Skin Assessment
Terms
undefined, object
copy deck
- What are you assessing?
- Skin
- What are you checking skin for?
- Edema
- What type of irritation are you looking for?
- Pressure Ulcer - Risk Score
- After assessing for pressure ulcers, what is next?
- Check temperature.
- After temperature, what's next?
- Skin Integrity
- What is integrity?
- Any break in the skin or open wounds or pressure ulcers on any pressure points
- After integrity what's next?
- Check color of skin
- What is the first intervention?
- Moisture Reduction - Change wet diaper or linen, apply topical agent or cream to prevent moisture.
- After moisture reduction, what's next?
- Offer food/fluids
- After offering food/fluids, what's next?
- Check bony prominences; reduce pressure off by repositioning or encouraging to change position.
- How do you prevent shearing of the skin?
- Use a draw sheet or lifting device to move pt.
- What is the last thing you do in skin assessment?
- Note pt's response to the interventions.