Impaired tissue integrity

Impaired tissue integrity

Domain 11. Safety-protection
Class 2. Physical injury
Diagnostic Code: 00044
Nanda label: Impaired tissue integrity
Diagnostic focus: Tissue integrity

Nursing diagnosis Impaired Tissue Integrity is a condition which occurs when inflammation, infection or trauma disrupts the normal homeostatic process of healing, leading to further damage and risk of disease. It is often a complicated issue with multiple causes, making it important for healthcare professionals to understand how these issues interact and the different nursing interventions they can utilize. By understanding this diagnosis, nurses can properly diagnose and treat the underlying causes, to promote effective healing and tissue repair.

NANDA Nursing Diagnosis Definition

According to Nanda International, the accepted definition of Impairment of Tissue Integrity is, “Damage to the skin, mucous membranes, or other tissues that interferes with their functioning and integrity.” This diagnosis can affect any body part, from minor surface wounds to deep organ damage.

Defining Characteristics:

  • Subjective: Complaints of pain, itching, burning, tenderness, difficulty in mobilizing, swelling, warmth, discoloration, altered sensation.
  • Objective: Decreased elasticity, maceration, ulceration, redness, edema, drainage, shearing skin, and signs of infection.

Related Factors

  • Nutritional Deficiencies: Inadequate dietary intake or absorption of nutrients, especially proteins, carbohydrates, vitamins, or minerals can lead to impaired tissue integrity.
  • Changes in Cellular Metabolism: Metabolic disorders, such as diabetes or renal failure, can interfere with normal tissue healing and put individuals at risk for impaired tissue integrity.
  • Environmental or Temperature Exposures: Prolonged or extreme exposure to temperature can lead to tissue injury and put people at risk for impaired tissue integrity.
  • Pressure: Prolonged pressure, especially on bony areas, can decrease blood flow and put people at risk for impaired tissue integrity.
  • Immunosuppression/Hypermetabolic State: diseases or medications which suppress or weaken the immune system can increase a patients risk of developing damaged tissue.

At Risk Population

The following populations are most at-risk for developing impaired tissue integrity:

  • Elderly: Due to age-related changes in metabolism, circulatory changes, and decreased ability to sense changes in the environment, elderly individuals are more prone to developing impaired tissue integrity.
  • Diabetics: People diagnosed with diabetes or holding pre-diabetic indicators may suffer from impaired tissue integrity due to altered metabolism and other associated issues.
  • Trauma or Surgery Patients: Patients recovering from trauma or surgery can experience a number of risk factors which can put them at risk for impaired tissue integrity, including physical limitations, pain, immobility and weakened immunity.
  • Patients with Weakened Immune Systems: Individuals with compromised immunity due to various diseases or treatments are prone to developing impaired tissue integrity.

Associated Conditions

Impaired tissue integrity is often associated with other conditions, such as:

  • Inflammatory Disorders: Autoimmune diseases, such as lupus, can affect the body’s ability to heal itself.
  • Severe Infections: Viruses, bacteria, fungi, and parasites can all cause tissue damage.
  • Toxic Exposure: Exposure to environmental or industrial toxins can cause tissue breakdown.
  • Wounds: Tissue breakdown can often occur along wounds, such as surgical incisions.

Suggestions for Use

When diagnosing or treating patients with impaired tissue integrity, healthcare professionals should always keep in mind the following points:

  • Conduct an assessment to identify the patient’s risk factors and current health status.
  • Determine any underlying causes, such as metabolic or immune deficiencies, toxic exposures, and/or infections.
  • Perform regular evaluations to monitor progress and identify any complications.
  • Where necessary, provide wound dressings or braces to protect injured tissue and prevent further damage.
  • Encourage proper nutrition, exercise, and adequate rest to promote healing.
  • As necessary, administer antibiotics, antivirals or other medications as determined by the underlying cause.
  • Educate the patient on how to care for and protect their impaired tissue.

Suggested Alternative NANDA Nursing Diagnoses

Healthcare professionals may want to consider the following diagnoses as alternatives to impaired tissue integrity, as they relate to the same basic issues and can be used to further treatment:

  • Activity Intolerance: This diagnosis relates to the decreased ability to tolerate activity, which often affects people with impaired tissue integrity.
  • Ineffective Health Maintenance: This diagnosis applies to a lack of knowledge or the neglect of necessary health practices necessary for the patient to maintain their health and wellness.
  • Ineffective Protection: Failure of a patient to recognize or respond to environmental or occupational risks which could put them at risk for tissue damage.
  • Risk for Deficient Fluid Volume: Relates to a state of dehydration, which is often associated with impaired tissue integrity.
  • Risk for Infection: Often an underlying factor of impaired tissue integrity, this diagnosis relates to a decreased ability of the body to ward off infection.

