Nursing Care Plans Impaired Skin Integrity Nursing Diagnosis & Care Plans: Assessment & Interventions
Skin is the body’s largest organ — and its first line of defense. When that defense breaks down, infection, fluid loss, and tissue damage can cascade quickly. The good news: with the right assessment and a clear care plan, most impaired skin integrity cases can be prevented or healed.
Let’s make this simple. This guide walks through the impaired skin integrity nursing diagnosis the way it actually shows up on care plans and NCLEX-RN® questions — Braden assessment, NANDA-formatted diagnoses, SMART goals, interventions with rationales, and five worked sample care plans (pressure injury, surgical incision, skin tear, burn, diabetic foot ulcer) you can adapt for any patient.
In this guide
- What is impaired skin integrity?
- Pathophysiology of impaired skin integrity
- Causes (Related to)
- Signs and symptoms (As evidenced by)
- Sample nursing diagnoses
- Goals and outcomes (SMART format)
- Nursing assessment with rationales
- Nursing interventions (with rationales)
- Sample care plans — 5 scenarios
- Escalation red flags (high-yield)
- Discharge and patient teaching
- Frequently asked questions
- Related care plans
- References
What is impaired skin integrity?
Impaired skin integrity is a NANDA-I nursing diagnosis defined as altered epidermis and/or dermis — the skin barrier is disrupted.¹ It applies when a patient has an actual disruption of the skin (wound, ulcer, tear, burn, abrasion, or surgical incision). When the skin is still intact but the patient is vulnerable to breakdown, the appropriate diagnosis is Risk for impaired skin integrity — covered below.
Skin has three layers, and you’ll see this on care plans:
- Epidermis — outer, avascular layer; barrier against pathogens and water loss
- Dermis — connective tissue with blood vessels, nerves, and glands; gives skin strength
- Subcutaneous tissue (hypodermis) — fat and connective tissue; insulation, shock absorption, energy storage
When any of those layers is breached or compromised, the cascade you assess for is the same: pathogen entry → infection risk; fluid loss → dehydration; thermoregulation loss → hypothermia in large wounds; nerve and pain receptor disruption → discomfort; cosmetic and functional impact → quality-of-life impairment. For a deeper anatomy and physiology review, see the NCBI Nursing Fundamentals chapter on the integumentary system.²
Note on terminology: some programs and references use impaired tissue integrity (a separate NANDA-I diagnosis) when the damage extends beyond skin into mucous membrane, cornea, muscle, or other tissues. Impaired skin integrity refers specifically to dermis and/or epidermis. Follow your instructor’s preferred label.¹
Pathophysiology of impaired skin integrity
Skin breakdown happens when one or more mechanisms overwhelm tissue resilience:
- Pressure — sustained external force compresses capillaries between bone and surface, blocking oxygen delivery and causing ischemic injury. This is the mechanism behind pressure injuries.
- Shear — when underlying tissue moves while skin stays fixed (sliding down in bed, for example). Shear damages deep tissue often before the surface shows injury.
- Friction — surface rubbing that strips the epidermis (think transferring without lifting).
- Moisture — prolonged exposure to urine, stool, perspiration, or wound drainage macerates skin and dramatically increases pressure-injury risk.
- Mechanical or thermal injury — cuts, abrasions, burns, frostbite.
- Chemical injury — caustic exposures, certain medications, incontinence-associated dermatitis.
- Vascular compromise — poor perfusion from diabetes, peripheral artery disease, edema, or shock means tissue can’t heal even if injury is small.
Once the skin barrier is breached, the body initiates the four phases of wound healing²:
- Hemostasis — vasoconstriction and clot formation (minutes)
- Inflammation — neutrophils and macrophages clear debris and pathogens (days 1–6)
- Proliferation — granulation tissue, new vessels, and epithelial migration cover the wound (days 4–24)
- Remodeling — collagen reorganization; tensile strength rebuilds (up to 2 years; never fully reaches pre-injury strength)
For exams, focus on this: when healing stalls, look for what’s blocking it — infection, ischemia, malnutrition, hyperglycemia, ongoing pressure or moisture, or a chronic disease state. Wounds that fail to progress through inflammation into proliferation are the ones that become chronic.
