Goals for newborn with impaired skin integrity

[RN2BMU2009]

I have a problem...My care plan from last week was so horrible but my instructor gave me a second chance to redeem myself. My second nursing diagnoses was impaired skin integrity r/t inflammation of the skin for a newborn (2day old) infant with erythema toxicum; a harmless rash that appears on some infants right after birth. It's unexplainable, harmless and warrants no medical attention. My question is that since it's harmless would the skin integrity even be considered impaired? There is nothing that can be done about it, no meds, the baby is not in any discomfort, no comfort measures, no pain assessment or interventions are even needed. Because this is the case would I even have any goals or outcome criteria or should I be looking for the next suitable nursing diagnoses?

[SuesquatchRN, BSN, RN]

Impaired skin integrity means there is a break in the skin. The baby doesn't have that.

[justme1972]

Impaired skin integrity means there is a break in the skin. The baby doesn't have that.

Pain assessments should be done on all newborns, just like adults. In the well-baby nursery we did this on every infant, every shift. A neonate can also be born with a defect not obvious at birth, but will show signs of pain that warrent further investigation.

It's called a Neonatal Infant Pain Scale (NIPS).

Here is the link....

http://www.anes.ucla.edu/pain/assessment_tool-nips.htm

[SuesquatchRN, BSN, RN]

Yes, I know, but what does that have to do with a diagnosis of impaired skin integrity?

[justme1972]

Yes, I know, but what does that have to do with a diagnosis of impaired skin integrity?

:chuckle Absolutely Nothing...I accidently copied your post...my mistake.

[SuesquatchRN, BSN, RN]

Oops.

I was seriously confuzzled.

[Daytonite, BSN, RN]

as i recall, i suggested that your diagnosis for that baby be written as impaired skin integrity related to genetic defect and immunologic response aeb [the symptoms]. the articles i found for you indicated that erythema toxicum is primarily felt to be an immunologic response. and, yes, it is impaired skin because it has altered the dermis and epidermis in some way as per the definition of this diagnosis. if you don't want to go with impaired skin integrity, why not deficient knowledge, skin care?

• http://kidshealth.org/parent/infections/skin/erythema_toxicum.html
  
• http://www.texaschildrenspediatrics.org/healthlibrary/pa_newbskin_hhg.aspx - newborn skin care
  
• http://www.chkd.org/healthlibrary/content.aspx?pageid=p02628 - bathing and skin care (newborn)

goals and outcomes apply to the predicted results of interventions. even though you have a harmless rash, skin care still needs to be done, doesn't it? if the mother says, "what do i do about this rash (the erythema toxicum)?" that is certainly a nursing problem. how do you want to classify that: impaired skin integrity or deficient knowledge? how do you then solve the problem? by giving teaching interventions on skin care. if the literature tells you that there is nothing to be done for this condition, then normal skin care is what should be done.

what is being done for the cord care?