Usage Tips

When using the diagnosis of impaired tissue integrity, healthcare professionals should take the following into consideration:

  • Remember to conduct a thorough assessment before making assumptions about the source of the patient’s impairment.
  • Be sure to closely monitor any signs of infection, as this can often complicate the healing process.
  • Educate the patient on their condition and its potential consequences, as well as how to properly care for the affected area.
  • Utilize the nursing diagnoses listed above to supplement or modify treatment, as needed.

NOC Outcomes

When treating impaired tissue integrity, nurses should strive to attain the following NOC Outcomes (Nursing Outcome Classification):

  • Pain Management: Evaluates the patient’s responsiveness to medical interventions, their ability to cope with the pain associated with the condition, and their comfort level with self-management.
  • Skin Integrity: Assesses the patient’s ability to protect the compromised area, utilizing the necessary dressing and measures, to maintain integrity.
  • Mobility: Assesses the patient’s ability to move without undue pain or stiffness, and their ability to modify activities as required.
  • Appetite: Assesses the patient’s health, ability to gain physical and emotional strength from their nutrition, and hydration and nutrient status.
  • Self-Care: Assesses the patient’s adherence to care instructions and the ability to perform self-care actions.

Evaluation Objectives and Criteria

The following objectives, related to the diagnosis of impaired tissue integrity, should be addressed, evaluated and monitored during the patient’s treatment plan:

  • Reduction of Pain: The patient should show a decrease in overall pain levels.
  • Improvement in Mobility: The patient should experience increased range of motion and ability to move without excessive pain, stiffness, or weakness.
  • Increased Appetite: Patients should demonstrate an increased interest in eating and drinking, and show sustained gains in weight.
  • Demonstrated Self-Care: Patients should demonstrate an understanding of their condition, be proactive in caring for their damaged area, and make use of available resources to better manage their condition.
  • Reduction of Complications: Any existing or potential complications should be monitored, and steps taken to lessen or avoid complications altogether.

NIC Interventions

Nurses may use the following NIC Interventions (Nursing Interventions Classification) to care for and treat patients suffering from impaired tissue integrity:

  • Simple Dressing Change: Nurses change bandages and wound dressings to maintain integrity and protect the affected area.
  • Understanding Environment: Nurses assess and modify the physical environment to reduce the chance of irritation or further damage.
  • Protection Procedure: Nurses mitigate the patient’s exposure to occupational and environmental risks which can cause tissue damage.
  • Mobility Planning: Nurses work with the patient to develop plans for safe and comfortable movement, both inside and outside of care facilities.
  • Self-Care Assistance: Nurses assist patients with dressings and hygiene, as needed, and educate patients on proper self-care techniques.

Nursing Activities

When caring for a patient suffering from impaired tissue integrity, nurses should focus on the following activities:

  • Pain Management: Nurses administer pain relief medications, apply ice or heat therapy, and use other techniques to help patients manage their discomfort levels.
  • Nutrition: Nurses evaluate the patient’s nutritional status and help create a diet plan based on their individual needs.
  • Skin Care: Nurses administer topical treatments as needed to help promote healing and protect the affected skin.
  • Spiritual Care: Nurses offer moral support and provide spiritual guidance to help the patient cope with their condition.
  • Mobility: Nurses monitor the patient’s mobility, provide assistive devices or braces, and recommend appropriate exercises to alleviate symptoms.
  • Follow-Up Evaluation: Nurses should perform evaluations at regular intervals throughout the patient’s recovery to ensure continued progress.


Impaired tissue integrity is a common and potentially serious health condition which frequently results from injury, infection, malnutrition, or changes in cellular metabolism. By understanding the diagnosis, associated factors, and available treatments, nurses can provide patients with the best chance at an uninterrupted and effective healing process.


  • What is impaired tissue integrity? – Impaired tissue integrity is a condition in which inflammation, infection or trauma interfere with the normal healing process, leading to further damage and potential disease.
  • What populations are most at risk for impaired tissue integrity? – Those most at-risk include the elderly, those with diabetes, trauma and surgery patients, and individuals with weakened immune systems.
  • What nursing interventions are suggested for treating impaired tissue integrity? – Suggested interventions include assessing the patient’s risk factors, providing wound dressings, encouraging proper nutrition, administering medications, as determined by the underlying cause, and educating the patient during their recovery.
  • What evaluation objectives and criteria should be used? – Nurses should strive to reduce pain, improve mobility, increase appetite, demonstrate self-care, and reduce complications.
  • What is the difference between NOC Outcomes and NIC Interventions? – NOC Outcomes are the desired outcomes, while NIC Interventions are the activities carried out to reach those outcomes.