Skin

A comprehensive skin assessment establishes a baseline and detects change. It is not limited to finding an open wound. Skin colour, integrity, temperature, moisture, turgor, lesions, pressure areas, and the client's symptoms must be considered together because a single observation can be misleading. Pressure, shear, moisture, impaired circulation, inflammation, infection, and medication effects can all alter the skin. Sustained pressure compresses small blood vessels; tissue then receives less oxygen and may become damaged before an ulcer is visible. Moisture softens the outer layer and increases friction, making this damage more likely. These mechanisms explain why pain, firmness, warmth, or a persistent colour change may be clinically significant even when the skin is still intact. An RPN may perform a comprehensive skin assessment, including inspection, palpation, and use of a validated risk-assessment tool, without a medical order when the activity is within regulated scope, individual competence, and employer policy. An order or additional authorisation may still be required for a treatment, diagnostic test, or intervention outside that scope. When findings exceed the nurse's authority or competence, the safe response is to...