Integumentary System Case Study
CONCEPT: Tissue Integrity
Mrs. Itchie, an 89 year old woman who has had chronic pruritis for the past 30 years. She has been to the doctor several times but she has not been diagnosed with a specific condition. Due to the inability for her to live on her own any longer, she comes to live in your long term care facility. She previously lived on her own for 22 years. She tells you that she has hated giving up her home and all of the friends she had developed in her old neighborhood.
Her constant itching and scratching make her hesitant to go to the dining or activity area where she can meet new acquaintances. Wanting to make her feel better about being at your facility, you tell her that you are going to make sure that her ‘itchiness goes away’ so that she can enjoy meeting new friends.
Despite all of your efforts, she continues to have chronic pruritis and has periods of extreme itching, especially when she is emotionally stressed. When she talks about her old neighborhood and friends she has lost, you notice that she sometimes scratches an area until bleeding occurs. In a couple of places on her shoulders, she has developed hard thickened skin because of the years of continual itching and scratching.
1. What predisposing factors might play a role in her chronic skin condition?
2. Develop a plan of care for her and other clients with chronic skin conditions. Give thought to altered comfort, risk for infection, as well as sleep pattern disturbance, anxiety, altered self esteem, and knowledge deficit of appropriate skin care.
3. One area of her pruritis has become an open oozing wound. What methods of debridement are available for treatment of this area?
4. She has isolated herself socially because of the continual scratching. What approach could be implemented to increase her socialization?
Developed by Carol Thorn, RN, MS
May use with permission for the purposes of nursing education
If questions/comments, please contact Carol Thorn at