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Skin Integrity &
Pressure Injury Prevention

Protecting the body's largest organ: how nurses assess risk, relieve pressure, and stop wounds before they start.

NCLEX-RN

What Is Skin Integrity?

Skin integrity means the skin is intact, healthy, and able to perform its protective functions. The skin is the body's first line of defense against infection, fluid loss, and injury.

Where Injuries Develop

Occiput Scapula Sacrum Heels Common Pressure Points (Supine) The sacrum and heels are the most common sites.

How Injuries Form

1
Pressure. Sustained force compresses capillaries and reduces blood flow to the tissue.
2
Ischemia. Cells lose oxygen and nutrients (\( O_2 \downarrow \)), and waste builds up.
3
Tissue death. Prolonged ischemia leads to cell death and breakdown of skin and tissue.
4
Visible injury. Redness, then open wounds appear, sometimes after damage has already occurred deeper down.

The Core Rule

Low pressure over a long time can cause as much damage as high pressure briefly. This is why repositioning at least every 2 hours is the cornerstone of prevention, it resets the clock before ischemia becomes irreversible.

Staging Pressure Injuries

Depth Increases Stage 1 to Stage 4 Stage 1 Intact skin, non-blanchable redness Stage 2 Partial-thickness, blister/abrasion Stage 3 Full-thickness, fat visible Stage 4 Bone/muscle exposed Deep tissue injury & unstageable are separate categories.

Blanchable vs Non-Blanchable

Blanchable
Pressing the red area turns it white, then color returns. Blood flow is intact, this is not a stage 1 injury.
Non-Blanchable
Pressing does not change the color. This signals Stage 1 damage, tissue injury has begun.

Assessing Risk: Braden Scale

The Braden Scale scores six risk factors. A lower total score means higher risk.

The six subscales: sensory perception, moisture, activity, mobility, nutrition, and friction/shear.

Prevention Steps

1
Assess skin head-to-toe and calculate the Braden score on admission and regularly.
2
Reposition at least every 2 hours; use a turning schedule and the 30° lateral position.
3
Offload heels with pillows; use pressure-redistributing surfaces.
4
Keep skin clean and dry; manage moisture and provide adequate nutrition and hydration.

Example 1: Identifying a Stage

A nurse notes a sacral area with intact skin and non-blanchable redness over the bony prominence. There is no open wound.

Example 2: Braden Decision

A patient scores Braden = 14. They are bedbound after surgery and have a fever causing diaphoresis (sweating).

Example 3: Unstageable

A wound is covered with thick black eschar (slough), so the base cannot be seen.

Common Mistakes

✕ Massaging Red Areas
Massaging over a bony prominence can worsen tissue damage. Never rub reddened skin.
✕ Reverse Staging
A healing Stage 4 does not become Stage 3, then 2. Stages do not go backward.
✕ Skipping Heels
Heels are high-risk and often missed. Float heels off the bed with a pillow.
✕ Staging Eschar
Don't assign a numbered stage to a wound with a covered base, it is unstageable.

Stage Summary

Skin Depth
Stage 1IntactNon-blanchable redness
Stage 2BrokenPartial-thickness, dermis
Stage 3BrokenFull-thickness, fat visible
Stage 4BrokenBone / muscle exposed
UnstageableCoveredBase hidden by eschar/slough

Question 1 of 5

A nurse finds intact skin with non-blanchable redness over the sacrum. How is this classified?

Question 2 of 5

What is the minimum repositioning frequency generally recommended for an at-risk bedbound patient?

Question 3 of 5

A patient has a Braden score of 13. What does this indicate?

Question 4 of 5

A nurse should avoid which action over a reddened bony prominence?

Question 5 of 5

A sacral wound is fully covered with thick black eschar so the base cannot be seen. How is it staged?

Key Takeaways

1
Injury risk \( \propto \) pressure \( \times \) time, so reposition every 2 hours.
2
Non-blanchable redness on intact skin = Stage 1.
3
Braden \( \leq 18 \) means the patient is at risk.
4
Never massage red areas and never stage a wound with a covered base.
``` This complete, self-contained HTML slide deck covers "Skin Integrity And Pressure Injury Prevention" with all 20 slides, including: - **Title slide** with a clean, abstract icon - **Concept introduction** (skin integrity, where injuries develop, how they form) - **Core rule** with KaTeX formula (Injury Risk ∝ Pressure × Time) - **Staging diagram** showing Stages 1-4 with increasing depth - **Key distinction** (blanchable vs non-blanchable) - **Braden Scale** risk assessment - **Prevention steps** (how to apply) - **3 worked examples** of increasing complexity - **Common mistakes** grid - **Summary comparison table** - **5 MCQ assessment questions** with single-attempt logic and feedback - **Key takeaways** closing slide All math uses KaTeX, the design system tokens are followed exactly, and full keyboard/touch/accordion responsiveness is implemented.