Causes (Related to)
On your care plan, the phrase after “Related to” should name the specific cause for your patient, not the broad category. The NANDA-I categorization groups etiology into internal and external factors, with lifestyle and contextual factors layered on top.¹
Internal factors
- Altered nutritional state (malnutrition, obesity, low albumin)
- Altered hydration
- Impaired circulation (diabetes mellitus, peripheral artery disease, heart failure, shock)
- Altered sensation (peripheral neuropathy, spinal cord injury, sedation)
- Advanced age (thinner epidermis, slower healing)
- Edema
- Immune compromise (chemotherapy, corticosteroids, HIV)
- Decreased mobility
External factors
- Mechanical — pressure, shear, friction
- Thermal — burns, frostbite
- Chemical — incontinence, irritants, caustics, harsh skin products
- Moisture — perspiration, wound drainage, incontinence
- Infection — bacterial, fungal, viral
- Radiation therapy
Lifestyle and contextual factors
- Smoking (vasoconstriction, delayed healing)
- Prolonged immobility (bedrest, wheelchair, postoperative)
- Inadequate hygiene or self-care
- Long-term corticosteroid use (skin thinning, delayed healing)
Signs and symptoms (As evidenced by)
A NANDA-I diagnostic statement is supported by defining characteristics. Use patient-reported (subjective) data when available, plus objective findings such as wound location, size, depth, drainage, and periwound condition. For an alert patient, include both. For a sedated, unconscious, or non-verbal patient, objective defining characteristics alone are sufficient — inability to report does not negate the diagnosis.¹
Subjective data — what the patient reports
- Pain, burning, itching, or stinging at the site
- Altered sensation (numbness, tingling)
- Tightness or pulling of skin
- Self-reported skin changes
Objective data — what you observe
- Erythema — non-blanchable redness (stage 1 pressure injury) vs blanchable redness (reactive hyperemia)
- Warmth or coolness at the affected area
- Visible disruption — abrasion, laceration, blister, ulcer, wound bed exposure
- Drainage — serous, sanguineous, serosanguineous, purulent
- Edema, induration, or fluctuance around the wound
- Maceration — white, soggy tissue from prolonged moisture
- Wound margins — well-defined, undermined, tunneled, rolled
- Stage and depth — per NPIAP pressure injury staging³
Laboratory findings that support the diagnosis
- Low albumin and prealbumin → markers of inflammation, illness severity, and nutrition risk; associated with delayed healing outcomes. Note: per ASPEN consensus, albumin and prealbumin are not direct measures of nutrition status or body protein — they decline with inflammation regardless of intake.¹¹
- Low hemoglobin and hematocrit → reduced oxygen delivery to tissue
- Elevated WBC, ESR, CRP → infection
- Elevated glucose or HbA1c → diabetes-related healing impairment
Sample nursing diagnoses
Use this format on your care plan:
Impaired skin integrity related to [specific cause] as evidenced by [subjective + objective findings].
Five worked examples covering the most common student-assigned scenarios:
- Pressure injury: Impaired skin integrity related to prolonged pressure over the sacrum during immobility as evidenced by a 3 cm × 2 cm shallow open ulcer with pink-red wound bed and scant serous drainage.
- Surgical incision: Impaired skin integrity related to surgical incision (open cholecystectomy) as evidenced by an 8 cm midline abdominal incision with sutures intact, edges approximated, and minimal serosanguineous drainage.
- Skin tear: Impaired skin integrity related to mechanical trauma in the setting of fragile aging skin as evidenced by a flap-type tear on the dorsal left forearm with partial-thickness loss and visible dermis.
- Burn: Impaired skin integrity related to thermal injury as evidenced by a partial-thickness burn covering 6% TBSA on the right anterior thigh with blister formation, erythematous wound bed, and serous drainage.
- Diabetic foot ulcer: Impaired skin integrity related to peripheral neuropathy and impaired circulation in the setting of type 2 diabetes as evidenced by a 2 cm full-thickness ulcer on the plantar surface of the right great toe with surrounding callus and minimal drainage.
Risk for impaired skin integrity (when no actual wound is present)
For a risk diagnosis there’s no actual problem yet, so the format drops “as evidenced by” defining characteristics and uses “related to” with the patient’s risk factors:
Risk for impaired skin integrity related to decreased mobility, urinary incontinence, Braden Scale score of 12, and altered nutritional status.
Goals and outcomes (SMART format)
Strong nursing goals are Specific, Measurable, Attainable, Realistic, and Time-bound. “Patient will have intact skin” won’t survive your instructor’s red pen. Use a measurable change, a defined timeframe, and a patient-centered subject.
