Full Skin Assessments

[*4!#6]

We have heard recently of incidents where things got missed on skin assessments on the unit (some very serious). I am soon to graduate and am just wondering how people go about doing a full skin assessment. I am good with checking the legs, feet, arms, upper chest, abdomen, and the back during my other parts of the assessment. The only problem I have is checking patient's groins/butts. I am wondering how you address this issue with patients. I want to maintain the patient's dignity but I also want to perform a thorough skin assessment and make sure nothing is missed.

EDIT: Also another issue is under skin folds/breasts. How do you approach this patients?

[nurseprnRN, BSN, RN]

for butts and backs, tell the patient what you're about to do, turn and look. this can be done as part of the bed bath. as a matter of fact, all of your skin chekcs can be done during the bed bath.

for groins, tell the patient you're going to check to see that the skin here is ok. lift and separate. likewise under the pannus (that big fold at the lower end of the abdomen) and the breasts. make it a matter-of-fact part of your care, and the patient will not freak out. all nervous and apologetic will freak them out, or at least make them nervous.

it's sort of like what vince lombardi said about getting to the end zone: act like you've been there before.

[*4!#6]

Thanks for the advice. I was a CNA in a nursing home for years before nursing and I have seen many butts and other body parts lol. I don't know what my shyness is about patients in the hospital.

[booboo123]

I think there is just a natural aversion to this that we all need to get past. Like Green Tea said, best advice is just to act like you have been there before, and if you can't do that... fake it until you become more comfy. You'll get there :)

[Do-over, ASN, RN]

For A&O patients (especially those that are likely to have skin issues) I simply ask them if they have any red/sore/irritated/open areas... Generally, if they do, they will show me themselves at that time. Also, when placing tele patches (and removing extras or ones that I don't like the placement of) is another opportunity to look (or go in when an EKG is being performed). Otherwise, to be honest, if they tell me "no" and they are walkie-talkie, etc. I am not going to push the issue of inspecting the places the sun don't shine... If I am ever admitted, and am still able to wipe my own butt, the nurse will have to take my word for the condition of my skin...

For nursing/group home patients, on admission, I do it as we are transferring them / changing them into a gown, etc. I tell them what I am doing as I am doing it, of course. It generally is not an issue - they are used to it.

[*4!#6]

I understand with AAOx4 patients that are able to walk on their own that there is probably little concern for issues such as pressure ulcers. This is what I am paranoid about missing. How would you chart if you asked the patient instead of looking? Partial skin assessment, no areas of concern per pt? I think my last facility required a full skin assessment each day. I bet if I asked the patient and explained the reasoning behind the assessment, most would understand, if the person refused then I guess I could chart "pt refused full skin assessment, no areas of concern per pt."

[Cuddleswithpuddles]

Hello,

I started a thread on the same issue hehe. I am new to acute care and also find full skin assessments a challenge, especially with larger bedbound patients. For such patients, I have given up on the notion that I will be able to assess their skin on my own first thing during shift. I do it in stages. I look at whatever I can during my initial assessment and then coordinate with the CNA during turning and bathing for the rest.

For oriented walky talkies, I ask them if they have skin issues on their back, buttocks and groin area. I will still look myself but I will use their answer to gauge how urgently I need to see what is going on. If they say nothing's wrong, they're on strict bedrest because of a femoral sheath, I need to set up monitors, the doctor's in the station, the family is there and this is their only opportunity to visit and will be leaving soon etc., looking for myself will take a backseat.

In my experience, most people do understand. The ones who do not are confused and/or resistant in general, not just to skin assessments. And if they do refuse to have their skin fully assessed, you can chart that and chart what you were able to see. Pt refuses assessment of posterior surface of body, skin on anterior surface pink, dry and intact, no drainage noted on bedsheets when pt OOB etc. etc.