Impaired skin integrity is a common nursing diagnosis that requires a well-structured care plan to promote healing, prevent infection, and improve patient comfort. One of the most effective ways to create a care plan for impaired skin integrity is by using the SMART goal framework.
What Is Impaired Skin Integrity?
Impaired skin integrity refers to damage to the epidermis or dermis, leading to open wounds, ulcers, burns, or rashes. This condition makes the skin vulnerable to infections, pain, and delayed healing.
Common Causes of Impaired Skin Integrity
| Cause | Explanation |
|---|---|
| Pressure Injuries | Prolonged pressure on bony areas (e.g., bedsores in immobile patients). |
| Friction and Shear | Rubbing against surfaces (e.g., during repositioning in bed). |
| Moisture | Excessive sweating, incontinence, or wound exudate leads to skin breakdown. |
| Surgical Incisions | Post-operative wounds that require proper care to prevent infection. |
| Burns | Thermal, chemical, or radiation burns causing skin damage. |
| Trauma | Cuts, abrasions, or injuries from falls and accidents. |
| Chronic Diseases | Diabetes, peripheral artery disease, and malnutrition delay wound healing. |
If left untreated, impaired skin integrity can lead to serious complications such as infections, pressure ulcers, and sepsis. That’s why nurses must develop an effective care plan using SMART goals.
What Are SMART Goals in Nursing?
SMART goals help nurses set clear, measurable, and achievable objectives for patient care.
SMART Goal Framework
| SMART Element | Description | Example in Skin Integrity Care Plan |
|---|---|---|
| S – Specific | The goal should be clear and focused on a specific outcome. | “The patient’s pressure ulcer will reduce in size by 20% within 2 weeks.” |
| M – Measurable | The progress should be trackable using measurable criteria. | “The wound will show signs of granulation tissue within 7 days.” |
| A – Achievable | The goal should be realistic given the patient’s condition. | “The patient will turn every 2 hours to reduce pressure injuries.” |
| R – Relevant | The goal must align with the patient’s health needs. | “Maintaining dry and clean skin will prevent further breakdown.” |
| T – Time-bound | The goal should have a specific deadline. | “The wound will show improvement within 5 days.” |
Using SMART goals ensures structured and effective nursing interventions.
Nursing Care Plan for Impaired Skin Integrity
Here is a sample nursing care plan incorporating SMART goals:
1. Nursing Diagnosis: Impaired Skin Integrity
Related to:
- Prolonged pressure on skin
- Decreased mobility
- Moisture from incontinence
As evidenced by:
- Stage II pressure ulcer on sacrum
- Redness, open wound with serous drainage
2. SMART Goal for Impaired Skin Integrity
Short-Term Goal:
“The patient’s wound will show a 10% reduction in size with new granulation tissue formation within 5 days.”
Long-Term Goal:
“The patient’s skin integrity will be fully restored with the ulcer healed within 4 weeks, preventing future recurrence.”
3. Nursing Interventions for Impaired Skin Integrity
| Nursing Intervention | Rationale | Expected Outcome |
|---|---|---|
| Assess the wound daily for size, depth, and signs of infection. | Helps monitor healing progress and detect complications early. | Wound shows improvement within 5 days. |
| Turn and reposition the patient every 2 hours. | Reduces pressure on affected areas and improves circulation. | Pressure ulcer does not worsen. |
| Keep the wound clean and dry using appropriate dressings. | Prevents infection and promotes healing. | No signs of infection. |
| Encourage high-protein nutrition (chicken, fish, eggs). | Supports tissue repair and wound healing. | Increased skin regeneration. |
| Apply prescribed barrier creams on affected areas. | Protects skin from moisture-related damage. | Skin remains intact and moisturized. |
4. Evaluation: How to Measure Nursing Care Effectiveness
- Wound size decreased by 10% within 5 days
- No new pressure ulcers developed
- Skin remains dry, intact, and free from infection
If goals are not met, the care plan should be re-evaluated and adjusted accordingly.
Preventive Measures for Impaired Skin Integrity
Apart from treating skin breakdown, prevention is key.
- Maintain Skin Hydration – Use moisturizing creams to prevent dryness.
- Encourage Mobility – Assist patients in changing positions regularly.
- Manage Incontinence Properly – Use absorbent pads and skin protectants.
- Monitor Blood Sugar Levels – Essential for diabetic patients to prevent ulcers.
- Use Pressure-Relief Devices – Cushions, air mattresses, and foam dressings reduce skin damage.
Key Takeaways
- Impaired skin integrity occurs due to pressure, moisture, or trauma, leading to wounds or ulcers.
- SMART goals help nurses set structured, trackable, and achievable patient care objectives.
- A nursing care plan should include assessment, interventions, and evaluation.
- Prevention is critical—keeping the skin dry, well-nourished, and protected prevents breakdown.
By implementing a SMART goal-oriented care plan, nurses can ensure faster healing, reduce complications, and improve patient comfort.
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