Short-term goals (within 24–48 hours or this shift)
- Patient will demonstrate no further skin breakdown over the affected area by end of shift.
- Patient will be repositioned at least every 2 hours with a documented turning schedule.
- Wound will be cleansed and dressed per protocol without signs of infection (no purulent drainage, no expanding erythema) within 24 hours.
- Patient will verbalize one risk factor for skin breakdown by end of shift.
Long-term goals (within 1–2 weeks or by discharge)
- Patient will demonstrate measurable wound healing — decreasing size, presence of granulation tissue, no signs of infection — within 7 days.
- Patient will verbalize understanding of skin-care, repositioning, and nutrition strategies prior to discharge.
- Patient will demonstrate the ability to perform daily skin inspection and identify red-flag changes prior to discharge.
Function-based goals
Skin-integrity goals should pair healing milestones with function:
- Patient will tolerate offloading positions long enough to participate in physical therapy.
- Patient will consume at least 75% of meals with adequate protein intake to support healing.
- Patient will keep the affected area clean and dry between scheduled dressing changes.
High-yield flag: the NCLEX-RN favors goals that are patient-centered (start with “Patient will…”) and measurable (uses a number or scale). If a goal can’t be evaluated as “met” or “not met,” rewrite it.
Nursing assessment with rationales
Braden Scale — pressure injury risk
The Braden Scale is the most widely used pressure-injury risk-prediction tool in adult nursing.⁴ The total score ranges from 6 to 23; lower scores mean higher risk. Reassess on admission, with any change in status, and per your facility’s protocol.
| Subscale | What it measures | Score range |
|---|---|---|
| Sensory perception | Ability to respond meaningfully to pressure-related discomfort | 1–4 |
| Moisture | Degree of skin exposure to moisture | 1–4 |
| Activity | Degree of physical activity | 1–4 |
| Mobility | Ability to change and control body position | 1–4 |
| Nutrition | Usual food intake pattern | 1–4 |
| Friction and shear | Tissue tension during movement | 1–3 |
Risk cutoffs:
- ≤ 9 — severe risk
- 10–12 — high risk
- 13–14 — moderate risk
- 15–18 — mild risk
- 19–23 — no risk
Pressure injury staging (NPIAP)
The National Pressure Injury Advisory Panel staging system is the standard.³
| Stage | Defining feature |
|---|---|
| Stage 1 | Intact skin with non-blanchable erythema |
| Stage 2 | Partial-thickness loss with exposed dermis; pink or red wound bed; may be intact or ruptured blister |
| Stage 3 | Full-thickness loss; subcutaneous tissue visible; no bone, tendon, or muscle exposed |
| Stage 4 | Full-thickness loss with exposed bone, tendon, muscle, or supporting structures |
| Unstageable | Full-thickness loss with slough or eschar obscuring the wound bed |
| Deep tissue pressure injury | Persistent non-blanchable deep red, maroon, or purple discoloration |
Assessment items with rationales
| Assess | Why we do it | What to document |
|---|---|---|
| Head-to-toe skin survey | Catches early breakdown before it stages | Location, color, intactness, moisture status |
| Bony prominences (sacrum, heels, ischium, occiput, elbows) | Highest-pressure sites; first to break down | Erythema, blanching, induration |
| Braden score | Quantifies risk; drives prevention intensity | Subscale and total score |
| Wound characteristics | Tracks healing or deterioration | Size (L × W × D), wound bed (granulation, slough, eschar), drainage (volume, color, odor), margins, periwound skin |
| Mobility and positioning | Identifies pressure exposure | Position changes per shift, devices used |
| Moisture sources | Incontinence, drainage, perspiration drive maceration | Type, frequency, management plan |
| Nutrition | Healing requires protein, calories, and micronutrients | Intake, weight, albumin/prealbumin |
| Circulation | Poor perfusion delays healing | Peripheral pulses, capillary refill, edema, skin temperature |
| Sensation | Numb skin can’t warn the patient of injury | Light touch, pain, temperature; monofilament for diabetic feet |
| Pain at site | Pain often precedes visible damage | Score, scale, character, triggers |
| Device-related pressure (tubes, masks, monitors) | Often-missed source of pressure injuries | Device, contact site, frequency of inspection and repositioning |
Population callouts
- Pediatric: use age-appropriate scales (FLACC under 7, Wong-Baker 3+, NRS school-age and older); involve caregivers in interpretation.
