Thanks! A Braden Skin Assessment should be completed by the nurse with every new admission, though some facilities require it on every shift. Observe the patients eating environment. Read More Activity Intolerance Nursing Diagnosis & Care PlanContinue, 2022 RNlessons | Disclaimer |Terms & Conditions, Imbalanced Nutrition: More Than Body Requirements [Nursing Care Plan], Readiness for Enhanced Nutrition Nursing Diagnosis & Care Plan, Ineffective Breathing Pattern Nursing Diagnosis & Care Plan, Mechanical forces (friction, shear, pressure), Expresses feelings of pain at the affected area, States noticing oozing and drainage from the affected site, Expresses frustration about lack of resources and knowledge to care for the wound, Tissue damage (integumentary, mucous membranes, corneal, subcutaneous tissue), Changes in the appearance of the affected area (redness, swelling, hot and tender to touch), The patient will maintain an intact tissue integrity, The patient will verbalize a plan of care to maintain uncompromised tissue integrity, The patient will experience an improved wound healing process, The patient will verbalize and demonstrate wound care correctly. Use an aseptic technique in changing wound dressings.Aseptic technique can reduce the risk of contamination and infection in the patients diabetic foot ulcer. She earned her BSN at Western Governors University. Edema and bruising. Read More Readiness for Enhanced Nutrition Nursing Diagnosis & Care PlanContinue. Dehydration can cause further skin injury due to skin dryness. This increases blood flow to the skin, which brightens the complexion. Saunders comprehensive review for the NCLEX-RN examination. The diet should be rich in nutrients such as carbs, fats, proteins, minerals, and vitamins. Encourage proper hydration. Baseline data will help in the evaluation of progress after interventions are made. Patients with diabetic foot ulcers may experience impaired physical mobility from their wound or amputation. 1. Read More Ineffective Breathing Pattern Nursing Diagnosis & Care PlanContinue. Vitamin deficits are also caused by malnutrition. Take note of the following: capillary refill (CRT), mucous membranes, and skin turgor. Dependent:-Apply topical lubricants (steroid creams or ointments) immediately after bathing as . Patient's skin will be free from complications of immobility by 10/01/2021 at 1500 as evidenced by: Edited to add: pain is always a hit with the nursing instructors. Our website services and content are for informational purposes only. Nursing Diagnosis: Impaired skin integrity (pressure ulcers) secondary to decreased mobility as evidenced by presence of stage 2 pressure ulcer on the sacrum. An expert may provide the patient with specialized apparatus to assist him/her in self-feeding. Redness and open areas to the skin put the patient at risk for infection such as. Knowing the why behind the patients motivation allows healthcare staff to personalize the care plan further. Suspected Deep tissue injury: - Skin is intact; appears purple or maroon. Assist him/her in employing techniques to prevent vomiting. Assess for edema. This is followed by the application of the prescribed antibiotic cream or ointment directly to the affected areas. X-rays, bone scans, and arterial doppler with ankle brachial index may also be performed to determine and rule out underlying fractures, osteomyelitis, and peripheral vascular disease. Encourage the patient on skin care.The patient should keep their skin moisturized, clean, and dry to prevent breakdown. Evaluating this information may help identify the need for further intervention. These challenges hinder food preparation. In order to aid patients and healthcare practitioners in diagnosing and treating nutritional deficiencies, it is necessary to understand the signs and symptoms of malnutrition. Inadequate dietary consumption. You guys gave me just the push I needed. An albumin level greater than 2.5 g/100 ml is a grave sign, indicating severe protein depletion. sharing sensitive information, make sure youre on a federal Most individuals choose quick, low-nutrient meals such as fast food in order to accommodate their busy schedules. Moreover, early detection of these symptoms is critical in determining whether or not the patient is suffering from another condition. Intake of high protein foods and supplements is essential for repairing body tissues. Her experience spans almost 30 years in nursing, starting as an LVN in 1993. Since neuropathy occurs due to uncontrolled (high) blood glucose, it is imperative to keep glucose levels normal to prevent worsening neuropathy. The importance of skin care and assessment. Measurements of wounds should occur at least weekly to monitor for progress. Assess the patients prospects for fatigue alleviation. . 