NURS 516
NURS 516 - EXAM 3 PREP - INTEGUMENTARY,
FLUID AND ELECTROLYTES GRADED A+ 2026
_____________ body largest organ and protects us from infection
Skin is
Must maintain integrity of ________________.
skin and tissue (such as mucous membranes)
Debridement
Remove dead tissue
Elasticity
Ability of skin to stretch and relax. Skin without elasticity is more vulnerable to injury.
Excision
Removal by cutting
Friction Injury
Injury produces when 2 surfaces rub again each other
Lesions
Unexpected break/mark on skin. Many descriptors that include hives, rashes, papules
(solid raised spot, acne), macules (altered color, not raised), vesicles (fluid filled)
Maceration
Damage to skin from being constantly wet
Shear injury
Injury when one layer tissues slides over other
Tenting
Dehydration, skin stays up (tents) when pinched-check over sternum
Wound
Area where tissue integrity is compromised
NURS 516
, NURS 516
Skin Assessment
•Inspect Skin Color
o General pigmentation
o Areas of hypo/hyperpigmentation
o Abnormal color changes
o Assesses both exposed and unexposed areas.
o Considers culture/ethnicity, gender, and developmental stage of client in interpreting
data.
•Assess skin temperature & color
•Assess for diaphoresis
•Assess for wounds or surgical incisions
•Lesions- describe size, shape, color, distribution, texture, exudate, tenderness, pain
•Assess for redness over pressure points
•Note any unusual odors
Labs/Diagnostics
- Patch Test
- WBC
- Wound Culture
Integumentary Assessment
•Skin color based on pigmentation of patient
•Mottling (poor perfusion), pale (shock, anemia), jaundice (liver disease)
•Skin Temperature: Warm- (adequate perfusion), cool (poor perfusion)
•Skin turgor (speed skin returns to place once pinched)
•Tenting (dehydration), edema (swollen skin is more fragile)
•Diaphoresis
•Moisture/sweating could be from hypoglycemia, shock states, cardiac
•Wounds or surgical incisions
•Redness beyond wound edges, yellow/green drainage (infection), rashes
•Assess for redness over pressure points
NURS 516
NURS 516 - EXAM 3 PREP - INTEGUMENTARY,
FLUID AND ELECTROLYTES GRADED A+ 2026
_____________ body largest organ and protects us from infection
Skin is
Must maintain integrity of ________________.
skin and tissue (such as mucous membranes)
Debridement
Remove dead tissue
Elasticity
Ability of skin to stretch and relax. Skin without elasticity is more vulnerable to injury.
Excision
Removal by cutting
Friction Injury
Injury produces when 2 surfaces rub again each other
Lesions
Unexpected break/mark on skin. Many descriptors that include hives, rashes, papules
(solid raised spot, acne), macules (altered color, not raised), vesicles (fluid filled)
Maceration
Damage to skin from being constantly wet
Shear injury
Injury when one layer tissues slides over other
Tenting
Dehydration, skin stays up (tents) when pinched-check over sternum
Wound
Area where tissue integrity is compromised
NURS 516
, NURS 516
Skin Assessment
•Inspect Skin Color
o General pigmentation
o Areas of hypo/hyperpigmentation
o Abnormal color changes
o Assesses both exposed and unexposed areas.
o Considers culture/ethnicity, gender, and developmental stage of client in interpreting
data.
•Assess skin temperature & color
•Assess for diaphoresis
•Assess for wounds or surgical incisions
•Lesions- describe size, shape, color, distribution, texture, exudate, tenderness, pain
•Assess for redness over pressure points
•Note any unusual odors
Labs/Diagnostics
- Patch Test
- WBC
- Wound Culture
Integumentary Assessment
•Skin color based on pigmentation of patient
•Mottling (poor perfusion), pale (shock, anemia), jaundice (liver disease)
•Skin Temperature: Warm- (adequate perfusion), cool (poor perfusion)
•Skin turgor (speed skin returns to place once pinched)
•Tenting (dehydration), edema (swollen skin is more fragile)
•Diaphoresis
•Moisture/sweating could be from hypoglycemia, shock states, cardiac
•Wounds or surgical incisions
•Redness beyond wound edges, yellow/green drainage (infection), rashes
•Assess for redness over pressure points
NURS 516