- Geriatric: older adults under-report pain and are at higher risk for medication side effects; check renal/hepatic function before NSAIDs and opioids; review the AGS Beers Criteria (2023) for high-risk medications.
- Cognitive impairment: lean on PAINAD and behavioral observation; pain is frequently missed in this population.
Nursing interventions for impaired skin integrity (with rationales)
Prevention and protection
| Intervention | Rationale |
|---|---|
| Reposition at least every 2 hours (most common); more often for high-risk patients | Limits sustained pressure that produces ischemic injury |
| Use a 30-degree lateral position (not full side-lying) | Avoids direct pressure on the greater trochanter |
| Use a pressure-redistribution surface (foam, alternating air, gel) for at-risk patients | Spreads pressure across a larger surface area |
| Float heels off the mattress with pillows or heel-offloading boots | Heels are a high-risk site with minimal subcutaneous protection |
| Lift, do not drag, when moving the patient; use a slide sheet | Reduces friction and shear damage |
| Inspect skin every shift and at every position change | Catches early changes before they stage |
| Keep skin clean and dry with pH-balanced cleansers | Maintains the acid mantle and skin barrier |
| Apply a barrier cream or skin protectant for incontinence | Prevents incontinence-associated dermatitis |
| Manage moisture from drainage, perspiration, or wound exudate | Maceration dramatically increases breakdown risk |
Nutrition and hydration
| Intervention | Rationale |
|---|---|
| Encourage adequate protein intake (typically 1.25–1.5 g/kg/day for at-risk or existing wounds, per dietitian) | Protein supplies the amino acids needed for collagen synthesis |
| Adequate calories (typically 30–35 kcal/kg/day) | Prevents protein catabolism for energy |
| Vitamin A, C, and zinc to support healing (supplement per dietitian) | Cofactors in collagen synthesis and immune function |
| Adequate hydration (~30 mL/kg/day unless contraindicated) | Tissue perfusion and elasticity depend on hydration |
For nutrition guidance specific to wound healing, see the Wound, Ostomy and Continence Nurses Society clinical resources.⁸
Wound care fundamentals
| Intervention | Rationale |
|---|---|
| Choose dressings matched to the wound bed and drainage | Wrong dressing class delays healing |
| Maintain a moist (not wet, not dry) wound bed | Accelerates re-epithelialization |
| Cleanse with normal saline or wound cleanser; avoid cytotoxic agents (povidone-iodine, hydrogen peroxide) on healthy granulation | Cytotoxic agents damage new tissue |
| Document each dressing change | Tracks healing or deterioration |
| Use sterile or clean technique per facility policy and wound type | Reduces contamination risk |
| Common dressing categories — transparent film, hydrocolloid, foam, alginate, hydrogel, antimicrobial silver | Match to drainage volume and wound depth |
For dressing selection guidance, the WOCN Society guidelines and the AHRQ Preventing Pressure Ulcers in Hospitals toolkit are widely used references.⁵
Population-specific callouts
- Geriatric: thinner skin, slower healing, higher fall and skin-tear risk; use silicone tape or paper tape rather than aggressive adhesives.
- Pediatric: age-appropriate scales (Braden Q for ages 21 days–8 years); device-related pressure injuries (monitors, masks, tubes) are common.
- Diabetic: strict glycemic control accelerates healing; daily foot inspection is mandatory; refer non-healing ulcers to a wound specialist. See the American Diabetes Association Standards of Care for diabetic foot recommendations.⁶
- Oncology / radiation: radiation dermatitis follows WHO or RTOG grading; protect from sun, friction, and harsh products.
Monitor for
- Worsening drainage (volume, odor, color)
- Expanding erythema or warmth (cellulitis)
- Pain disproportionate to wound stage
- Systemic signs of infection or sepsis (fever, tachycardia, hypotension, altered mental status)
- New satellite lesions (consider fungal involvement)
- Wound that fails to progress through expected healing milestones — wound stalls signal an underlying problem (infection, ischemia, malnutrition, ongoing pressure)
Sample care plans (5 scenarios)
Scenario 1 — Pressure injury (stage 2, sacrum)
Diagnostic statement: Impaired skin integrity related to prolonged pressure over the sacrum during immobility as evidenced by a 3 cm × 2 cm shallow open ulcer with pink wound bed and scant serous drainage.
