Impaired Skin integrity

Selasa, 30 Juli 2013

Altered epidermis and/or dermis

Defining Characteristics:

  • Invasion of body structures; 
  • destruction of skin layers (dermis); 
  • disruption of skin surface (epidermis)

Related Factors:

External
  • Hyperthermia; 
  • hypothermia; 
  • chemical substance (e.g., incontinence); 
  • mechanical factors (e.g., friction, shearing forces, pressure, restraint); 
  • physical immobilization; 
  • humidity; 
  • extremes in age; 
  • moisture; 
  • radiation; 
  • medications
Internal
  • Altered metabolic state; 
  • altered nutritional state (e.g., obesity, emaciation); 
  • altered circulation; 
  • altered sensation; 
  • altered pigmentation; 
  • skeletal prominence; 
  • developmental factors; 
  • immunological deficit; 
  • alterations in skin turgor (change in elasticity); 
  • altered fluid status

NOC Outcomes (Nursing Outcomes Classification)

Suggested NOC Labels
  • Tissue Integrity: Skin and Mucous Membranes
  • Wound Healing: Primary Intention
  • Wound Healing: Secondary Intention

Client Outcomes
  • Regains integrity of skin surface
  • Reports any altered sensation or pain at site of skin impairment
  • Demonstrates understanding of plan to heal skin and prevent reinjury
  • Describes measures to protect and heal the skin and to care for any skin lesion

NIC Interventions (Nursing Interventions Classification)

Suggested NIC Labels
  • Incision Site Care
  • Pressure Ulcer Care
  • Skin Care: Topical Treatments
  • Skin Surveillance Wound Care

Nursing Interventions and Rationales

1. Assess site of skin impairment and determine etiology (e.g., acute or chronic wound, burn, dermatological lesion, pressure ulcer, skin tear) (Krasner, Sibbald, 1999).
Prior assessment of wound etiology is critical for proper identification of nursing interventions (van Rijswijk, 2001).

2. Determine that skin impairment involves skin damage only (e.g., partial-thickness wound, stage I or stage II pressure ulcer). Classify superficial pressure ulcers in the following manner:
  • Stage I: Observable pressure-related alteration of intact skin with indicators as compared with the adjacent or opposite area on the body that may include changes in one or more of the following: skin temperature (warmth or coolness), tissue consistency (firm or boggy feel), and/or sensation (pain, itching). The ulcer appears as a defined area of persistent redness in lightly pigmented skin, whereas in darker skin tones, the ulcer may appear with persistent red, blue, or purple hues (National Pressure Ulcer Advisory Panel, 1999).
  • Stage II: Partial-thickness skin loss involving epidermis or dermis superficial ulcer that appears as an abrasion, blister, or shallow crater (National Pressure Ulcer Advisory Panel, 1999).
NOTE: For wounds deeper into subcutaneous tissue, muscle, or bone (stage III or stage IV pressure ulcers), see the care plan for Impaired Tissue integrity.

3. Monitor site of skin impairment at least once a day for color changes, redness, swelling, warmth, pain, or other signs of infection. Determine whether client is experiencing changes in sensation or pain. Pay special attention to high-risk areas such as bony prominences, skinfolds, the sacrum, and heels.
Systematic inspection can identify impending problems early (Bryant, 1999).

4. Monitor client's skin care practices, noting type of soap or other cleansing agents used, temperature of water, and frequency of skin cleansing.

5. Individualize plan according to client's skin condition, needs, and preferences.
Avoid harsh cleansing agents, hot water, extreme friction or force, or cleansing too frequently (Panel for the Prediction and Prevention of Pressure Ulcers in Adults, 1992).

6. Monitor client's continence status, and minimize exposure of skin impairment and other areas to moisture from incontinence, perspiration, or wound drainage.

7. If client is incontinent, implement an incontinence management plan to prevent exposure to chemicals in urine and stool that can strip or erode the skin. Refer to a urologist or gastroenterologist for incontinence assessment (Doughty, 1991; Wound, Ostomy, and Continence Nurses Society, 1992, 1994; Fantl et al, 1996).