4. Ascertain that the patient is receiving enough intake of nutrition to meet his/her metabolic demands. Patient will maintain intact skin as evidenced by: no redness over bony prominences, and capillary refill less than 6 seconds over areas of redness. Patients with type 2 diabetes frequently have impaired skin integrity caused by a stage 3 heel ulcer. traction, restraints, casts, or other devices and evaluate the skin and tissue integrity: Mechanical injury to the skin and tissues by . Eating is less likely to be used as a coping method for emotional distress. Nursing Diagnosis: Impaired Physical Mobility. When patients have short-term objectives that he/she can achieve, they become more engaged in the process of recovery. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. Once the subcutaneous tissue is involved, impaired tissue integrity is the diagnosis that needs to be used. Clean and dress bedsore as needed. On the other hand, diagnosing vitamin deficiencies caused by overnutrition might be more challenging. Proper intake of fluids increases oxygen and nutrient delivery to the wound bed by increasing the blood volume. Risk for impaired skin integrity related to limited physical mobility as evidenced by weakness in client's right side, inability to ambulate or turn himself in bed, and area of blanchable erythema on client's right hip. Vitamin A deficiency is associated with dry eyes and an increased risk of infection. impaired Skin/Tissue Integrity may be related to infectious lesions, possibly evidenced by disruption of skin surfaces and mucous membranes. doi: 10.1097/GOX.0000000000004513. Step-by-step explanation. Common causes of friction include the patient rubbing heels or elbows against bed linen and moving the patient up in bed without the use of a lift sheet. Monitor the glucose level frequently and keep it within a tight range. Use less pressure and massage the skin lightly, especially around the bony prominences. Boney prominences such as hips, knees, heels, and elbows should be supported with pillows or devices to allow for proper skin perfusion. Her nursing career has led her through many different specialties including inpatient acute care, hospice, home health, case management, travel nursing, and telehealth, but her passion lies in educating through writing for other healthcare professionals and the general public. Unique Variation of Barber's Disease: A Case Report. Risk Factors: unsteady gait, BP, generalized weakness. - Skin is intact but red and non-blanchable. Our website services and content are for informational purposes only. Proper measuring of the adhesive wafer and fitting of the pouch system will help with sealing around the stoma to prevent leakage and peristomal skin irritation. Patient will exhibit no signs of infection. This includes tailoring an individualized dietary plan, consumption of meals that is rich in nutrients (e.g., fruits and vegetables), Tube feedings. St. Louis, MO: Elsevier. Advise the patient to avoid walking in bare feet.The patient should wear footwear at all times. Saunders comprehensive review for the NCLEX-RN examination. and transmitted securely. St. Louis, MO: Elsevier. In order to maintain enough energy reserves, the patient will require a nutritionally balanced diet. Protein deficiency may result from a low nitrogen balance, necessitating further intervention. Consult a dietician for an in-depth review of the patients nutritional state and available nutritional support. Impaired skin integrity is only used for wounds that only go as deep as the epidermis and heal in a week. Seasoning may enhance the flavor of meals and make them more appealing to eat. National Library of Medicine Encourage physical activity for over-nourished individuals. Encourage the patient and family members to participate in care.Motivation and assistance by family members may be necessary to assist the patient with movement and repositioning expectations. Read More Risk for Infection Nursing Diagnosis & Care PlanContinue. Lots of older, experienced nurses that I work with don't really care too much about pain and it bothers me. Remind the patient to inspect the feet daily.Patients with neuropathy or peripheral vascular disease may not be able to feel when they have cut their skin. Assess the level of edema on the legs and cut on the ankle. Foot ulcers are frequent sites of delayed healing and risk becoming infected. Patients who are malnourished tend to have dry, thick skin that is easily bruised; therefore, moisturization is necessary to keep the skins integrity and, as a result, limit the likelihood of infection from occurring. The skin is a waterproof, flexible organ that covers the human body. Instead of showering daily, suggest bathing on alternate days. Assess the patients wound.The color, odor, visibility of bones, and the presence of necrosis must be assessed to determine an appropriate plan of care for the patients condition. Specializes in Med nurse in med-surg., float, HH, and PDN. Ulcers most commonly occur on the plantar surface of the foot, including the heel and tips of hammer toes. Assess the extent of skin impairment.Pressure ulcers can be classified as partial thickness, stage 1-4, or unstageable. Evidence-based nursing intervention to reduce skin integrity impairment in children with diaper dermatitis: A systematic review . Check for physical signs of malnutrition. Evaluate his/her willingness to participate in fatigue-reduction activities and the patients level of support they receive from family and friends. Nursing Care Plan 1. 