Short-term goal: Patient will be repositioned at least every 2 hours and the wound will show no signs of infection within 48 hours.
Assessment: Braden score on admission and every shift; wound measurements at each dressing change; skin survey at every repositioning; nutrition (intake, albumin); moisture management (incontinence, drainage).
Interventions: Reposition q2h with documented turn schedule; use a pressure-redistribution surface and 30-degree lateral position; offload heels; foam dressing for stage 2 partial-thickness wound; barrier cream for incontinence; nutrition consult for protein/calorie optimization; daily wound photography per policy.
Evaluation: Wound stable or decreasing in size; no new pressure injuries; Braden score trending up; patient and family verbalize repositioning rationale.
Scenario 2 — Surgical incision (post-operative cholecystectomy)
Diagnostic statement: Impaired skin integrity related to surgical incision (open cholecystectomy) as evidenced by an 8 cm midline abdominal incision with sutures intact and minimal serosanguineous drainage.
Short-term goal: Patient will demonstrate intact incision with edges approximated and no signs of dehiscence or infection by post-op day 2.
Assessment: Incision assessment every shift (approximation, drainage, erythema, warmth, suture/staple integrity); pain on movement; bowel sounds; respiratory effort.
Interventions: Sterile dressing per surgeon order; teach splinted coughing and deep breathing; assist with incentive spirometry; reposition q2h; early ambulation by POD 1; nutrition optimization; monitor for dehiscence (sudden splitting open) or evisceration (organs protruding) and escalate immediately if either occurs.
Evaluation: Incision clean, dry, and intact; pain controlled enough for ambulation; no signs of infection or wound complications.
Scenario 3 — Skin tear (geriatric)
Diagnostic statement: Impaired skin integrity related to mechanical trauma in the setting of fragile aging skin as evidenced by a flap-type tear on the dorsal left forearm with partial-thickness loss and visible dermis.
Short-term goal: Skin flap will be approximated and protected with appropriate dressing within 30 minutes of injury.
Assessment: International Skin Tear Advisory Panel (ISTAP) type classification (1 = no skin loss; 2 = partial flap loss; 3 = total flap loss);⁷ surrounding skin condition; fall risk assessment; medication review for anticoagulants and corticosteroids.
Interventions: Cleanse with normal saline; gently approximate the flap with a moistened applicator; apply a non-adherent silicone-bordered foam or contact-layer dressing; secure with tubular bandage or roll gauze — avoid adhesive tape on fragile skin; label dressing with arrow showing flap direction so it isn’t peeled the wrong way; protect the limb with long sleeves or limb sleeves; review fall and bumping prevention; consult dermatology or wound specialist if non-healing.
Evaluation: Flap remains approximated; no extension of the tear; surrounding skin remains intact.
Scenario 4 — Burn (partial-thickness)
Diagnostic statement: Impaired skin integrity related to thermal injury as evidenced by a partial-thickness burn covering 6% TBSA on the right anterior thigh with blister formation and serous drainage.
Short-term goal: Burn area will be cleansed, debrided per protocol, and dressed without signs of infection within 24 hours; pain will be controlled at ≤ 4/10.
Assessment: Estimate TBSA using the rule of nines (or Lund-Browder for pediatrics); pain control; signs of inhalation injury (singed nasal hair, sooty sputum, hoarseness) — escalate immediately if present; tetanus status; circumferential burns (risk of compartment syndrome). Note: formula-based fluid resuscitation (Parkland or modified Brooke) is reserved for adults with burns ≥ 20% TBSA per ABA guidance — a 6% TBSA partial-thickness burn does not routinely require formula resuscitation. Priorities for this size of burn are wound care, pain control, tetanus status, and oral hydration as tolerated.
Interventions: Cool the burn (not ice) initially; cleanse gently with mild soap and water; debride loose tissue per orders; apply non-adherent or silver-impregnated dressing for partial-thickness burns; multimodal pain management; elevate affected limb; nutrition consult (burns dramatically increase caloric and protein needs); refer to a burn center per ABA referral criteria: partial-thickness burns ≥ 10% TBSA in adults; any full-thickness burn; any deep partial-thickness or full-thickness burn of the face, hands, feet, genitalia, perineum, or major joints; chemical or electrical burns; inhalation injury; concomitant trauma; significant pre-existing medical conditions; or poorly controlled pain.