8. For clients with limited mobility, use a risk-assessment tool to systematically assess immobility-related risk factors (van Rijswijk, 2001).
A validated risk-assessment tool such as the Norton or Braden scale should be used to identify clients at risk for immobility-related skin breakdown (Panel for the Prediction and Prevention of Pressure Ulcers in Adults, 1992).

9. Do not position client on site of skin impairment. If consistent with overall client management goals, turn and position client at least every 2 hours. Transfer client with care to protect against the adverse effects of external mechanical forces such as pressure, friction, and shear.

10. Evaluate for use of specialty mattresses, beds, or devices as appropriate (Fleck, 2001).
If the goal of care is to keep a client (e.g., a terminally ill client) comfortable, turning and repositioning may not be appropriate. Maintain the head of the bed at the lowest possible degree of elevation to reduce shear and friction, and use lift devices, pillows, foam wedges, and pressure-reducing devices in the bed. Evaluate for the use of specialty mattresses or beds as appropriate (Krasner, Rodeheaver, Sibbald, 2001; Panel for the Prediction and Prevention of Pressure Ulcers in Adults, 1992; Wilson, 1994).

11. Implement a written treatment plan for topical treatment of the site of skin impairment. A written plan ensures consistency in care and documentation (Maklebust, Sieggreen, 1996).
Topical treatments must be matched to the client, wound, and setting (Krasner, Sibbald 1999).

12. Select a topical treatment that will maintain a moist wound-healing environment and that is balanced with the need to absorb exudate.
Caution should always be taken not to dry out the wound (Bergstrom et al, 1994).

13. Avoid massaging around the site of skin impairment and over bony prominences.
Research suggests that massage may lead to deep-tissue trauma (Panel for the Prediction and Prevention of Pressure Ulcers in Adults, 1992).

14. Assess client's nutritional status. Refer for a nutritional consult, and/or institute dietary supplements as necessary.
Inadequate nutritional intake places individuals at risk for skin breakdown and compromises healing (Demling, De Santi, 1998).

Home Care Interventions

1. Instruct and assist client and caregivers to remove or control impediments to wound healing (e.g., management of underlying disease, improved approach to client positioning, improved nutrition).
Wound healing can be delayed or fail totally if impediments are not controlled (Krasner, Sibbald, 1999).

2. Initiate a consultation in a case assignment with a wound, ostomy, continence nurse (WOC nurse) to establish a comprehensive plan as soon as possible.

Client/Family Teaching

1. Teach skin and wound assessment and ways to monitor for signs and symptoms of infection, complications, and healing.
Early assessment and intervention help prevent serious problems from developing.

2. Teach client to use a topical treatment that is matched to the client, wound, and setting.
The topical treatment must be adjusted as the status of the wound changes (van Rijswijk, 2001; Krasner, Sibbald, 1999; Ovington, 1998).

3. If consistent with overall client management goals, teach how to turn and reposition at least every 2 hours.
If the goal of care is to keep a client (e.g., terminally ill client) comfortable, turning and repositioning may not be appropriate (Krasner, Rodeheaver, Sibbald, 2001; Panel for the Prediction and Prevention of Pressure Ulcers in Adults, 1992).

4. Teach client to use pillows, foam wedges, and pressure-reducing devices to prevent pressure injury.

38 komentar:

Anonim mengatakan...

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Unknown mengatakan...

I had no idea that there were so many factors that went into impaired skin integrity. That definitely is something to consider if you're worried. I'm glad I gave this article a look so that I know what I need to do to prevent this. http://www.skilledwoundcare.com/nursing-homes/

cathyhudgins mengatakan...

