3. Changes in Clients Condition

Because the caregiver spends a lot of time with the client, the caregiver acts as the eyes and ears on the client’s well-being. The client’s condition can change quickly and must be reported immediately.

Changes in a client’s condition should be reported immediately.


Skin care involves keeping the skin clean, preventing pressure on the skin for long periods of time, good nutrition and exercise if possible.  It is important to regularly check the client’s skin for color changes, signs of soreness, breakdown and infection.

Skin care after toileting is very important.  Urine and fecal matter can cause skin irritation and rashes.  If a client is incontinent and uses Depends, skin care is very important. Pericare and rectal care should be done gently, from front to back, using gentle strokes rather than scrubbing. If there are areas that are very sore, squeeze water over it and pat dry.

Changing Depends®  

Check for:
  • Red areas
  • Bruises and Cuts
  • Bed Sores
  • Tears in the skin


If the client has skin tears, do not grab the client’s arm.  Skin can become very fragile and even the simplest bump can cause a tear.

Clients who cannot change position in bed or in a chair on their own must have the PCA change their position every two hours.

How to Recognize Signs of Skin Damage

  • Red or pink areas on the skin that do not go away
  • Skin that appears shiny around the elbow
  • Blisters
  • Dark, discolored skin

Severe, untreated wounds may cause fatalities. Infections occurring due to severe wounds may cause death from deep tissue infection, bone infection, gangrene or blood infection. Spotting it early and getting help is extremely important. Clients who cannot get out of bed or a chair are at greater risk.  PCAs are required to report sores and wounds to their supervisors. Wounds are easier to treat in early stages.

Stage 1: red area with pain, burning or itching.

Stage 2: swollen, painful, warm, and/or red; may ooze clear fluid or pus. Recovery time: 3 days to 3 weeks.

Stage 3: looks like a crater, may have a bad odor, with red edges, pus, heat, and/or drainage. The tissue in or around the sore is black if it has died. Recovery time: at least one month, and up to 4 months.

Stage 4: deep, big, black sore; shows signs of infection with red edges, pus, odor, heat, and/or drainage; may see tendons, muscles, and bone. These wounds need immediate attention. Recovery time: from 3 months or even years to heal.


The PCA plays an important role in detecting changes in appetite, fluid intake and preventing possible complications.  Good reporting can make a big difference in helping the client. Poor appetite is a common problem in older people. It can contribute to unhealthy weight loss, nutritional deficiencies and serious health problems. Loss of appetite may be due to poor fitting dentures making it difficult to chew. A gradual, slow decline in appetite and thirst may mean the client has a medical condition and should be reported. A sudden loss of appetite must be reported to your supervisor immediately.  Also monitor how much the client drinks to avoid dehydration.  If the client is having difficulty urinating, constipation or frequent diarrhea, report this to your supervisor.

Behavior Changes

Any gradual or sudden changes in a client’s behavior must be reported to your supervisor.  If family members are involved in the client’s life, it is good to tell them, but you must also report it to your supervisor. Behavior changes may mean the client has a medical problem like a urinary tract infection or dehydration.  Examples of behavior change:

  • Becoming very tired and sleepy
  • Sleeping for very long periods of time
  • Dizziness
  • Restlessness, pacing, repeating the same thing over and over, asking for a lot of attention, complaining and swearing
  • Aggressive behavior, yelling, saying mean or hurtful things
  • Doing strange things the client has not done before
  • Self neglect, such as refusing to let you help with bathing, dressing; or refusing to eat
  • Talking about deceased loved ones and wanting to join them, talking about wanting to die