W5 · Fragile skin or skin tears
Risk Wounds and skin
Definition
Thin or dry skin tears or bruises easily.- Aging
- steroids
- dehydration
- poor nutrition
- Thin shiny skin
- tears
- bruises
📋 Scenario
An 82-year-old on long-term steroids has thin, dry skin on her forearms and needs help dressing.
Subjective (S): "My skin is so thin."
Objective (O): Thin dry skin; purple patches on the forearms; on steroid tablets; skin intact; sleeves pulled over her arms during dressing.
Assessment tools for this scenario: CP-SKIN Skin & Wound Score
Validated scales to consider: Braden Scale, TIME wound chart
**CarePath diagnosis:** Fragile skin or skin tears related to aging, steroids and dry skin (risk factors); no signs of the problem are present yet.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Handle gently. | Thin skin tears from shearing, pulling and friction, so slow, careful handling and lifting instead of dragging lowers the chance of injury. |
| Keep skin moist. | Moisturized skin is more flexible and less likely to split, and it helps repair the dry surface. |
| Protect limbs. | Padding or sleeves on arms and legs guard against knocks, rubbing and catching on furniture or equipment. |
| Avoid strong adhesives. | Strong adhesives can pull off the top layer of fragile skin, so gentler dressings or tapes avoid causing a tear. |
| Pad edges. | Padding hard edges on beds, chairs and rails reduces bumps that can tear or bruise thin skin. |
**Expected outcomes**
- No new tears.
- Skin moisturized.
- Patient states protective measures.
**Linking the data to the diagnosis**
The patient says, 'My skin is so thin.' She is 82, takes steroid tablets, and has thin dry skin and purple patches on her forearms. The skin is intact, with no tears, so the problem has not occurred. This is why a risk statement fits, and it rests on aging, steroids and dry skin. The nurse notes that her sleeves are pulled over her arms during dressing, a clear risk of injury. The plan aims for no new tears, moisturized skin and for her to state protective measures.
CarePath diagnosis
Fragile skin or skin tears related to aging, steroids and dry skin (risk factors); no signs of the problem are present yet.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Handle gently. | Thin skin tears from shearing, pulling and friction, so slow, careful handling and lifting instead of dragging lowers the chance of injury. |
| 2. Keep skin moist. | Moisturized skin is more flexible and less likely to split, and it helps repair the dry surface. |
| 3. Protect limbs. | Padding or sleeves on arms and legs guard against knocks, rubbing and catching on furniture or equipment. |
| 4. Avoid strong adhesives. | Strong adhesives can pull off the top layer of fragile skin, so gentler dressings or tapes avoid causing a tear. |
| 5. Pad edges. | Padding hard edges on beds, chairs and rails reduces bumps that can tear or bruise thin skin. |
Expected outcomes
- No new tears.
- Skin moisturized.
- Patient states protective measures.
Linking the data to the diagnosis
The patient says, 'My skin is so thin.' She is 82, takes steroid tablets, and has thin dry skin and purple patches on her forearms. The skin is intact, with no tears, so the problem has not occurred. This is why a risk statement fits, and it rests on aging, steroids and dry skin. The nurse notes that her sleeves are pulled over her arms during dressing, a clear risk of injury. The plan aims for no new tears, moisturized skin and for her to state protective measures.