There is nothing wrong with light treatments ( letting fresh air or sunlight/ sunlamps ) to help ameliorate skin integrity issues ( though it's not often used in America ). Also, in fail elderly clients who are bedridden, even if they are " terminal" should also be repositioned regularly. The idea to not reposition a terminally ill client would put undue pressure on whatever hip was receiving pressure, and it does not take very long, sometimes less than 6 hours, for a frail elderly person or a child to develop pressure areas. After doing professional nursing for many years , though people often don't use it , honey is a great healing topical agent. For centuries honey, preferably raw honey , is very good to place on stage two pressure ulcers. Light massage to surrounding tissue also is acceptable. Treatments should always involve a dermatological approach and common best practices. Prevention is the most important thing.. Keeping the client ( an incontinent frail elder) person clean, dry and check skin daily for any changes during Bath time ( sponge bath etc). Always consult or alert a medical professional for any pressure wound , as there are many treatment options and care plans for keeping the skin intact. Adequate hydration and nutrition is imperative.

anderson mengatakan...

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Unknown mengatakan...

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Neha Sharma mengatakan...

Many treatments use a combination of topical lotions or gels along with a sunscreen. Skin Pigmentation Treatment

Unknown mengatakan...

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Anonim mengatakan...
Komentar ini telah dihapus oleh pengarang.
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Anneke Sergio mengatakan...

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Anneke Sergio mengatakan...

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Lisa Kenneth mengatakan...

I'm 57 years old and female. I was diagnosed a couple of years ago with COPD and I was beyond scared! My lung function test indicated 49% capacity. After having had flu a year ago, the shortness of breath, coughing and chest pains continued even after being treated with antibiotics. I've been smoking two packs a day for 36 years. Being born without a sternum caused my ribs to be curled in just one inch away from my spine, resulting to underdeveloped lungs. At age 34 I had surgery and it was fixed. Unfortunately my smoking just caused more damage to my already under developed lungs. The problem was having is that I enjoy smoking and don't want to give up! Have tried twice before and nearly went crazy and don't want to go through that again. I saw the fear in my husband and children's eyes when I told them about my condition then they start to find solution on their own to help my condition.I am an 57 now who was diagnose COPD emphysema which I know was from my years of smoking. I started smoking in school when smoking was socially acceptable. I remember when smoking was permitted in hospitals. It was not known then how dangerous cigarettes were for us, and it seemed everybody smoked but i was able to get rid of my COPD lung condition through the help of  Dr Akhigbe   total cure herbal medicine. my husband saw his testimony on the internet he used his powerful medicine to cured different diseases. we contacted his email   [drrealakhigbe@gmail.com}   He has the right herbal formula to help you get rid and repair any lung conditions and others diseases, will cure you totally and permanently with his natural organic herbs,We received the medicine through courier delivery service. I wish anybody who starts smoking at a young age would realize what will eventually happen to their bodies if they continue that vile habit throughout their life.
Dr Akhighe also cured diseases like, HERPES, DIABETES, HIV/AIDS, COPD, CANCER,ASTHMA,STROKE,LUPUS,JOINT PAIN,CHRONIC DISEASES,PARKINSON DISEASES,TUBERCULOSIS,HIGH BLOOD PRESSURE,BREAST INFECTION,WOMEN SEXUAL PROBLEM, GINGIVITIS, ERYSIPELAS,STAPHYLOCOCCUS,HEPATITIS A/B, QUICK EJACULATION, IMMUNOTHERAPY, GONORRHEA,SYPHILIS,WAST/BACK PAIN,PELVIC INFLAMMATORY, DICK ENLARGEMENT,HEART DISEASES,TERMINAL ILLNESS,SHIFT IN FOCUS,ATAXIA,COMMON COLD,CROHN'S DISEASES,ALCOHOL SPECTRUM DISORDER,GRAVES DISEASE,HEARING LOSS, INTERSTITIA CYSTITIS,LEUKEMIA,MULTIPLE SCLEROSIS,OBESITY,RABIES,SCOLIOSIS,INFLUENZA, POLIO,JACOB,ETC. If you are out there looking for your cure please  contact  dr Akhigbe  by his email    drrealakhigbe@gmail.com     or contact his whatsapp number   +2349010754824
God bless you Dr Akhigbe for your good hand work on my life.

Unknown mengatakan...

