Checking the Skin for Risk Factors

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It is important to look for risk factors that can lead to skin problems such as pressure ulcers.

These risk factors are listed below.

Risk Factors

  • Pressure
  • Shear/friction
  • Too much moisture
  • Dryness
  • Nutrition

Skin that remains under pressure may develop pressure ulcers in as little as 2 hours. In particular, a bone that pushes against the skin (bony prominence) is more likely to cause injury. Continuous pressure on any soft parts of the body (tissue) may lead to the development of pressure ulcers as well.1

Shear and friction contribute to the formation of pressure ulcers.2, 3

Shear is the result of gravity pulling tissue in one direction while friction keeps the skin still or causes it to go in the opposite direction. 3

Shear often occurs when the head of the bed is in an upright position. Friction may be caused when the skin is dragged across a rough surface such as bed linens.2

Extra moisture on the skin may be the result of incontinence (from urine or feces). It can also come from fluid that comes out of a wound, as well as sweat.2, 4 Although this moisture on the skin does not directly cause pressure ulcers, it softens (macerates) the skin, making it much easier for damage to occur from friction or shear.2

When skin loses its moisture, it becomes dry, flaky, and less flexible. Ulcers are more likely to develop in dry skin. 2

Poor nutrition may contribute to the development of pressure ulcers. 2 Making sure patients maintain a proper diet may help prevent them.

Other Sources

In addition to the factors listed above, there are others that may put a patient at risk for the development of pressure ulcers5 Some of these can be determined by using special scales. The ones used most often by health care professionals are called the Braden and Norton scales. The Braden and Norton scales can also identify risk factors such as a patient's ability to move around (mobility) or feel pain (sensory perception), which may also have an impact on how ulcers develop.6

  1. Revis DR, Caffee HH. Pressure ulcers, nonsurgical treatment and principles. February 14, 2006. eMedicine Web site. http://www.emedicine.com. Accessed October 15, 2007.
  2. Moreau D, ed dir; Philadelphia Publishing Company Staff, eds. Wound Care Made Incredibly Easy. Philadelphia, Pa: Lippincott Williams & Wilkins; 2003:14-229.
  3. CMS Manual System Pub 100-07: State Operations Provider Certification. Transmittal 4. November 12, 2004. Centers for Medicare & Medicaid Services Web site. http://www.cms.hhs.gov. Accessed October 15, 2007.
  4. Gray M, Ratliff C, Donovan A. Perineal skin care for the incontinent patient. Adv Skin Wound Care. 2002 Jul/Aug;15[4]:170-178.
  5. Clinical Practice Guideline Number 15: Treatment of Pressure Ulcers. Rockville, Md: US Dept of Health and Human Services, Agency for Health Care Policy and Research; 1994. AHCPR publication 95-0652.
  6. Clinical Practice Guideline Number 3: Pressure Ulcers in Adults: Prediction and Prevention. Rockville, Md: US Dept of Health and Human Services, Agency for Health Care Policy and Research; 1992. AHCPR publication 92-0047.

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