Skin turgor represents the skin’s elasticity, which is its ability to change shape when pinched and quickly return to its normal contour. This characteristic is directly related to the fluid content within the body’s tissues, making the assessment a simple, non-invasive method for evaluating a person’s hydration status. A change in elasticity suggests fluid imbalances, most commonly indicating a fluid volume deficit or dehydration.
Performing the Skin Turgor Assessment
The physical assessment involves a technique known as the pinch test, which requires selecting an appropriate site to minimize interference from natural age-related skin changes. For a reliable reading, a healthcare professional chooses areas where the skin is thin and over a bony prominence, such as the skin just below the clavicle on the chest or the forearm. These locations are preferred because the skin here is less affected by localized fat deposits, which can mask poor turgor.
The procedure begins by gently grasping a fold of skin, about 1 to 2 centimeters wide, using the thumb and forefinger. The skin is lifted slightly, creating a temporary tent-like shape, and held for a few seconds before being released. It is important to avoid using sites on the back of the hand or the forehead, especially in older adults, because the natural loss of collagen and elastin with age causes decreased skin elasticity regardless of hydration. The assessor must then observe the speed and manner in which the lifted skin fold returns to its flat, original position.
Defining and Interpreting Assessment Findings
Interpretation of the skin turgor assessment is based on the time it takes for the skin fold to recoil after being released. Normal turgor, often described as “brisk,” means the pinched skin snaps back immediately, typically within one to two seconds. This rapid return indicates sufficient fluid volume in the interstitial spaces of the skin.
A finding of “poor” or “sluggish” turgor is noted when the skin remains elevated for an extended time, a phenomenon known as “tenting.” If the skin fold stays tented for three seconds or longer, it suggests a reduction in tissue fluid volume, characteristic of moderate to severe fluid loss.
The natural aging process causes a loss of tissue elasticity, meaning a slow return time in an elderly person may not necessarily indicate dehydration alone. Conversely, edema, or fluid accumulation, can make the skin difficult to pinch up, potentially suggesting normal turgor even with a fluid imbalance. The turgor result must be synthesized with other clinical signs, such as mucous membrane moisture and urine output.
Standardized Charting and Documentation
A complete chart note must include the finding, the location of the assessment, and the estimated recoil time. For a normal finding, the documentation might state, “Skin turgor brisk, non-tenting noted.” When turgor is decreased, the note must be more detailed, such as, “Skin turgor sluggish, 4-second tenting noted above the right clavicle.” Documenting the exact anatomical site is important because different body locations can yield varying results.
Following a finding of poor turgor, the documentation must reflect any subsequent actions taken by the healthcare provider. If a fluid deficit is suspected, the note should include details of communication and intervention, such as “Abnormal finding reported to Dr. Smith” or “Increased oral intake encouraged, to re-assess turgor in two hours.” This confirms that the care team has addressed the potential fluid imbalance promptly.