2003 Jun;49(6):27-8, 30, 33 passim, contd. 1-612-816-8773. Silk Fibroin Biomaterials and Their Beneficial Role in Skin Wound Healing. Alteration/Impairment in Skin Integrity. The patient is scored on six categories:Sensory perception,Moisture, Activity, Mobility, Nutrition, Friction and Shear. An elevated white blood count also signals an infection. Skin is affected by both intrinsic and extrinsic factors. :), I really have no idea about how to classify a woundwe haven't done anything like that. Encourage mobility Physical activity helps promote circulation and fluid drainage. Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). She takes the topics that the students are learning and expands on them to try to help with their understanding of the nursing process and help nursing students pass the NCLEX exams. Observed wound and skin breakdown requires accurate documentation in order to monitor the healing and effectiveness of interventions. Physiotherapists can help assess mobility and advise on positioning and mobility aids. 2023. Disclaimer. To provide baseline data to assess care. Related to: As evidenced by: immobility, imbalanced nutritional state, mechanical factors (friction, pressure, shear), moisture . If the infection is mild and have not spread to other areas of the body, the sores can be treated through the use of over-the-counter antibiotic cream containing bacitracin, as a home remedy. 3. Patients who cannot reposition themselves should be turned in bed on a schedule at least every 2 hours. She received her RN license in 1997. Similarly, overnutrition can be combated in large part through regular physical activity. Radiated skin becomes thin and friable, may have less blood supply, and is at higher risk for breakdown. Healthy skin varies from individual to individual, but should have good turgor (an indication of moisture), feel warm and dry to the touch, be free of impairment, and have quick capillary refill (less than 6 seconds). Maintaining a healthy balance in dietary and fluid consumption will help to improve the state of the patients skin. The patient will be able to identify the source of his/her exhaustion and the areas in which he/she has control. Educate on proper fitting and emptying of the ostomy pouch. This ensures the continuation of the program. Nursing care plans: Diagnoses, interventions, & outcomes. Assess skin turgor, sensation, and circulation. Ensure that the patient finishes the course of antibiotic prescribed by the physician. 2005 Dec 8-2006 Jan 11;14(22):1172-6. doi: 10.12968/bjon.2005.14.22.20167. impaired skin integrity nanda nursing diagnosis list, nursing diagnosis and planning related to movement and, impaired skin integrity nursing diagnosis and nursing, appendix individualized a care plans fully developed, nursing interventions and rationales impaired physical, ncp nursing diagnosis risk for Stumped on Nursing Diagnosis for Episiotomy. - Lippincott 2012-09-26 The new edition of Nursing Care Planning Made Incredibly Easy is the resource every student needs to master the art of care planning, including concept mapping. It involves extensive and complete removal of dead tissue even beyond the area of necrosis. These techniques will encourage patients to take an active role in developing, implementing, and evaluating their own treatment plans for fatigue relief. It may be necessary to limit spicy foods, alcohol, and high-fiber foods which can cause, Encourage use of pastes/powders to prevent irritation. Why Do Nursing Students Fail Nursing Program? Administer antibiotics.Severely infected diabetic foot ulcers may require inpatient hospitalization and IV antibiotics. The patient will maintain a healthy weight, as demonstrated by steady or improved albumin levels. Has 8 years experience. The twenty-first century clinician has several online, evidence-based tools to assist with optimal treatment plans. At some point, the bodys metabolism slows down when it reaches a state known as a plateau. This is produced by the body activating a survival mechanism in an attempt to avoid starvation. In order to maintain weight loss in the face of these changes, it is necessary to devise a new plan that is both vigorous and consistent. Biomolecules. Regularly assess condition for bedsores. Change sheets regularly and avoid folds and creases. Obese people who eat largely processed meals may be deficient in nutrients, vitamins, and minerals. Neurogenic