NANDA-I 2024-2026 edition · Reviewed November 2, 2026 by the editorial team
Diagnosis at a glance
| Code | 00047 |
|---|---|
| Label | Risk for impaired skin integrity |
| Spanish label | Riesgo de deterioro de la integridad cutánea |
| Domain | 11. Safety / protection |
| Class | 2. Physical injury |
| Type | Risk |
| Status | Current |
What it means
It describes the chance that the outer layers of the skin (epidermis and dermis) will be injured: a crack, a blister, irritation or an erosion. The skin is healthy at the time of the assessment, and the diagnosis is there to protect what has not been damaged yet.
Explanation written by our team. The official definition is in the NANDA-I 2024-2026 book.
When to use it
Clinical situations where it commonly shows up. The diagnosis is confirmed by your assessment, not by the medical diagnosis.
- Patients with diabetes and peripheral neuropathy, to prevent foot injuries.
- Urinary or fecal incontinence, because of the risk of moisture-associated dermatitis.
- Bedbound patients or those with limited mobility, alongside the pressure injury risk assessment.
- Leg edema from heart failure or venous insufficiency.
- Fragile skin in older adults or in patients on long-term corticosteroids.
- Devices and adhesives: tubes, masks, splints, dressings.
What to assess
- Full skin inspection on admission and every shift, paying attention to bony prominences, skin folds and areas under devices.
- Moisture: incontinence, sweating, drainage; how often briefs or linens are changed.
- Skin hydration: dryness, flaking, turgor.
- Braden Scale: a score of 18 or lower indicates risk in most protocols.
- In diabetes: sensation with a 10 g monofilament, pedal pulses, nails, the spaces between the toes and the type of footwear.
- Edema: location and pitting grade.
- Nutritional status and fluid intake.
- What the patient or caregiver already knows about skin and foot care.
Risk factors
What makes the problem more likely, and what nursing can monitor or modify.
- Persistent skin moisture from incontinence, sweat or drainage.
- Dry skin from very hot baths, harsh soaps or lack of moisturizing.
- Friction and shear when moving or repositioning the patient in bed.
- Shoes or clothing that rub or are too tight.
- Inadequate foot care: not checking the feet daily, trimming nails incorrectly, walking barefoot.
- Constant pressure from not changing position.
- Inadequate fluid and protein intake.
- Pulling adhesives off too quickly.
- Insufficient knowledge of the patient or caregiver about protecting the skin.
At-risk populations
- Older adults.
- People who are bedbound or use a wheelchair.
- People with incontinence.
- Newborns, especially preterm infants.
- ICU patients.
Associated conditions
- Diabetes with peripheral neuropathy.
- Peripheral artery disease.
- Edema from heart, kidney or venous failure.
- Long-term corticosteroid therapy.
- Radiation therapy.
- Medical devices in contact with the skin.
Risk factors are the ones nursing can modify: moisture, dryness, friction, footwear, foot care. Diabetes, edema or corticosteroids are associated conditions: they raise the risk, but they are not treated with independent nursing interventions.
How to write it (PES)
Risk for impaired skin integrity related to inadequate foot care, inappropriate footwear and dry skin from insufficient moisturizing, in a patient with type 2 diabetes and peripheral neuropathy (associated condition).
There is no “as evidenced by” because the skin is intact. If a crack, blister or erosion is already present, the diagnosis becomes Impaired skin integrity (00046).
Example written by our team for a fictional patient. Adapt it to your own patient's data. Build your statement with the PES generator.
Goals / expected outcomes
Written in measurable terms: what, how much and by when.
- Skin remains intact, with no nonblanchable redness, throughout the hospital stay.
- Skin on the feet and legs is moisturized and free of flaking within one week.
- Before discharge, the patient inspects their feet using a mirror and demonstrates it to the nurse.
- At the 2-week follow-up visit, the patient arrives wearing closed shoes that fit, with no inside seams.
- With incontinence: perineal skin stays free of redness and erosions for as long as the incontinence lasts.
Nursing interventions and rationales
| Intervention | Rationale |
|---|---|
| Inspect the skin every shift and at every position or brief change. | Redness caught early can be reversed; an erosion takes weeks to heal. |
| Wash with warm water and a mild soap and pat dry without rubbing, taking special care between the toes. | Moisture between the toes promotes cracks and fungal infections. |
| Apply moisturizer to the legs and feet, but not between the toes. | Dry skin cracks easily; between the toes, lotion traps moisture. |
| With incontinence, cleanse after every episode and apply a barrier product. | It shields the skin from urine and stool, which irritate and soften it. |
| Reposition the patient by lifting with a draw sheet instead of dragging, and turn on a schedule based on their risk. | Reduces friction and constant pressure over bony prominences. |
| Protect the skin under tubes, masks and splints, and reposition them every shift when possible. | Devices always press on the same spot. |
| Remove adhesives slowly, in the direction of hair growth, while supporting the skin. | Prevents skin tears in fragile skin, especially in older adults. |
| Teach daily foot care: inspect the feet, cut nails straight across or see a podiatrist, never walk barefoot and check inside shoes before putting them on. | With neuropathy, the person cannot feel a pebble, a blister or a burn. |
| Promote adequate fluid and protein intake, and consult the dietitian if the patient is not meeting it. | Poorly nourished or dehydrated skin breaks down sooner and heals more slowly. |
NOC outcomes and NIC interventions
Outcomes (NOC) and interventions (NIC) that published sources link to this diagnosis. Pick the ones that fit your patient.
