30 degrees or less helps redistribute pressure more evenly and reduces the risk of the redness turning into deeper tissue damage.

What to include in the care plan for stage 1

If you’re shaping a care plan for this scenario, here are the core elements you’ll want to weave together, with the head-of-bed limit at the center.

• Limit head-of-bed elevation to 30 degrees or less

This is the star move. It minimizes prolonged pressure and shear on the affected area while still allowing the patient to breathe comfortably and receive any necessary treatments. It’s a simple change with meaningful impact.

• Reposition regularly

Avoid leaving the patient in one position for long periods. A practical rhythm is to turn or reposition every 2 hours, with protective positioning to offload the injury. If the patient is alert and able, you can encourage small shifts when safe, but don’t rely on micro-movements alone to prevent pressure buildup.

• Use pressure-relieving surfaces

A high-quality pressure-relieving mattress or cushion can dramatically reduce sustained pressure. Devices like foam or alternating-pressure overlays distribute weight more evenly, giving the skin a chance to recover between pressure points.

• Maintain clean, dry skin

Daily skin assessments are a must. Keep the skin clean and dry after bathing, and avoid harsh cleansers that strip moisture. If the skin is dry, gentle emollients can help, but avoid occlusive products that trap moisture in intact skin. The goal is a balanced, breathable surface.

• Protect intact skin from moisture

Incontinence, sweating, or spilled fluids can dampen the skin and raise irritation risks. Use moisture barriers or breathable protective dressings as needed, and address moisture quickly to prevent breakdown.

• Gentle moisture balance

Hydration supports skin integrity, and nutrition matters too. Adequate protein, calories, vitamins, and minerals help the skin repair itself. If there’s concern about nutrition, involve a dietitian to review the patient’s intake and dietary supplements.

• Avoid occlusive ointments on intact skin as the sole treatment

While skin care matters, don’t rely on a thick ointment to “solve” a stage 1 injury. The primary job of care at this stage is pressure relief and moisture balance, not a curing cream. If you do use topical products, opt for those that protect and hydrate without creating a heavy barrier that traps heat or moisture.

• Monitor and document

Document changes in the patch’s size, color, temperature, or sensation. If the redness persists beyond 24–48 hours, worsens, or if new symptoms appear (pain, warmth, discharge), escalate care and reassess the plan.

• Encourage mobility within safety limits

Encourage gentle movement as tolerated. Any activity that improves circulation in the surrounding tissue is a win, but keep safety at the forefront. Fall risk, device lines, and pain limits can shape how much movement is appropriate.

• Check hydration and nutrition

Dehydration and poor nutrition slow healing. A quick check of intake and urine output, plus coordination with nutrition services, helps ensure a body is ready to repair itself.

• Involve the patient and family

Explain what stage 1 means and why the bed position matters. Simple, clear instructions empower caregivers at the bedside and at home, if the patient is transitioning out of the hospital.

Common questions—what to watch for and what to ignore

You’ll often hear concerns about whether to “just slap on a thick cream” or to keep the patient perfectly flat all day. Here’s where the nuance matters:

• Is it okay to leave the HOB up for meals or treatments?

Yes, but keep it as low as feasible during the rest of the day. For meals, a little elevation is often necessary, but aim to minimize the time spent above 30 degrees.

• Should I keep changing positions every hour?

Hourly changes are a great prevention habit, but they’re most effective when paired with proper HOB elevation and pressure-relief surfaces. It’s about combining strategies, not chasing one perfect move.

• Is ointment the answer?

Not by itself. Stage 1 care centers on relieving pressure and maintaining a moist but breathable skin surface. Ointments aren’t a miracle cure here; they’re part of skin care, not a stand-alone treatment.

• What if the redness doesn’t fade?

If redness lingers beyond 24–48 hours or if you notice warmth, swelling, or pain, revisit the care plan. Look for added pressure points, signs of infection, or other factors like moisture, friction, or nutrients that need addressing.

A practical mindset for nurses and students

Working with stage 1 injuries isn’t about dramatic interventions. It’s about steady, thoughtful actions that reduce pressure and support healing. The simple act of adjusting the head of the bed, combined with regular turning and the right supports, can set the stage for improvement.

Here’s a quick, memorable checklist you can carry into rounds:

• HOB at ≤30 degrees unless clinically required to be higher

• Turn every 2 hours or as tolerated

• Use a pressure-relieving surface

• Inspect the skin daily and document changes

• Keep skin clean and dry; use moisturizers carefully

• Protect from moisture and friction

• Ensure good hydration and nutrition

• Communicate with the care team about any red flags

A small tangent you might appreciate

If you’re ever stuck on a care plan, bring in the bigger picture: preventing new injuries matters as much as healing the current one. A well-placed mattress overlay or cushion can be a game changer, particularly in patients with limited mobility or those who are heavier. And when we talk about dignity in care, it’s the subtle things—comfort, warmth, and clear explanations—that keep patients engaged in their own healing journey.

Closing thoughts

In the real-world setting, the most effective intervention for a stage 1 pressure injury is straightforward: limit elevation of the head of the bed to 30 degrees or less. This small adjustment protects vulnerable tissue and supports the body’s natural healing processes. Pair it with thoughtful turning schedules, protective surfaces, skin care that respects moisture balance, and a focus on nutrition and hydration, and you’ve built a solid foundation for recovery.

If you’re studying ATI physical assessment scenarios or simply brushing up on patient care fundamentals, remember this: the simplest changes often carry the most power. A modest tilt of the bed, a gentle turn, a protective cushion—these aren’t flashy, but they’re the kind of moves that add up. They’re the kind of steps that feel almost intuitive once you see how they protect skin, support comfort, and keep a patient moving toward healing. And that’s a win, not just for the skin, but for the person behind it.