Shock Nursing Diagnosis & Care Plan, The use of chemical irritants that may be present in regular household items such as soaps and hair dye, Very young and very old individuals extremes in age are associated to frail and sensitive skin, Mechanical factors such as pressure, shear, and friction, Trauma such as scratches, skin tear, surgical incision. . Nursing Diagnosis: Impaired Skin Integrity. The patient will demonstrate normal skin turgor. Assist with debridement.Wounds with necrotic tissue or nonviable tissue must be removed to allow for treatment and healing. Unauthorized use of these marks is strictly prohibited. A low-residue diet is often prescribed initially as the bowel heals. The doctor may also prescribe oral antibiotic drugs in patients who have a lot of impetigo sores. Nursing Diagnosis Impaired skin integrity related to pressure over bony prominences and secondary to moisture from bodily secretions as evidenced by superficial ulcerations on patients right ischium, both elbows, both heels, and sacrum. I always got big red Xs on my concept maps whenever I tried to use pain because the instructors say its redundant and that I'm being lazy. He/she could also substitute fluid in place of calories, which in turn disrupts the fluid balance in the body. Evidenced by bilateral swelling of the legs and feet and a small cut on the left ankle. Iron deficiency causes impaired cognitive function, trouble controlling body temperature, and stomach problems. A brief description of these causes is provided in the following. Purulent drainage may be cultured. An official website of the United States government. Elderly, especially those who live alone or are disabled. New stoma creation requires assessment and education from a wound care/ostomy specialist to ensure the stoma is healing properly and the correct ostomy supplies are being used to fit the stoma correctly. Tight clothing can further irritate skin damage and rashes. Assess the vital signs of the patient. The .gov means its official. Nursing Diagnosis: Risk for Impaired Skin Integrity related to loss of subcutaneous fat, secondary to malnutrition, as evidenced by inadequate dietary intake, anorexia, nausea, vomiting, and difficulty to absorb nutrients. To establish baseline observations and check the progress of the infection as the patient receives medical treatment. Clean or assist patient in cleaning himself after opening bowels. Patients who are unable to ask for assistance to use the bathroom or are incontinent need frequent monitoring to keep skin dry and clean. Providing pain relief will help encourage patients to mobilize and change position. The lower the score, the higher the risk of tissue injury. Maegan Wagner is a registered nurse with over 10 years of healthcare experience. Assess patient's nutritional status, including weight, weight loss, and serum albumin levels. Overall, the most effective treatment options may be contingent on identifying the source of malnutrition. On the other hand, Marasmus is a disorder caused by a severe calorie deficit resulting in wasting and considerable fat and muscle mass loss. Increase tissue perfusion by massaging around affected area. Certain types of malnutrition are more common in some groups than others due to factors such as lifestyle, geography, and access to food. Leaving them intact maintains the skin's natural function as barrier to pathogens while the impaired area below the blister heals. Monitor for signs of infection such as redness, swelling, or drainage. 2022 Sep 16;10(9):e4513. Experts (e.g., nutritionists) can use nitrogen balance to measure the patients nutritional state. Assess vital signs and monitor the signs of infection. Specializes in 5 yrs OR, ASU Pre-Op 2 yr. ER. 5. Buy on Amazon, Silvestri, L. A. This is done to avoid overnutrition. Please read our disclaimer. By lending the patient a helping hand, dehydration or continuous fluid loss may be prevented. He has impaired skin integrity, as shown by the presence of a superficial rash, impaired tissue integrity that can be seen in a wound on his right leg, an imbalanced diet, and ineffective health maintenance. Along with a turning schedule, patients should be assessed for any bodily secretions. A prosthetist is trained to work with those with disabilities and instruct on the wear and use of the prosthetic for optimal mobility. The patient can wear slippers indoors. This is critical since it will determine the additional information required. Observed wounds should be monitored to ensure dressings are intact or that skin breakdown is not worsening, such as increased redness. Patients who may have adequate mobility but are under the use of restraints are also at risk. skin being adversely altered use this guide to develop your impaired skin integrity nursing care plan the skin is the largest organ in the human body and is a protective barrier it protects the body from heat light, nursing diagnosis