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Skin assessment is an important task for nurses and nursing assistants to perform during every shift; in frail or bedridden persons, the skin needs to be visually evaluated every 2 hours when turning the patient. Pressure sores, which begin as redness, can begin to develop within an hour of laying on a bony prominence such as shoulders, elbows, hips, spinal column, sides of knees, and the backs of heels. Skin breakdown can progress rapidly, and more so when the patient is incontinent of stool or urine. Wrinkles in sheets or bedclothes, crumbs or food on the sheets, and incontinence all contribute to rapid breakdown of skin tissues.

Some patients who would need frequent skin assessment include:

  • immobile patients
  • immediate post-op patients
  • frail elderly patients
  • extremely thin patients
  • patients who are confined to a wheelchair
  • patients who cannot lift their buttocks from a chair without help
  • patients who are restrained (soft or hard restraints)

If a patient is able to move his or her own body weight, the skin rarely breaks down.

Since most skin breakdown occurs in patients with a lack of mobility, they will need assistance to move and reduce pressure on bones. The type of assistance varies, but could include patients who need:

  • a 1, 2, or 4 person assist to lift and/or turn/roll to the opposite side (such as a quad; or a post-op abdominal patient)
  • Active Range of Motion (ROM) performed each shift
  • assistance to use a bedpan, or assist to bathroom, or those patients who have an indwelling catheter
  • assistance to lift higher onto the bed
  • assistance to turn but the patients can do most of the work by themselves
  • a full lift to re-position in a chair
  • a full-assist to stand from a chair

Assessment includes looking at every inch of skin, with special attention to areas over bones/joints, the privates including under the scrotum in men and in all skin folds for overweight patients, the spine, hips, and heels/feet including the sides of each toe where one toe presses against another or presses against the bed.

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Q: What assistance may a patient need when their skin is being assessed?
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