I experienced dark urine and ribs pain, so I went to the hospital for treatment and I was diagnosed for chronic HEP B. The doctor gave me drugs to slowdown the viral load which later worsens the ailment because the drugs weren’t effective anymore. And I was so scared because they say it has no cure, I told a friend about it and luckily he told me he ones battled same problem in the past but he was saved by Dr. Iyabiye. He gave me his contact and I reached him and I became well and tested negative after the treatment. Here is his contact if you have such case. Contact: +234-815-857-7300, (iyabiyehealinghome@gmail.com)

Oscar mengatakan...



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julia moreton mengatakan...

My names are Julia moreton I’m a citizen of UK, My younger sister was sicking of
breast cancer and her name is Florence   I and my family have been taking her
to all kind of hospital over here(UK) still yet no good result. I decided to go to
the internet and search for cancer cure so that was how I find a lady
called Sophia Charlotte,   she testifies to the world about the goodness of a
herbal man who has the roots and herbs to cure all kind of disease and the
herbal man email was there. So I decided to contact the herbal man @ kokobiherbalremedycentre@gmail.com for my
younger sister to see if he can cure her from the ailment that has befallen her(breast cancer). I contacted him and told him
my problem he told me that I should not worry that my sister will be
cure, he told me that there is a medicine that he is going to send give to me to cook and give it to my sister to drink for one week, so I ask how
can I receive the cure that I am in UK, he told me
That I will pay for the delivery service. The courier service can
transport it to me so he told me the amount I will pay, so my dad paid for
the delivery fee. two days later I receive the cure from the courier
service so I used it as the herbal man instructed me to, before the week runs out, my sister cancer was healed and it was like a dream to me not
knowing that it was physical I and my family were very happy about the
miracle of Doctor kokobi. my dad wanted to pay him 5 million  dollars as token of our appreciation towards his good work but the
herbal man declined the offer which I don't know why, he only say that I should tell the world about him
and the miracle he perform so am here now to tell the world about him if
you or your relative is having any kind of disease that you can't get a solution to from
the hospital please contact kokobiherbalremedycentre@gmail.com or WhatsApp him
+254746618873 or call him via his calling line +2348114448587 . And if you need more information about the doctor you can send me an mail @
juliamoreton78@gmail.com

mary johnson mengatakan...

ALL THANKS TO DR OSO WITH HIS HERBAL PORTION I WAS COMPLETELY CURED FROM BREAST CANCER. I'm here again to appreciate it. DR OSO God will always continue to bless you more abundantly, for the good works you do in my life, I will always keep on writing good and posting my testimonies about you on the Internet, I’m MARY JOHNSON from TEXAS . I was tested breast cancer positive, I saw a blog on how DR OSO cured people with his herbal portion, i did not believe in natural medicine but i just decided to give him a try, I contacted him, and explain my situation to him, few day later he sent me the herb, after taking DR OSO herbal medicine for few weeks i went to hospital for check up so luckily i was healed with his herbal portion, i am so happy. If you have any type of cancer problem or you are also infected with any kind of disease,

contact him drosohaberhome@gmail.com

 call/WhatsApp +2348162084839

for advice and for his product, I hope this testimony also helps someone out there ..       Here is the dr website.....

https://sites.google.com/view/drosohaberhome/

His blog page
 https://drosohaberhome.blogspot.com 

you can also email me for more info about DR oso via maryjohnson9700@gmail.com ALL THANK TO DR OSO .

Margret mengatakan...

Big thanks to Dr. Iyabiye who treated/cure my brother of chronic HEPATITIS B and Cirrhosis. My brother was diagnosed of the disease last year and we tried several antiviral medications but they were all to no avail. At a point my brother developed swollen stomach and loss of appetite, I went online out of frustration for a new medication and I came across this doctor’s recommendation. I reached out to him and my brother was cured after the completion of the medicine and tested negative at the hospital. Dr. iyabiye’s contact: call/whatsapp: +234-815-857-7300 and email: iyabiyehealinghome@gmail.com

MATINA mengatakan...

