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