C6 · Itching or skin discomfort
Actual Comfort and rest
Definition
Skin itch, burning, or irritation that disturbs rest and may lead to scratching damage.- Dry skin
- allergy
- kidney or liver disease
- rash
- medicines
- Scratching
- red or broken skin
- disturbed sleep
- irritability
📋 Scenario
An older woman scratches her legs until they bleed at night.
Subjective (S): "My skin itches so much at night."
Objective (O): Scratch marks on legs; dry flaky skin; broken sleep; no rash; skin intact except scratches.
Assessment tools for this scenario: CP-PAIN Pain & Comfort Score CP-SKIN Skin & Wound Score
Validated scales to consider: NRS 0–10, FLACC, PAINAD, Braden Scale, TIME wound chart
**CarePath diagnosis:** Itching or skin discomfort related to dry skin, as evidenced by scratching and red or broken skin.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Keep skin moist. | Moisturizer restores the skin barrier and holds water in dry skin, which reduces the itch signals that drive scratching. |
| Trim nails. | Short, smooth nails cause less damage when the patient scratches, especially during sleep, helping keep skin intact. |
| Use cool compresses. | Cool compresses calm itching by dulling skin nerve activity and easing irritation. |
| Avoid harsh soap. | Harsh soaps strip natural oils from the skin and worsen dryness and itching, so mild cleansers are used instead. |
| Give itch medicine as ordered. | Itch medicine lowers the itch sensation, so the patient can rest and scratch less. |
| Check for rash. | Checking for rash helps find a different cause, such as allergy or infection, that would need other treatment. |
**Expected outcomes**
- Within 2 days: itching 2/10 or lower, no new scratch wounds, sleeps through most of the night.
- Patient moisturizes twice daily.
**Linking the data to the diagnosis**
The older woman says her skin itches so much at night, and she scratches her legs until they bleed. The nurse saw scratch marks, dry flaky skin and broken sleep, with no rash and skin otherwise intact. Dry skin explains the itch, and the lack of rash makes a rash-related cause less likely. Because itching and scratch damage are present, this is an actual diagnosis. The plan aims within 2 days for itching of 2/10 or lower, no new scratch wounds, sleep through most of the night, and the patient moisturizing twice daily.
CarePath diagnosis
Itching or skin discomfort related to dry skin, as evidenced by scratching and red or broken skin.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Keep skin moist. | Moisturizer restores the skin barrier and holds water in dry skin, which reduces the itch signals that drive scratching. |
| 2. Trim nails. | Short, smooth nails cause less damage when the patient scratches, especially during sleep, helping keep skin intact. |
| 3. Use cool compresses. | Cool compresses calm itching by dulling skin nerve activity and easing irritation. |
| 4. Avoid harsh soap. | Harsh soaps strip natural oils from the skin and worsen dryness and itching, so mild cleansers are used instead. |
| 5. Give itch medicine as ordered. | Itch medicine lowers the itch sensation, so the patient can rest and scratch less. |
| 6. Check for rash. | Checking for rash helps find a different cause, such as allergy or infection, that would need other treatment. |
Expected outcomes
- Within 2 days: itching 2/10 or lower, no new scratch wounds, sleeps through most of the night.
- Patient moisturizes twice daily.
Linking the data to the diagnosis
The older woman says her skin itches so much at night, and she scratches her legs until they bleed. The nurse saw scratch marks, dry flaky skin and broken sleep, with no rash and skin otherwise intact. Dry skin explains the itch, and the lack of rash makes a rash-related cause less likely. Because itching and scratch damage are present, this is an actual diagnosis. The plan aims within 2 days for itching of 2/10 or lower, no new scratch wounds, sleep through most of the night, and the patient moisturizing twice daily.