I was diagnosed as HEPATITIS B carrier in 2013 with fibrosis of the
liver already present. I started on antiviral medications which
reduced the viral load initially. After a couple of years the virus
became resistant. I started on HEPATITIS B Herbal treatment from
ULTIMATE LIFE CLINIC (www.ultimatelifeclinic.com) in March, 2020. Their
treatment totally reversed the virus. I did another blood test after
the 6 months long treatment and tested negative to the virus. Amazing
treatment! This treatment is a breakthrough for all HBV carriers.

Greg Farr mengatakan...

Hey plz share this I am here to testify how a herbal helped me out with herbs and roots which he prepared for me in use of curing Herpes.natural remedy work perfectly I takes the product which he prepared for me for some few days before I am to know I was totally cured out of it. Please you need to reach him in any similar illness, his product is helpful and it heals perfectly...his info drdestinyspellhome@gmail.com his calling WhatSapp number +2348105074556 communication with facebook page: https://web.facebook.com/Doctor-Destiny-106008014979860,,

Facey Nancy mengatakan...

Hello views, I am so excited to share this wonderful story here .

I was diagnosed with herpes virus and I was told there was no cure except medication that can control it, I totally lost hope, all I could think was losing my life because I was so depressed and confused about the whole situation , few weeks ago I read about Dr Oso online how he cured someone from cancer which was guaranteed, but i never still believe on it but i decided to give a try on him so I ordered the medicine after using it for few days i started experiencing changes all over me so i waited until i finish using the medication, so after everything I went for blood test to confirm if i am really healed from this virus to my greatest surprise it came out negative i jump up and shattered oh my goodness what a wonderful miracle i never believed in . I am so excited to share my testimony. Thank you so much Dr Oso . You are a great man. I must tell everyone I know who has any kind of disease or virus. you can also email him on via drosohaberhome@gmail.com or Call/WhatsApp +2348162084839

you can check on Dr oso site : https://sites.google.com/view/drosohaberhome/

you can also contact me for more info about Dr Oso faceynancy1@gmail.com

Nanda mengatakan...

Impaired Skin Integrity related to Pressure Ulcers (Nursing Care Plan)

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Impaired Skin Integrity - Nursing Diagnosis, Outcomes and Interventions

william Michael mengatakan...

few week ago I felt some pains and I went to the hospital my doc told me I had Herpes about 1 year ago and I need to start the treatment early, he gave me some medicine to be taking and I told him no I’ll not, because I hated taking medicine when I won’t not see cure for the purpose. After I got home I started getting worried searching for strong advice and I found valid natural treatment online a lot of people says they got herpes cure from DR.IMOUDU and I contacted DR.IMOUDU that same day I purchase his cure online, after two weeks of taking the herbel treatment i got cured totally. i tested negative all thank to DR.IMOUDU you can also reach him on his email: [DR.IMOUDUHEALERTEMPLE@GMAIL.COM ] or message him on WhatsApp +2348109609753 God bless you

Unknown mengatakan...

HOW DR KPUDU CURE MY HPV VIRUS WITH HIS HERBAL MEDICATION. Living with HPV for the past two years has been hell to me and I have tried all possible means to get cure but all to no avail, luckily for me one day as i was browsing through the Internet searching for remedy on HPV, and i saw comment of people talking about how Doctor Kpudu cured them, so i contacted him base on the testimonies i have been seeing about him on the internet, Lo and behold friends, that was the end of my fear for HPV virus.. I was cured too by him in three weeks he collected my two years bad omen(HPV) now i'm free no more matters that touches the heart. Dr words is just not enough to express what you have done for me, thanks to you.... You are indeed a light to those living with HPV virus and may you remain bless for your good work... please he can save you too !!! kindly contact him today through his email: drkpudu.herbalhome@gmail.com

Tommy mengatakan...

I am amazed by Ohikhobo's remedy. I Have had herpes for over 6 years with frequent outbreaks. Sometimes I average 2-3 times per month. Before one breakout could end, the next would begin. Nothing has helped me. I came online in search for a possible way to see how I can fight this virus so I found Ohikhobo here online after seeing a lot of testimonies of how he cured herpes and other diseases with natural herbs so I decided to give it a try I only took his remedy for two weeks and I was completely cured. I recommend Ohikhobo's remedy to anyone suffering from herpes that wants to be completely cured too.

