NCLEX Review Guide: Risk Factors for Integumentary Problems

Age-Related Changes

• Decreased collagen and elastin production leads to thinner, more fragile skin that tears easily and heals slowly.
• Sebaceous gland activity reduction results in dry skin and increased susceptibility to cracking and infection.
• Decreased subcutaneous fat provides less protection against pressure and temperature extremes.

Chronic Medical Conditions

• Diabetes mellitus causes poor circulation, neuropathy, and delayed wound healing due to hyperglycemia.
• Peripheral vascular disease reduces oxygen and nutrient delivery to skin tissues, increasing ulcer risk.
• Immunocompromised states (HIV, cancer, steroids) decrease the body's ability to fight skin infections and heal wounds.

Environmental and Lifestyle Factors

• Prolonged sun exposure causes photoaging, increases skin cancer risk, and damages cellular DNA.
• Smoking reduces tissue oxygenation and impairs wound healing by vasoconstriction.
• Poor nutrition, especially protein and vitamin C deficiency, compromises skin integrity and repair mechanisms.
• Excessive alcohol consumption leads to dehydration and nutrient malabsorption affecting skin health.

Physical Trauma and Pressure

• Pressure ulcers develop from prolonged pressure exceeding capillary pressure (32 mmHg).
• Friction and shearing forces during repositioning can cause skin breakdown in vulnerable patients.
• Moisture from incontinence creates maceration and increases infection risk.

1. Remember that multiple risk factors are cumulative - patients rarely have just one risk factor
2. Focus on modifiable vs. non-modifiable factors when planning interventions
3. Prioritize prevention strategies based on the patient's highest risk factors
4. Always assess skin integrity on admission and regularly thereafter

Self-Assessment:

• ☐ Can you identify at least 5 intrinsic risk factors?
• ☐ Can you explain why diabetes increases skin breakdown risk?
• ☐ Do you understand the difference between friction and pressure?
• ☐ Can you prioritize interventions based on risk factors?