Skin, clammy

Skin, clammy: Excerpt from Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series

Clammy skin — moist, cool, and commonly pale — is a sympathetic response to stress, which triggers release of the hormones epinephrine and norepinephrine. These hormones cause cutaneous vasoconstriction and secretion of cold sweat from eccrine glands, particularly on the palms, forehead, and soles.

Clammy skin typically accompanies shock, acute hypoglycemia, anxiety reactions, arrhythmias, and heat exhaustion. It also occurs as a vasovagal reaction to severe pain associated with nausea, anorexia, epigastric distress, hyperpnea, tachypnea, weakness, confusion, tachycardia, and pupillary dilation or a combination of these findings. Marked bradycardia and syncope may follow.

Act Now: Clammy skin commonly accompanies emergency conditions, such as shock, acute hypoglycemia, and arrhythmias. (See Clammy skin: A key finding, page 274.)

Assessment

History

If the patient’s condition permits, obtain his medical history. Does he have type 1 diabetes mellitus or a cardiac disorder? Is he taking medication? If so, determine whether he takes an antiarrhythmic. Is he experiencing pain, chest pressure, nausea, or epigastric distress? Does he feel weak? Does he have a dry mouth? Does he have diarrhea or increased urination? 

Physical examination

Check the patient’s vital signs. Perform a complete cardiovascular assessment, followed by a physical assessment. Check the patient’s blood glucose level. Next, examine the pupils for dilation. Also, check for abdominal distention and increased muscle tension.

Pediatric pointers

Be aware that absence of clammy skin doesn’t rule out shock in infants. Clammy skin doesn’t occur in infants younger than 12 months because their sweat glands aren’t yet fully developed.

Geriatric pointers

Elderly patients develop clammy skin easily because of decreased tissue perfusion. Always consider bowel ischemia in the differential diagnosis of older patients who present with cool, clammy skin — especially if abdominal pain or bloody stools occur.

Medical causes

Anxiety

An acute anxiety attack commonly produces cold, clammy skin on the forehead, palms, and soles. Other features include pallor, dry mouth, tachycardia or bradycardia, palpitations, and hypertension or hypotension. The patient may also develop tremors, breathlessness, headache, muscle tension, nausea, vomiting, abdominal distention, diarrhea, increased urination, and sharp chest pain.

Arrhythmias

Cardiac arrhythmias may produce generalized cool, clammy skin along with mental status changes, dizziness, and hypotension.

Cardiogenic shock

Generalized cool, moist, pale skin accompanies confusion, restlessness, hypotension, tachycardia, tachypnea, narrowing pulse pressure, cyanosis, and oliguria.

Heat exhaustion

In the acute stage of heat exhaustion, generalized cold, clammy skin accompanies an ashen appearance, headache, confusion, syncope, giddiness and, possibly, a subnormal temperature, with mild heat exhaustion. The patient may exhibit a rapid and thready pulse, nausea, vomiting, tachypnea, oliguria, thirst, muscle cramps, hypotension, blurred vision, and loss of consciousness.

Hypoglycemia (acute)

Generalized cool, clammy skin or diaphoresis may accompany irritability, tremors, palpitations, hunger, headache, tachycardia, and anxiety. Central nervous system disturbances include blurred vision, diplopia, confusion, motor weakness, hemiplegia, and coma. These signs and symptoms typically resolve after the patient is given glucose.

Hypovolemic shock

With this common form of shock, generalized pale, cold, clammy skin accompanies subnormal body temperature, hypotension with narrowing pulse pressure, tachycardia, tachypnea, and a rapid, thready pulse. Other findings are flat neck veins, increased capillary refill time, decreased urine output, confusion, and a decreased level of consciousness.

Septic shock

The cold shock stage causes generalized cold, clammy skin. Associated findings include a rapid and thready pulse, severe hypotension, persistent oliguria or anuria, and respiratory failure.

Nursing considerations

Take the patient’s vital signs frequently and monitor urine output. If clammy skin occurs with an anxiety reaction or pain, offer the patient emotional support, administer pain medication, and provide a quiet environment.

Patient teaching

If an underlying illness is related to the patient’s clammy skin, provide information on the condition. If the condition is related to an alteration in the patient’s blood glucose level, provide information on management of hypoglycemia and early signs of a falling blood glucose level. Provide information on the importance of nutrition and hydration.

Pictures

Book Source Details

• Book Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series
• Author(s): Springhouse
• Year of Publication: 2007
• Copyright Details: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-58255-624-5

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