NOC outcomes
- 1101Tissue Integrity: Skin & Mucous Membranes
- 0602Hydration
- 1902Risk Control
NIC interventions
- 3590Skin Surveillance
- 4130Fluid Monitoring
- 2080Fluid/Electrolyte Management
- 3540Pressure Ulcer Prevention
Linkages drawn from care plans published by health services, universities and nursing journals. Labels may vary depending on the NIC and NOC edition your facility uses.
Case study: Preventing diabetic foot injuries
Patient. Lucía, 66, has had type 2 diabetes for 15 years and comes to her primary care clinic for a routine visit. She has no wounds but reports tingling in her feet at night. She lives with her daughter.
Assessment
- Unable to feel the 10 g monofilament at 4 of 10 sites on each foot.
- Pedal pulses present and symmetric; capillary refill 2 seconds.
- Dry, flaking skin on the heels, no open cracks.
- Long, thickened toenails; says she can't reach to trim them properly.
- Wears open sandals and walks barefoot at home.
- Has never checked the soles of her feet.
- HbA1c 7.6% one month ago.
Nursing diagnosis
Risk for impaired skin integrity related to inadequate foot care, inappropriate footwear and dry skin from insufficient moisturizing, in a patient with type 2 diabetes and peripheral neuropathy (associated condition).
Goal
At the 4-week visit, Lucía demonstrates her daily foot check with a mirror, arrives in closed shoes, and the skin on her heels is moisturized and free of cracks.
Interventions
- Taught daily foot inspection with a mirror, with her daughter involved.
- Taught washing with warm water, drying between the toes and moisturizing without applying lotion between them.
- Referral to podiatry for nail care.
- Advised closed shoes with no inside seams and no walking barefoot, even at home.
- Instructed not to use hot water bottles or soak her feet.
Evaluation
At 4 weeks she arrives in closed shoes and seamless socks. Her heels are moisturized, with no flaking or cracks, and she demonstrates the mirror check. The risk diagnosis stays active because the neuropathy persists, with a foot check at every visit.
How it differs from similar diagnoses
- Impaired skin integrity (00046): Impaired skin integrity: the injury to the epidermis or dermis is already there. Use 00047 while the skin is still intact.
- Risk for impaired tissue integrity (00248): Risk for impaired tissue integrity: the potential damage reaches deeper tissues (subcutaneous tissue, muscle, mucous membranes).
- Risk for adult pressure injury (00304): Risk for adult pressure injury: more specific. If the main risk is pressure in a bedbound adult, use this one.
Common mistakes
- Keeping the risk diagnosis once a crack or erosion has appeared.
- Using it for pressure risk in a bedbound adult when a specific diagnosis exists.
- Writing “related to diabetes” or “related to advanced age” with no factors nursing can change.
- Applying lotion between the toes or massaging reddened skin.
Assessment scales
Used in these conditions
Other diagnoses in the Physical injury class
Domain 11, Safety / protection. See every diagnosis in this domain.
Frequently asked questions
What is the NANDA code for risk for impaired skin integrity?
00047, in Domain 11 (Safety/protection), Class 2 (Physical injury). It is still current in the 2024-2026 edition.
What is the difference between skin integrity and tissue integrity?
Skin integrity refers to the epidermis and dermis. Tissue integrity covers deeper tissues: subcutaneous tissue, muscle, bone, mucous membranes or cornea.
Should I use it for pressure ulcer prevention?
For adults, the 2024-2026 edition has a specific diagnosis: Risk for adult pressure injury (00304). Keep 00047 for other skin risks: moisture, dryness, friction, diabetic feet.
Can I use it for a diabetic foot?
Yes, to prevent superficial injuries on a healthy foot. If circulation is also poor, consider Risk for ineffective peripheral tissue perfusion (00228) as well.
Study material: the explanation, characteristics, factors, examples and case study on this page were written by our editorial team. The official text for Risk for impaired skin integrity (00047) is in NANDA International Nursing Diagnoses: Definitions and Classification 2024-2026. This page does not replace clinical judgment or your facility's protocols.
Classification sources: NANDA-I 2024-2026, Thieme supplement · Elsevier summary of changes · Spanish edition table of contents · NOC/NIC: source 1, source 2. Reviewed November 2, 2026.