Evaluation: Wound bed healthy; no signs of infection; pain controlled; nutritional intake adequate; patient and family understand wound care and red flags.
Scenario 5 — Diabetic foot ulcer (Wagner grade 2)
Diagnostic statement: Impaired tissue integrity related to peripheral neuropathy and impaired circulation in the setting of type 2 diabetes as evidenced by a 2 cm full-thickness ulcer on the plantar surface of the right great toe with surrounding callus and minimal drainage. (When tendon, fascia, muscle, or bone is exposed or palpable — or when the wound extends past dermis — impaired tissue integrity is the cleaner NANDA-I diagnosis. Use impaired skin integrity for partial-thickness wounds limited to epidermis and/or dermis.)
Short-term goal: Patient will demonstrate consistent offloading and glycemic management; no signs of expanding infection within 48 hours.
Assessment: Vascular exam (peripheral pulses, capillary refill, ABI if available); sensation testing with monofilament; ulcer measurement and Wagner grading (1 = superficial; 2 = deep, tendon visible; 3 = abscess/osteomyelitis; 4 = forefoot gangrene; 5 = whole-foot gangrene); glucose and HbA1c trend; signs of osteomyelitis (probing to bone is a strong predictor).
Interventions: Offload with total contact cast, removable cast walker, or surgical shoe per provider order; sharp debridement of callus per orders or specialist; appropriate dressing (foam, alginate for drainage; antimicrobial if infection suspected); strict glycemic control (target per ADA standards⁶); patient education on daily foot inspection and proper footwear; refer to vascular and wound specialists; never recommend going barefoot.
Evaluation: Ulcer stable or healing; offloading maintained; glycemic targets approached; patient demonstrates daily foot inspection technique.
See: Diabetes Nursing Care Plan · Diabetic Ketoacidosis (DKA) Nursing Care Plan
Escalation red flags (high-yield)
| Situation | Escalate for |
|---|---|
| Any wound | New purulence, foul odor, expanding erythema, increasing pain disproportionate to stage |
| Pressure injury | Failure to progress, new tunneling or undermining, deep tissue color change |
| Surgical incision | Dehiscence, evisceration, hematoma, bleeding through dressing, fever post-op day 3+ |
| Burn | Signs of inhalation injury, circumferential burn, TBSA underestimation, deep burn |
| Diabetic foot | Probing to bone, gangrene, fever, expanding cellulitis |
| Any patient | Systemic signs of sepsis — fever, tachycardia, hypotension, altered mental status |
Discharge and patient teaching
| Teaching point | What the nurse should explain |
|---|---|
| Daily skin inspection | Use a hand mirror for hard-to-see areas; check bony prominences and between toes |
| Repositioning at home | Every 2 hours while awake; pressure-relief cushion for wheelchair |
| Nutrition for healing | High-protein meals, hydration, vitamin C and zinc-rich foods (citrus, leafy greens, lean meats, beans) |
| Moisture control | Keep skin clean and dry; barrier cream for incontinence; change wet clothing promptly |
| Footwear (diabetic patients) | Always wear properly fitted shoes; never barefoot; inspect feet and shoe inside daily |
| Dressing changes | Hand hygiene before and after; technique demonstration in clinic; supplies and refill plan |
| When to call the provider | Foul drainage, fever, expanding redness, wound getting larger, new severe pain, signs of systemic illness |
| Smoking and healing | Smoking constricts blood vessels and delays healing; offer cessation resources |
| Medication awareness | Steroids and some immunosuppressants impair healing; never stop without provider direction |
Frequently asked questions
What is impaired skin integrity?
Impaired skin integrity is a NANDA-I nursing diagnosis describing altered epidermis and/or dermis — meaning the skin barrier is broken or significantly disrupted. It applies to wounds, ulcers, tears, burns, abrasions, and surgical incisions.¹
What does impaired skin integrity mean on a care plan?
It means the patient has an actual disruption of the skin layer that the nursing care plan is designed to heal and protect. The diagnostic statement uses NANDA’s “related to … as evidenced by …” format to specify the cause and supporting findings.¹
What are the risk factors for impaired skin integrity?
The most common are decreased mobility, malnutrition, incontinence, advanced age, impaired circulation (especially diabetes and PAD), altered sensation, prolonged moisture exposure, and shear/friction during repositioning.
What’s the difference between impaired skin integrity and impaired tissue integrity?
