The nurse is caring for a patient with potential skin breakdown.Which components would the nurse include in the skin assessment? (Select all that apply. )

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Assessment of the skin includes both visual and tactile inspection.The nurse assesses for hyperemia and abnormal reactive hyperemia (when the skin turns red after an obstruction of blood flow returns and vasodilatation causes the tissue to turn red).The nurse also assesses for indurated (hardened)areas on the skin and palpates reddened areas for blanching.Changes in temperature can indicate changes in blood flow to that area of the skin.Mobility and nutritional status are certainly part of the overall assessment for pressure injury risk but are not part of the actual skin assessment.

The Nurse Is Caring for a Patient with Potential Skin