Skin turgor, decreased
Skin turgor, decreased: Excerpt from Professional Guide to Signs & Symptoms (Fifth Edition)
Skin turgor—the skin’s elasticity—is determined by observing the time required for the skin to return to its normal position after being stretched or pinched. With decreased turgor, pinched skin “holds” for up to 30 seconds, then slowly returns to its normal contour. Skin turgor is commonly assessed over the hand, arm or sternum, areas normally free from wrinkles and wide variations in tissue thickness. (See Evaluating skin turgor.)
Decreased skin turgor results from dehydration, or volume depletion, which moves interstitial fluid into the vascular bed to maintain circulating blood volume, leading to slackness in the skin’s dermal layer. It’s a normal finding in elderly patients and in people who have lost weight rapidly; it also occurs with disorders affecting the GI, renal, endocrine, and other systems.
History and physical examination
If your examination reveals decreased skin turgor, ask the patient about food and fluid intake and fluid loss. Has he recently experienced prolonged fluid loss from vomiting, diarrhea, draining wounds, or increased urination? Has he recently had a fever with sweating? Is the patient taking a diuretic? If so, how often? Does he frequently use alcohol?
Next, take the patient’s vital signs. Note if his systolic blood pressure is abnormally low (90 mm Hg or less) when he’s in a supine position, if it drops 15 to 20 mm Hg or more when he stands, or if his pulse increases by 10 beats/minute when he sits or stands. If you detect these signs of orthostatic hypotension or resting tachycardia, start an I.V. line for fluids.
Evaluate the patient’s level of consciousness for confusion, disorientation, and signs of profound dehydration. Inspect his oral mucosa, the furrows of his tongue (especially under the tongue), and his axillae for dryness. Check his neck veins for flatness and monitor his urine output.
Medical causes
Cholera
This infection is characterized by abrupt watery diarrhea and vomiting, which leads to severe water and electrolyte loss. These imbalances cause the following symptoms: decreased skin turgor, thirst, weakness, muscle cramps, oliguria, tachycardia, and hypotension. Without treatment, death can occur within hours.
Dehydration
Decreased skin turgor commonly occurs with moderate to severe dehydration. Associated findings include dry oral mucosa, decreased perspiration, resting tachycardia, orthostatic hypotension, dry and furrowed tongue, increased thirst, weight loss, oliguria, fever, and fatigue. As dehydration worsens, other findings include enophthalmos, lethargy, weakness, confusion, delirium or obtundation, anuria, and shock. Hypotension persists even when the patient lies down.
Special considerations
Even a small deficit in body fluid may be critical in patients with diminished total body fluid—young children, elderly people, the obese, and people who have rapidly lost a large amount of weight.
To prevent skin breakdown in a dehydrated patient with poor skin turgor, decreased level of consciousness, and impaired peripheral circulation, turn the patient every 2 hours, and frequently massage his back and pressure points. Monitor his intake and output, administer I.V. fluid replacement, and frequently offer oral fluids. Weigh the patient daily at the same time on the same scale. Be alert for urine output that falls below 30 ml/hour and for continued weight loss. Closely monitor the patient for signs of electrolyte imbalance.
Pediatric pointers
Diarrhea secondary to gastroenteritis is the most common cause of dehydration in children, especially up to age 2.
Geriatric pointers
Because it’s a natural part of the aging process, decreased skin turgor may be an unreliable physical finding in elderly patients. Other signs of volume depletion—such as dry oral mucosa, dry axillae, decreased urine output, or hypotension—must be carefully evaluated.
Patient counseling
Advise patients who experience fluid loss (for example, from vomiting or diarrhea) to drink enough fluids to replace their losses. Tell them to drink at least one glass of water (or, preferably, a beverage with higher electrolyte content such as a sports drink) after each loose bowel movement or episode of vomiting, to avoid dehydration. If the patient can’t keep fluids down because of persistent vomiting, he may need an antiemetic or I.V. fluid replacement.
Pictures
Book Source Details
- Book Title: Professional Guide to Signs & Symptoms (Fifth Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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