Integumentary System
Key Points
- The integumentary system protects against injury, infection, and fluid loss.
- Aging skin is thinner and more fragile, increasing risk for tears and pressure injuries.
- CNA prevention priorities include moisture control, pressure relief, and friction/shear reduction.
Pathophysiology
The integumentary system includes skin and associated structures that form a protective barrier. With aging and chronic illness, dermal thickness and elasticity decline, reducing tolerance to pressure, moisture, and friction.
Sustained pressure over bony prominences impairs perfusion and can cause localized tissue injury. Shear and friction accelerate epidermal separation and skin tears.
Because skin injury increases infection and immobility risk, prevention-focused daily care is essential.
Classification
- Barrier function: Protection from pathogens, trauma, and fluid imbalance.
- Pressure-related risk: Tissue injury from prolonged compression and shear.
- Moisture-associated risk: Maceration from incontinence or perspiration.
- Aging vulnerability: Thin, fragile skin with reduced healing reserve.
Nursing Assessment
NCLEX Focus
Priorities include early recognition of non-blanchable redness and prevention strategies for high-risk residents.
- Inspect bony prominences and skin folds for redness, breakdown, moisture damage, or tears.
- Assess mobility limits that increase pressure duration.
- Identify friction/shear sources during repositioning and transfers.
- Report early skin changes promptly to nurse for timely intervention.
Nursing Interventions
- Reposition dependent residents on schedule and offload pressure points.
- Keep skin clean, dry, and protected after incontinence episodes.
- Use lift-sheet techniques instead of dragging to reduce shear.
- Smooth linens and avoid wrinkles under pressure areas.
- Implement ordered pressure-relief surfaces and support devices.
Avoidable Injury Risk
Missed repositioning, unmanaged moisture, or rough handling can lead to preventable skin breakdown and complications.
Pharmacology
| Drug Class | Examples | Key Nursing Considerations |
|---|---|---|
| topical-skin-protectants | Barrier creams | Apply per care plan to reduce moisture-associated damage risk. |
| antibiotics | Skin-infection treatment contexts | Early skin-change reporting supports timely treatment escalation. |
Clinical Judgment Application
Clinical Scenario
A bedbound resident with incontinence develops persistent heel redness and sacral moisture irritation.
Recognize Cues: Pressure and moisture injury precursors. Analyze Cues: Current prevention plan is insufficient for risk level. Prioritize Hypotheses: Immediate priority is pressure offloading and moisture control. Generate Solutions: Increase repositioning reliability, float heels, apply barrier care, and improve linen smoothness. Take Action: Implement interventions and report findings to nurse. Evaluate Outcomes: Skin integrity stabilizes without progression to open injury.
Related Concepts
- moving-and-positioning-clients - Repositioning technique directly affects shear and pressure risk.
- complications-of-immobility - Immobility increases skin breakdown vulnerability.
- making-an-occupied-bed - Linen management influences moisture and friction exposure.
- body-mechanics-and-safe-equipment-use - Safe handling reduces skin trauma during movement.
- documenting-and-reporting-data - Objective skin-change documentation supports timely care escalation.
Self-Check
- Which daily care actions most reduce pressure-injury risk?
- Why does shear cause deeper tissue damage even when skin appears intact early on?
- What findings should be reported immediately for skin-integrity escalation?