Skin, clammy
Clammy skin — moist, cool, and usually 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, pupillary dilation, or a combination of these findings. Marked bradycardia and syncope may follow.
History
Ask the patient if he has a history of type 1 diabetes mellitus or a cardiac disorder. Is the patient taking any medications, especially 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 assessment
Take vital signs and perform a cardiovascular assessment. Then proceed with the remainder of a complete physical assessment. Be sure to examine the pupils for dilation. Also, check for abdominal distention and increased muscle tension.
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.
Cardiac arrhythmias
Cardiac arrhythmias may produce generalized cool, clammy skin along with mental status changes, dizziness, and hypotension. The pulse rate may be rapid, slow, or irregular. The patient may report palpitations, chest pain, diaphoresis, light-headedness, and weakness.
Cardiogenic shock
With cardiogenic shock, generalized cool, moist, pale skin accompanies confusion, restlessness, hypotension, tachycardia, tachypnea, narrowing pulse pressure, cyanosis, and oliguria. Associated signs and symptoms include anginal pain, dyspnea, jugular vein distention, ventricular gallop, and a weak, rapid pulse.
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, and hypotension.
Hypoglycemia (acute)
With acute hypoglycemia, 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 hypovolemic shock, generalized pale, cold, clammy skin accompanies subnormal body temperature, hypotension with narrowing pulse pressure, tachycardia, tachypnea, and rapid, thready pulse. Other findings are flat neck veins, increased capillary refill time, decreased urine output, confusion, and decreased level of consciousness.
Septic shock
The cold shock stage of septic shock causes generalized cold, clammy skin. Associated findings include rapid and thready pulse, severe hypotension, persistent oliguria or anuria, and respiratory failure.
Special 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.
Pediatric pointers
Infants in shock don’t have clammy skin because of their immature sweat glands.
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.
Patient counseling
Because the patient with cool, clammy skin may be acutely ill, provide emotional support to him and his family. Explain what’s happening using short, simple sentences. Orient them to the intensive care unit, if applicable, explaining the equipment and the unit’s routines.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Numbness
Read excerpts from these other book chapters related to Numbness:
Medical Books Excerpts
- Analgesia
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Analgesia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Paresthesia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Skin, clammy
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Analgesia
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Skin, clammy
- "Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series" (2007)
- [ read ]
- Paresthesia
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Analgesia
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2008 Williams & Wilkins.
More About Causes of Numbness
» Next page: Vision Disturbances (The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Rate This Website
What do you think about the features of this website?
Take our user survey and have your say:
Website User Survey
Medical Tools & Articles:
Next articles:
Tools & Services:
Medical Articles:
Forums & Message Boards
- Ask or answer a question at the Boards:
