You are performing routine foot care for a resident with diabetes when you notice a dark, blackish discoloration on their toe that wasn’t there yesterday. The area looks dried out and has a distinct smell. You aren’t looking at a simple bruise; you are seeing gangrene, a serious condition that requires immediate notification to the nurse.
What is Gangrene?
Gangrene (GANG-green) refers to the death of body tissue (necrosis) caused by a loss of blood supply or a serious bacterial infection. It often affects the extremities like toes, fingers, and limbs, but can also occur in internal organs. For CNAs, you will most commonly encounter this during skin checks or hygiene care, particularly in residents with poor circulation or diabetes.
Why Gangrene Matters in Your Daily Care
This is a critical observation because gangrene indicates that tissue is dying due to lack of oxygen. If left untreated, it can spread to other parts of the body, lead to sepsis, or require amputation. Your role in spotting the earliest color changes or smells can literally save a resident’s limb or life by getting them rapid medical treatment. It is a “report immediately” situation.
What You’ll See During Your Shift
During your shift, look for skin that has turned black, blue, green, or purple. The tissue may look shriveled and dry (dry gangrene) or swollen and oozing (wet gangrene). A foul, distinct odor is often present. You might also notice that the resident has severe pain in the area or, conversely, a complete loss of sensation if nerve damage has occurred.
“Nurse Sarah, I was providing peri-care for Mr. Henderson and noticed a black area on his right heel that looks dry and shriveled. It wasn’t there yesterday. There is a slight foul odor, and his foot feels cool to the touch compared to the other one.”
Common Pitfall & Pro Tip
⚠️ Pitfall: Assuming dark discoloration is just a healing bruise or dirt, and trying to scrub it off during a bath. Never attempt to scrub or debride dead tissue; this can cause further injury and introduce infection.
Pro Tip: Trust your nose. A foul, rotting odor is often the first sign you notice before visual changes are obvious. If you smell something “off” during cares, don’t ignore it—gently check skin folds and bony prominences.
Memory Aid for Gangrene
Think “Dead and Read”: If tissue looks Dead (black/dry) and has a smell, it needs to be Read (reported) immediately.
This reminds you that seeing dead tissue means stopping your task to communicate with the nurse right away.
State Test Connection
Expect questions on Observation and Reporting regarding skin integrity. The exam will test whether you understand that black, necrotic tissue is an abnormal finding requiring immediate reporting, not something to treat independently.
Related Care Concepts
Understanding gangrene is connected to monitoring Peripheral Vascular Disease (PVD) and diabetes, as these residents are at highest risk. It also relates to pressure ulcers (if a sore progresses to deep tissue damage) and circulation checks (noting cold or pale limbs).
Quick Reference
✓ Key signs: Black/blue/green skin color, foul odor, swelling, loss of sensation ✓ When to report: Immediately upon spotting any signs of tissue death ✓ Care reminders: • Do not wash, scrub, or apply lotions to the area • Do not massage the limb (can dislodge clots) • Keep the area clean and dry per nurse orders • Monitor for fever or signs of infection (sepsis) • Document exactly what you see and smell
Bottom line: When you see signs of gangrene, you are witnessing a medical emergency. Your swift eyes and accurate reporting protect your resident from life-threatening complications.