Skin Integrity Assessment

Braden scale for pressure injury risk and skin inspection records

Rajan Mehta, 75M · ICU-4

Assessed: 23 Jun 2026 06:00 by Sr. Priya R.

High Risk

Braden: 11/23

Special Mattress

In Use

Turning Frequency

2-hourly

Stage 2 pressure ulcer — sacrum. No new breakdown.

Arjun Pillai, 82M · ICU-2

Assessed: 23 Jun 2026 06:00 by Sr. Kavya N.

Moderate Risk

Braden: 14/23

Special Mattress

Not in use — review needed

Turning Frequency

3-hourly

Skin intact. Bony prominences reddened over right heel — monitor closely.

Sensory Perception

1=Completely limited → 4=No impairment

Moisture

1=Constantly moist → 4=Rarely moist

Activity

1=Bedfast → 4=Walks frequently

Mobility

1=Completely immobile → 4=No limitation

Nutrition

1=Very poor → 4=Excellent

Friction & Shear

1=Problem → 3=No apparent problem

Skin Inspection Findings

Preventive Interventions