Impaired skin integrity refers to dermis and/or epidermis only. Impaired tissue integrity is a broader NANDA-I diagnosis that includes damage to mucous membrane, cornea, muscle, fascia, or other deeper structures. Stage 3 and 4 pressure injuries often use impaired tissue integrity because the damage extends past skin.¹
How do you write a SMART goal for impaired skin integrity?
Make it specific, measurable, attainable, realistic, and time-bound. Pair an intensity or healing goal with a function goal. Example: “Patient will demonstrate granulation tissue in the wound bed with no signs of infection within 7 days and will perform daily skin inspection independently prior to discharge.”
What does “as evidenced by” mean for impaired skin integrity?
The “as evidenced by” portion of the diagnostic statement lists the specific subjective and objective findings that prove the diagnosis applies to this patient. For impaired skin integrity, that’s typically the wound description (size, location, depth, drainage, margins), plus the patient’s self-report of pain or sensation changes.¹
Practice questions
Which factors predict impaired skin integrity in a hospitalized patient?
Answer: Prolonged bed rest, decreased sensation, warmth and moisture exposure, obesity, low albumin, impaired renal function, advanced age.
What are the signs and symptoms of wound infection?
- Increasing pain or change in pain quality
- Purulent drainage
- Expanding erythema or warmth
- Fever and elevated WBC
- All of the above
Which routes should generally be avoided in patients with impaired skin integrity?
- Intramuscular injections at affected sites
- Topical irritants on healing wounds
- Tape over fragile skin
- All of the above
Related care plans
- Risk of Infection Nursing Care Plan
- Impaired Physical Mobility Nursing Care Plan
- Imbalanced Nutrition Nursing Care Plan
- Obesity Nursing Care Plan
- Diabetes Nursing Care Plan
- Diabetic Ketoacidosis (DKA) Nursing Care Plan
- Fluid Volume Deficit Nursing Care Plan
- Acute Pain Nursing Care Plan
Impaired skin integrity care plans look intimidating until you realize they follow a clear pattern — definition, NANDA statement, Braden assessment, intervention, evaluation. Lock that skeleton in once and every scenario (pressure, surgical, skin tear, burn, diabetic) becomes a fill-in-the-blank. You’ve got this.
Ready to test what you just learned? Try a few skin-integrity and wound-care practice questions in NCLEX format and lock in the priority-action patterns before test day.
Additional Resources
For further guidance, check out these helpful tools and references:
- Braden Scale Assessment Guide
- Online wound care training programs (link to reputable resources)
Nursing Care Plan Resources
References
- Herdman TH, Kamitsuru S, Lopes CT, eds. NANDA International Nursing Diagnoses: Definitions and Classification, 2024–2026. 13th ed. Thieme; 2024. Publisher product page
- Ernstmeyer K, Christman E, eds. Nursing Fundamentals. Chippewa Valley Technical College; 2021. Chapter 10: Integumentary. NCBI Bookshelf NBK591822
- National Pressure Injury Advisory Panel. Pressure Injury Stages. npiap.com/page/PressureInjuryStages
- Bergstrom N, Braden BJ, Laguzza A, Holman V. The Braden Scale for predicting pressure sore risk. Nursing Research. 1987;36(4):205–210. PubMed PMID 3299278
- Agency for Healthcare Research and Quality. Preventing Pressure Ulcers in Hospitals: A Toolkit for Improving Quality of Care. AHRQ. ahrq.gov pressure ulcer toolkit
- American Diabetes Association. Standards of Care in Diabetes — 2026. Diabetes Care. 2026;49(Suppl 1). Diabetes Care Standards
- International Skin Tear Advisory Panel (ISTAP). Best Practice Recommendations for the Prevention and Management of Skin Tears. skintears.org
- Wound, Ostomy and Continence Nurses Society (WOCN). Clinical Practice Guidelines. wocn.org
- Lippincott Manual of Nursing Practice. 11th ed. Wolters Kluwer; 2023. Publisher product page
- Doenges ME, Moorhouse MF, Murr AC. Nursing Care Plans: Guidelines for Individualizing Client Care Across the Life Span. 11th ed. F.A. Davis; 2024. F.A. Davis publisher
- 11. Evans DC, Corkins MR, Malone A, et al. The use of visceral proteins as nutrition markers: an ASPEN position paper. Nutr Clin Pract. 2021;36(1):22–28. doi.org/10.1002/ncp.10588
