How to Assess Circulation & Skin Integrity

Instructor: Adrianne Baron

Adrianne has a master's degree in cancer biology and has taught high school and college biology.

Nurses are responsible for knowing the overall health of their patients. They have certain methods that they use as part of an assessment to check for circulation and skin integrity. We will look at how the assessment is done and discuss why, as well as expectations.

Circulation and Skin Integrity

While learning about the body, we have to keep in mind that every organ system in the body works with at least one other organ system. Actually, most body systems work with almost every other system in the body. This is definitely the case when we look at the skin and circulatory system. The circulatory system is the system responsible for moving blood throughout the body. This system works with every organ in the body because every organ needs the oxygen, cells, nutrients, and proteins that circulate in the blood.

Our skin needs the substances present in our blood in order to remain intact and healthy. The health status of the skin is known as skin integrity. There are numerous blood vessels that supply blood to the skin in order to maintain good skin health.


Since the circulation of blood is related to the health of skin, we can look at the skin to understand how well blood is circulating and look at circulation to get an idea of the overall health of the skin. As a matter-of-fact, that is exactly what healthcare professionals, such as nurses, do regularly in order to assess the circulation and skin integrity of their patients.


One way to assess circulation is something you may have done on yourself after exercising. The pulse, temporary swelling of an artery as blood passes through with each heartbeat, is one way nurses determine that blood is circulating.

The top of the foot and wrists are the most commonly used pulse points for the assessment
Diagram showing pulse points

There are pulse points in every extremity of the body, as well as on the neck and temples. Nurses detect a patient's pulse on their wrists and top of the ankles. They take the pulse on both sides of the body and compare them to be sure it is the same strength on both sides.

Our body temperature is maintained by blood circulating. Nurses check the temperature on various parts of the body to make sure blood is reaching that area. An area feeling cooler than the rest of the body indicates a lack of sufficient circulation. An area that is hotter than normal may indicate that the patient has an infection in that area. Checking body temperature is done for the circulation as well as skin assessments.

Did you ever pinch your finger when you were younger until it turned white and watch the red color come back after you let go? If so, you did the part of the circulation assessment called the capillary refill. Nurses do this to be sure blood is flowing at a normal rate. The red color should return within 3 seconds of letting go of the finger.

The skin is able to maintain its normal color based on circulation, so nurses check the color of the skin to be sure blood is circulating. Skin that is pale indicates a lack of circulation.


Checking the color of the skin is a part of the skin assessment as well. In addition to pale skin, nurses also look for reddened skin. This could indicate inflammation in the deeper layers of the skin.

Edema in the person
Picture showing edema in the right hand

Nurses also look for edema, commonly called swelling, and bruising which go along with reddened skin. This assessment lets nurses know whether or not the skin may be infected.

Nurses pay attention to their patient's diet and mobility since that plays a role in circulation and skin integrity. Diets high in fat and cholesterol tend to have a negative impact on circulation, which negatively impacts the skin. Mobility is necessary for proper circulation, since the muscles in the body keep blood flowing from the lower part of the body back to the heart. Mobility is also needed for healthy skin integrity. Immobile patients tend to have areas of the skin that develop sores due to pressure from being in one position cutting off the supply of blood to those areas of the skin.

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