ok, so you are told to do a care plan on risk for impaired skin integrity d/t moisture from diaphoresis.
the diaphoresis is due to fever of several days' duration.
pathophysiology defined is "the study of how normal physiological processes are altered by disease" (page 1421, taber's cyclopedic medical dictionary
, 18th edition, published in 1997 by f.a. davis company). when you are referring to the pathophysiology of something, you are usually referring to a disease or an abnormal condition. in this case, it would be skin breakdown because that is what impaired skin integrity
means. the definition of impaired skin integrity
is "altered epidermis and/or dermis"
(page 199, nanda-i nursing diagnoses: definitions & classification 2007-2008
). the taxonomy gives description of this as destruction of skin layers, disruption of skin surfaces or invasion of body structures. maceration is a term that means "the dissolution of skin". what you are looking for is how the process of maceration occurs as a result of sweating. the moisture weakens the skin so that friction or sheering forces against the skin causes it to be torn away. that is the pathophysiology of skin breakdown due to moisture from diaphoresis. you can read about this on several websites to verify it.
this article (http://www.nursingcenter.com/library...icle_id=810532
) indicates that "moisture raises the surface temperature and humidity and contributes to maceration" which accounts for elevated body temperature and diaphoresis. then, "partial-thickness skin loss caused by maceration of the skin and friction may occur". this site http://www.pathguy.com/lectures/skin.htm
talks about intertrigo and maceration--"maceration: wet keratin eventually tends to break down, destroying its protective function. mild cases in body creases become intertrigo, which can get fungal or bacterial superinfection and so forth. the worst cases can lead to "jungle foot", etc." it is not until these areas become open that bacteria or yeast then invade. this article on emedicine also refer to both types of skin maceration mentioned in the two articles referred above: http://www.emedicine.com/derm/topic67.htm
there is information on how to write a care plan on this sticky thread:
you still follow the steps of the nursing process as i listed them above for you. if you ever see a copy of the book nursing care planning made incredibly easy
you will see that it is organized the same way. everything starts with the assessment and that includes the pathophysiology.
to complete this care plan for this diagnosis, see the information about the nursing interventions for anticipated problems on this post: http://allnurses.com/forums/2751313-post8.html
keep in mind that you anticipate
that there is going to be skin opening due to diaphoresis, so you will aim your interventions at preventing
the diaphoresis or maybe the fever (although i am skeptical about focusing on interventions for the fever since there is a nursing diagnosis that specifically addresses fevers--i would stick to things regarding the skin) as well as protecting the skin. you don't want the skin breakdown to happen and that is the focus of your interventions: preventing it from happening, not
treating actual skin break down because that hasn't happened--yet. remember that.