Email: drohikhoboherbalcenter @ gmail com

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I'm 30 years old female I tested genital herpes (HSV1-2) positive in 2014. I was having bad outbreaks. EXTREMELY PAINFUL. I have try different kinds of drugs and treatment by the medical doctors all to know was avail. Six months ago I was desperately online searching for a helpful remedies for genital herpes (HSV1-2) cure, which i come across some helpful remedies on how Dr David have help so many people in curing genital herpes (HSV1-2) with the help of herbal treatment because I too believe there is someone somewhere in the world who can cure herpes completely. As of the past 2 months, however, I've been following his herpes protocol Via (dr.davidherhalhomesolution@gmail.com) and it stopped all outbreaks completely! To my greatest surprise I was cured completely by following the protocol of his herbal medicine . Don't be discouraged by the medical doctors. There is a cure for HSV with the help of herbs and roots kindly contact him for more information Via (dr.davidherbalhomesolution@gmail.com)
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Tom Neil mengatakan...

Hi, there. I am Tom Neil and I wish to describe how life had been for my younger brother living with schizophrenia and how he had been permanently able to overcome this debilitating condition via a naturopathic, herbal method.

Maicon - my kid brother was twenty years old when he was brought to the emergency room by the campus police of the college from which he had been suspended several months ago. A professor had called and reported that he had walked into his classroom, accused him of taking his tuition money, and refused to leave.

Although he had much academic success as a teenager, his behavior had become increasingly odd during the past year. He quit seeing his friends and no longer seemed to care about his appearance or social pursuits. He began wearing the same clothes each day and seldom bathed. He lived with several family members but rarely spoke to any of them. When he did talk to them, he said he had found clues that his college was just a front for an organized crime operation. He had been suspended from college because of missing many classes. My sister said that she had often seen him mumbling quietly to himself and at times he seemed to be talking to people who were not there. He would emerge from my room and ask my family to be quiet even when they were not making any noise.

My father and sister told the staff that Maicon's great-grandmother had had a serious illness and had lived for 30 years in a state hospital, which they believed was a mental hospital. Our mother left the family when Maicon was very young. She has been out of touch with us, and they thought she might have been treated for mental health problems.

Maicon agreed to sign himself into the psychiatric unit for treatment. The whole family except I had agreed to have Maicon transferred to a mental asylum. I knew inwardly there was still some plausible means by which my kid brother could overcome this condition. I knew botanical means of treatment will be more favorable than any other type of treatment, and as such, I had taken a keen interest in the research of naturopathic alternative measures suitable for the treatment of schizophrenia. I had pleaded for some little patience from the family in the delay of the transfer, I was looking forward to proving a point to the entire family, of a positive botanical remedy for this condition.

It was during my ceaseless search on the internet I had been fortunate enough to come across Dr. Utu Herbal Cure: an African herbalist and witch doctor whose professional works had majored on the eradication of certain viral conditions, especially schizophrenia, ( improving the memory capacity positively), via a traditional, naturopathic process and distinguished diet plan. It was by the administration of this herbal specialist that my brother had been able to improve his condition for better.

Before the naturopathic remedy - Maicon's story had reflected a common case, in which a high-functioning young adult goes through a major decline in day-to-day skills. Although family and friends may feel this is a loss of the person they knew, the illness can be treated and a good outcome is possible.

My brother Maicon is just like many other patients out there suffering from this disease. Although he was able to overcome this condition via a naturopathic herbal remedy administered by this African herbal physician and saved completely thus, rekindling the lost joy which had been experienced by the family members.

I wish to use this opportunity to reach across to anyone who may happen to be diagnosed with this disastrous condition to spread the hope of an everlasting herbal remedy that is capable of imposing a permanent end to this disease.

For more information concerning this naturopathic herbal remedy, feel free to contact this African herbal practitioner via email:
drutuherbalcure@gmail.com

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