Skin turgor, decreased
Skin turgor—the skin's elasticity—is determined by observing the time required for the skin to return to its normal position after being stretched or pinched. With decreased turgor, pinched skin “holds” for up to 30 seconds, and then slowly returns to its normal contour. Skin turgor is commonly assessed over the hand, arm, or sternum—areas normally free from wrinkles and with wide variations in tissue thickness. (See Evaluating skin turgor.)
Decreased skin turgor results from dehydration, or volume depletion, which moves interstitial fluid into the vascular bed to maintain circulating blood volume, leading to slackness in the skin's dermal layer. It's a normal finding in elderly patients and in people who have lost weight rapidly; it also occurs with disorders affecting the GI, renal, endocrine, and other systems.
History and physical examination
If your examination reveals decreased skin turgor, ask the patient about food and fluid intake and fluid loss. Has he recently experienced prolonged fluid loss from vomiting, diarrhea, draining wounds, or increased urination? Has he recently had a fever with sweating? Is the patient taking a diuretic? If so, how often? Does he frequently use alcohol? How much fluid, especially water, does he ingest daily?
Next, take the patient's vital signs. Note if his systolic blood pressure is abnormally low (90 mm Hg or less) when he's in a supine position, if it drops 15 to 20 mm Hg or more when he stands, or if his pulse increases by 10 beats/minute when he sits or stands. If you detect these signs of orthostatic hypotension or resting tachycardia, insert an I.V. catheter for fluid administration.
Evaluate the patient's level of consciousness for confusion, disorientation, and signs of profound dehydration. Inspect his oral mucosa, the furrows of his tongue (especially under the tongue), and his axillae for dryness. Also, check his jugular veins for flatness, and monitor his urine output.
Medical causes
Cholera.Cholera is characterized by abrupt watery diarrhea and vomiting, which leads to severe water and electrolyte loss. These imbalances cause the following symptoms: decreased skin turgor, thirst, weakness, muscle cramps, oliguria, tachycardia, and hypotension. Without treatment, death can occur within hours.
Dehydration.Decreased skin turgor commonly occurs with moderate to severe dehydration. Associated findings include dry oral mucosa, decreased perspiration, resting tachycardia, orthostatic hypotension, a dry and furrowed tongue, increased thirst, weight loss, oliguria, fever, and fatigue. As dehydration worsens, other findings include enophthalmos, lethargy, weakness, confusion, delirium or obtundation, anuria, and shock. Hypotension persists even when the patient lies down.
Nursing considerations
▪ Turn the patient every 2 hours to prevent skin breakdown.
▪ Monitor the patient's intake and output, administer I.V. fluids, and frequently offer oral fluids.
▪ Weigh the patient daily.
▪ Monitor the patient for signs of electrolyte imbalance; monitor laboratory values.
Patient teaching
▪ Explain the disorder and treatment.
▪ Explain to the patient the importance of fluid replacement.
▪ Explain signs and symptoms the patient needs to report.
Pictures
Book Source Details
- Book Title: Nursing: Interpreting Signs and Symptoms
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.
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Copyright Details: Nursing: Interpreting Signs and Symptoms, Copyright © 2008 Williams & Wilkins.
More About Causes of Flaky skin
» Next page: Skin, clammy (Nursing: Interpreting Signs and Symptoms)
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