Nursing Care Plan Interventions for Impaired Skin Integrity

Written by: Marie Hasty, BSN, RN Content Writer

Looking for a skin-focused nursing care plan? Interventions for impaired skin integrity focus on preventing wounds and mitigating complications. The skin is the largest organ in the body, and no matter where you work as a nurse, you might come across patients who have skin issues. Learn more about nursing care for impaired skin integrity.

Nursing interventions are a key part of the nursing process, a systematic approach to nursing care that includes assessment, diagnosis, planning, interventions, and evaluation. Nursing interventions are distinct in that they don’t require a physician's order, and can typically be implemented independently or with the help of support staff like nursing assistants (CNAs).

What Is Impaired Skin Integrity?

Skin integrity refers to the health of the skin. An impaired skin integrity nursing diagnosis means that a patient’s dermis or epidermis is damaged or altered. This is a separate diagnosis from impaired tissue integrity, which refers to damage to underlying fascia, bone, mucous membranes, organs, or other underlying tissue.

This nursing diagnosis can be applied in the presence of an active wound, incision, infection, or injury. It can also apply to patients whose skin is intact but is thin, overly moist, overly dry, or something else.

Diagnoses That May Impair Skin Integrity

Why might a patient’s skin integrity be impaired? The skin requires proper circulation and oxygenation, but these processes may be weakened if the heart cannot properly pump blood, the arteries cannot transport it, or the immune system is weak. These patients are more at risk for wounds and may have trouble with chronic or slow-healing wounds.

Certain problems may be a clue that a patient needs a nursing plan of care for impaired skin integrity. These include:

Heart failure or low cardiac output: Reduced blood flow means less oxygen and fewer nutrients reach the skin and tissues, slowing healing and making skin more vulnerable to breakdown.
Arterial insufficiency: Narrowed or blocked arteries decrease circulation to the extremities, which can cause tissue death, delayed healing, and ulcers.
Venous insufficiency: Poor venous return causes blood and fluid to pool in the legs, leading to swelling, skin discoloration, and fragile skin that breaks down easily.
Impaired immune function: A weakened immune system makes it harder for the body to fight infection and repair damaged tissue.
Inadequate nutrition: Protein, vitamins, and calories are essential for maintaining skin health and wound healing. Malnutrition weakens tissue integrity and delays recovery.
Obesity: Excess weight increases pressure on the skin, reduces mobility, and can trap moisture in skin folds, all of which raise the risk of skin breakdown.
Prolonged moisture exposure: Constant exposure to sweat, urine, wound drainage, or stool softens and irritates the skin, making it easier to tear or erode.
Smoking: Nicotine constricts blood vessels and decreases oxygen delivery to tissues, impairing circulation and slowing wound healing.
Age: Aging skin becomes thinner, drier, and less elastic, making it more fragile and more susceptible to injury.
Mobility issues: Limited movement leads to prolonged pressure on certain areas of the body, such as the buttocks and back of the head, reducing circulation and increasing the risk of pressure injuries.

Settings Where You’re Likely to Need a Nursing Care Plan for Skin Integrity

Skin issues are very common — as many as one in three Americans may be affected by them at any given time. That means that you may come across this nursing diagnosis in a broad range of settings. You’re likely to need a nursing plan of care for impaired skin integrity in any of the following areas:

Sample Nursing Care Plan for Impaired Skin Integrity

Does your patient qualify for the nursing diagnosis of impaired skin integrity? Nursing care plan steps for these patients will follow the workflow below. We’ve created a sample patient to help guide your learning:

1. Assessment

Pamela is a 72-year-old female who presents to the wound care clinic with a post-surgical incision on her hip. She had her hip replaced six months ago after a fall, but the site is not healing as expected, and is increasingly painful. Pamela has a history of type II diabetes and smoking.

Pamela’s nurse must assess Pamela’s:

Vital signs
Pain level
Skin condition, including temperature, moisture, and bruising
Wound appearance, including site depth, width, exudate, swelling, and inflammation
Mobility

The nurse will also review Pamela’s chart for A1C levels and her diabetes management plan.

2. Diagnosis

Using the assessment findings, Pamela’s nurse creates the following nursing diagnosis:

Impaired skin integrity related to smoking, age, and hyperglycemia, as evidenced by a nonhealing surgical wound and A1C of 9 per last primary care visit.

3. Planning

Now, Pamela’s nurse sets nursing goals for impaired skin integrity:

Patient will experience complete wound closure within three months with no worsening infection.
Patient will demonstrate competence in at-home wound care and dressing changes.
Patient will demonstrate competence in understanding the link between hyperglycemia and delayed wound closure, as evidenced by teach-back.

4. Intervention

It’s time to implement nursing care plan interventions for impaired skin integrity. To help Pamela achieve the goals above, her nurse uses the following interventions:

Create a wound care plan including wound cleaning, packing, and scheduled dressing changes.
Advising Pamela on cleaning techniques, such as using warm rather than hot water, drying the skin thoroughly, and using non-adhesive dressings.
Educating about the link between unmanaged diabetes, smoking, and impaired wound healing, emphasizing the need for proper hydration and nutrition.
Teaching about signs of further infection and symptoms that indicate a worsening status.
Scheduling bi-weekly follow-up appointments to assess progress and prevent complications.

5. Evaluation

The final step in this impaired skin integrity care plan is to evaluate what worked or didn’t work, as evidenced by patient outcomes. At Pamela’s next visit, her wound is less inflamed, and her at-home dressing is clean and dry. While the sides of her wound have not closed, this marks progress towards the plan. The nurse reassesses Pamela and uses these findings to adjust her care and guide further nursing care plan interventions for impaired skin integrity.

Put Nursing Care Plan Interventions for Impaired Skin Integrity Into Action

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