risk for impaired skin integrity may be related tothin skin fragile capillaries near the skin surface absence of . [Attention to the health of the skin. Make a report on the patients actual weight and not an approximation. The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. Specific symptoms distinguish some forms of undernutrition. Encourage patient to elevate legs and avoid putting them on a dependent position for a long period of time. Risk for infection. Educate the patient and caregiver about proper wound hygiene through washing the sores with soap and water. Building trust begins with listening attentively to the patients concerns and questions. NurseTogether.com does not provide medical advice, diagnosis, or treatment. Other signs and symptoms include decreased concentration, paleness, dry skin, confusion, loss of subcutaneous tissue, dullness and brittle hair, swollen tongue, etc. Otherwise, scroll down to view this completed care plan. A low-air loss mattress alternates inflating and deflating to mimic the shifting of a patient in bed which helps in repositioning and relieving pressure. Malnutrition is more likely among people who are fragile, have poor movement, or lack muscle power because of their inability to collect and prepare meals. Evaluate the patients laboratory results. The loss of sensation results in ongoing trauma, skin breakdown, and ulcer development. She found a passion in the ER and has stayed in this department for 30 years. Ensure tight glycemic control.Uncontrolled diabetes prevents wound healing from reducing oxygenation to tissues. An ineffective breathing pattern is a condition of inadequate ventilation due to an impairment in the mechanism of inspiration and expiration. Anna Curran. 1. 2. Assess the patients wound.Wound characteristics like green or yellow drainage, foul odor, and erythema are signs of an infection. The nursing process is a scientific-based method of diagnosin Despite the lack of evidence that spot reduction or mechanical gears can assist people in losing weight, certain activities or equipment may be able to tone certain body areas. Bed linens, clothing, and any use of adult diapers must be kept dry as urine, feces, and sweat are irritating to the skin. Patient recovery and prognosis can be adversely affected by fluid retention, electrolyte changes, and impaired renal function. Aspirin use may be reduced the risk of Bile duct cancer ! Desired Outcome: Patient's bedsore will show optimal healing, and further bedsores will be prevented. The https:// ensures that you are connecting to the Leave blisters intact by wrapping in gauze, or applying a hydrocolloid (Duoderm, Sween-Appeal) or a vapor-permeable membrane dressing (Op-Site, Tegaderm). Since 1997, allnurses is trusted by nurses around the globe. Diagnoses of mental illness. Our members represent more than 60 professional nursing specialties. This can also worsen childhood infections and potentially cause mortality. Extrinsic factors include falls, accidents, pressure, immobility, and surgical procedures. She found a passion in the ER and has stayed in this department for 30 years. Nursing Care Planning Made Incredibly Easy! Gardiner L et al Evidence based best practice in. Assess for history of radiation therapy. 7. Bekiaridou A, Karlafti E, Oikonomou IM, Ioannidis A, Papavramidis TS. Skin is the largest organ in our body which protects from heat, light, injury and . Preventive interventions and early management can minimize the severity of the skin reaction. document.getElementById("ak_js_1").setAttribute("value",(new Date()).getTime()); This site uses Akismet to reduce spam. The patient will exhibit intact skin or tissues with absent excoriation. To prevent prolonged pressure on one area of the body. Vitamin D Deficiency can cause rickets, a juvenile illness that causes skeletal abnormalities (soft bones) in children. https://surgery.ucsf.edu/conditionsprocedures/diabetic-foot-ulcers.aspx, https://www.ncbi.nlm.nih.gov/books/NBK537328/, https://my.clevelandclinic.org/health/diseases/17169-foot-and-toe-ulcers, https://www.healthline.com/health/diabetic-foot-pain-and-ulcers-causes-treatments, Hearing Loss Nursing Diagnosis & Care Plan, Peripheral Neuropathy Nursing Diagnosis & Care Plan. Due to the damage that this high blood sugar can do to the skin's small blood vessels and nerves . Specializes in Geriatrics/Oncology/Psych/College Health. It is important that nurses understand how to assess, prevent, treat, and educate patients on impaired skin integrity. This form of short-term memory is supported by the prefrontal cortex (PFC) and is believed to rely on the ability of selectively tuned pyramidal neuron networks to persist in firing even after a to-be-remembered stimulus is removed from the environment. Assess the patients fluid balance and determine the steps necessary to restore or maintain it. This form of malnutrition is caused by a lack of calories, protein, and micronutrients in the diet. Encourage patient to maintain short toenails. Baseline data is needed for prompt evaluation after interventions are made. Place silver-containing dressings on the affected site/s after each debridement. Healthline. Patients skin will remains intact, as evidenced by: no redness over bony prominences, and capillary refill less than 6 seconds over areas of redness. Journaling daily can help patients determine the times of day in which they are most rested. Impaired Skin Integrity related to the stage 3 ulcer on the right heel as evidenced by the presence of an open wound and the patient's medical history of Type 2 Diabetes. As needed, wound will need to be dressed and cleaned. 