Skin turgor, decreased

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, and then slowly returns to its normal contour. Skin turgor is commonly assessed over the hand, arm, or sternum — areas normally free from wrinkles and with wide variations in tissue thickness. (See Evaluating skin turgor, page 570.)

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 (LOC) 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. Also, check his jugular veins for flatness, and monitor his urine output.

Medical causes

Cholera

Cholera 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, a dry and furrowed tongue, increased thirst, weight loss, oliguria, a 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, obese people, and people who have rapidly lost a large amount of weight.

To prevent skin breakdown in a dehydrated patient with poor skin turgor, a decreased LOC, and impaired peripheral circulation, turn him every 2 hours, and frequently massage his back and pressure points. Monitor his intake and output, administer I.V. fluids, 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. Also, 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 also be carefully evaluated.

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Book Source Details

• Book Title: Handbook of Signs & Symptoms (Third Edition)
• Author(s): Springhouse
• Year of Publication: 2006
• Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.

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Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Handbook of Signs & Symptoms (Third Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-402-1

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