May be related to
Thin skin, fragile capillaries near the skin surface (prematurity)
Inability to changepositions to relieve pressure points, use of restraints (protecting invasive lines/tubes)
Possibly Evidenced by
presence of signs/symptoms establishes an actual diagnosis
RISK FOR IMPAIRED SKIN INTEGRIGTY
The neonate will
Maintain intact skin
Be free of dermal injury.
Inspect skin every shift. Describe and document skin condition, and report changes. These measures provide evidence of the effectiveness of the skin care regimen.
Provide mouth care using saline or glycerin swabs. Apply petroleum jelly to lips.
Bathe infant using sterile water and mild soap. Wash only grossly soiled body parts. Minimize manipulation of infant’s skin
[After 4 days, skin develops some bactericidal properties because of acid pH. Frequent bathing using alkaline soaps or moisturizers may raise skin pH, compromising normal flora and natural defense mechanisms that protect against invading pathogens.]
Change electrodes only when necessary.
Baby T experienced no skin breakdown and maintained adequate skin circulation.