2) Risk assessment includes identifying whether a skin break is present or not. 2 Focus Note James is a 79-year-old male patient with a three-year history of increased glucose levels. ", I agree with Marie. Chapter 01: Professional Nursing Test Bank MULTIPLE CHOICE 1. Stage 1. Stool may contain enzymes that cause skin breakdown. Screening and Physical Examination. The development of a diabetic foot ulcer begins with a callus from neuropathy. These may include diseases such as celiac disease, Crohns disease, and systemic infection in the intestines. (adsbygoogle = window.adsbygoogle || []).push({}); Patients Diagnosis: Alcohol includes calories; thus, a chronic alcohol user may not feel hungry after drinking. When a patient is being screened for malnutrition, healthcare providers tend to check for indicators of malnutrition. Stoma following surgery should be moist and pink-red in color. Care Plan Impaired Skin Integrity Related Immobility below. A risk diagnosis is not evidenced by signs and symptoms, as the problem has not occurred yet, and nursing interventions are directed at the prevention of signs and symptoms. 1. to use this representational knowledge to guide current and future action. Undernutrition: Undernutrition is most commonly caused by a lack of sufficient nutrients in ones diet. Putting legs on dependent position will worsen leg edema. After nursing interventions, the patient is expected to: Individuals who are malnourished may suffer from the following: 5. Blisters are sterile natural dressings. Does this seem right? HHS Vulnerability Disclosure, Help allnurses is a Nursing Career & Support site for Nurses and Students. Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2008). Note: you need to indicate time frame/target as objective must be measurable. Activity intolerance is a nursing diagnosis defined by NANDA as insufficient physiological or psychological energy to continue or complete necessary or desired activities. My instructor is a stickler too! Application of non-stick bandages over the affected areas can also help prevent the spread of sores and further infection. Prepare patient for vascular treatment. The speech therapist can help the patient with their nutritional intake by adjusting meal thickness and consistency. Patients should have their skin assessed every shift. Reviewed: April 27, 2022. Pressure ulcer or injury; Skin integrity; Skin tears; Ulcers; Wounds. Writing a clear-effective nursing care plan for impaired tissue integrity can be challenging for most students and even nursed on duty. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Regular assessment of the skin is critical for those at risk for impaired skin integrity. To determine the severity of impetigo and any affected areas that require special attention or wound care. Keywords: Scales such as 1 to 10 can assist a patient in determining their level of exhaustion/fatigue. Semin Oncol Nurs. Malnutrition is a condition in which a persons diet is deficient in one or more essential nutrients. Create an alternative plan for rewarding the patient and their significant others. Elderly patients' skin is normally less elastic and has less moisture, making for higher risk of skin impairment. Heavy alcohol consumption. 3. 2.2 and 2.3 finally offers some evidence-based, probabilistic information for the patient and the physician to make 2 Timing of Intervention for Unilateral Vocal Fold Paralysis 0.15 Probability 4 months 66% 0 0 10 20 30 Weeks 40 50 60 40 50 60 Probability 0.15 6 months 86% 0 0 10 20 30 Weeks . Probiotics and Their Effect on Surgical Wound Healing: A Systematic Review and New Insights into the Role of Nanotechnology. Patient will demonstrate interventions that promote wound healing and decrease the risk of infection. Provide appropriate mattress and cushion. Plast Reconstr Surg Glob Open. Assess patient's awareness of the sensation of pressure. b. Her experience spans almost 30 years in nursing, starting as an LVN in 1993. Patients may have tachycardia and increased blood pressure reading on their vitals. Risk for impaired skin integrity. In order to help the patient identify energy drains, to establish links between different activities and fatigue levels.