2Describe normal skin changes associated with aging. 24/04/2011LEARNING OUTCOME 1Describe normal skin changes associated with aging.
3Normal Structure and Function of the Skin 24/04/2011Skin consists of 15–20% of the total body weightEpidermisConsists of five continually regenerating and shedding layersDermis
4Figure 12-1 Corpuscles and their distribution in the skin. 24/04/2011Figure 12-1 Corpuscles and their distribution in the skin.
5Normal Structure and Function of the Skin 24/04/2011Subcutaneous layersA specialized connective tissue attached to musclesContains blood vessels, lymphatic channels, hair follicles, and sweat glands
6Normal Structure and Function of the Skin 24/04/2011Accessory structuresHairNailsGlandsSebaceous glandsApocrine sweat glands
7Normal Structure and Function of the Skin 24/04/2011FunctionProtectionRegulation of immune functionsThermoregulationVitamin synthesisSensory receptor for CNS
8Skin Changes Associated with Aging 24/04/2011Intrinsic factorsGenetic makeup and the normal aging processExtrinsic factorsUV lightingSmokingEnvironmental pollutants
9Figure 12-2 Normal changes of aging in the integumentary system. 24/04/2011Figure 12-2 Normal changes of aging in the integumentary system.
10Skin Changes Associated with Aging 24/04/2011Epidermal changesThinningReduced moisture leading to a dry, rough appearanceMitosis slows after age 50 by 30%Increased healing timeIncreased risk of infection
11Skin Changes Associated with Aging 24/04/2011Epidermal changesRete ridges flatten: in the dermal layer, less collagen is being produced. The elastin fibers also wear out. Such factors will cause the skin to sag and wrinkle. The rete ridges, meanwhile, will flatten out. This will cause the skin to be fragile.Increased risk of skin breakdownReduced melanocytesPaler complexionIncreased risk of UV damage
12Skin Changes Associated with Aging 24/04/2011Epidermal changesScattered pigmented areasNevi (skin moles)Age spotsLiver spotsIncreased number and size of freckles (clusters of concentrated melanin)Age spots — also called liver spots and solar lentigines — are flat gray, brown or black spots. They vary in size and usually appear on the face, hands, shoulders and arms — areas most exposed to the sun. Though age spots are very common in adults older than age 40, they can affect younger people as well.
13Skin Changes Associated with Aging 24/04/2011Dermal changesDecreased thickness and function begin in 3rd decade of lifeElastin decreases in qualityWrinkling and saggingCollagen less organizedLoss of turgor
14Skin Changes Associated with Aging 24/04/2011Dermal changesReduced vascularityPaler complexionCapillaries thin and are easily damagedSenile purpura Easy skin bruising in older peopleReduced touch and pressure sensations
15Skin Changes Associated with Aging 24/04/2011Subcutaneous layerTissue thins in the face, neck, hands, and lower legsVisible veins in exposed areasHypertrophy of tissue in certain body areasIncreased body fatIncreased body fat in abdomen and thighs
16Hair Changes with Aging 24/04/2011Reduced number of functioning melanocytesReplacement of pigmented strands of hair with nonpigmented hairHormone levels declineLoss of hair in pubic and axillary areasGrowth of facial hair in womenGrowth of nasal and ear hair in menIncreased baldness
17Nail Changing with Aging 24/04/2011Color changesDullYellowing or graynessSlowed growthThicker nails prone to splittingLongitudinal striationsRelated to damage at the nail matrix (the ROOT of the nail)
18Nail Changing with Aging 24/04/2011Longitudinal pigmented bandsSingle or multiple brown or black bands on thumb and index fingerFrequently seen in African-Americans over age 20Increased visibility in the older adult
19Glandular Changes with Aging 24/04/2011Eccrine or sweat glandsDecreased number; decreased ability to regulate body temperatureSebaceous glandsIncreased size; decreased activity; increased water evaporation causes cracked, dry skin
20Identify risk factors related to common skin problems of older adults. 24/04/2011LEARNING OUTCOME 2Identify risk factors related to common skin problems of older adults.
21“The Sun Never Forgets” 24/04/2011Ultraviolet radiation (UVR)Ultraviolet A (UVA)
22“The Sun Never Forgets” 24/04/2011Responsible for premature aging and decreased immune functionUltraviolet B (UVB): The elderly have reduced capacity to synthesize vitamin D in skin when exposed to UVB radiation.Intense, intermittent exposuresBasal cell carcinomaMalignant melanomaChronic sun exposureSquamous cell carcinomaPhotoaging: refers to the damage that is done to the skin from prolonged exposure, over a person's lifetime, to UV radiationActinic keratosis: is a premalignant condition of thick, scaly, or crusty patches of skin
23Skin Tears Traumatic separation of the epidermis from the dermis 24/04/2011Traumatic separation of the epidermis from the dermis
24Pressure Ulcers24/04/2011Impact between 1 and 3 million people annually in the United StatesLocalized injury to the skin and underlying tissueUsually over a bony prominenceResults from pressure or pressure and shear force and/or friction
25Pressure Ulcers High-risk populations Hospitalized patients 24/04/2011High-risk populationsHospitalized patientsIndividuals over age 65
26Cellulitis24/04/2011Acute bacterial infection of the skin and subcutaneous tissueRisk factorsSkin breaksChronic illnessAge-related skin changes
27Conditions of the Finger and Toe Nails 24/04/2011Risk factorsTraumaAge-related changesSystemic diseases
2824/04/2011LEARNING OUTCOME 3Delineate skin changes associated with benign and malignant skin types.
29Skin Cancer is the Leading Cancer in the United States 24/04/2011Malignancies are associated with the time spent in the sunOlder and light-skinned persons are at an increased riskDarker-skinned persons may be at risk
30Actinic Keratosis24/04/2011Most common precancerous lesion; it is seen more in men than women1:1,000 will progress to skin cancerAlso known as solar keratosis or senile keratosisSore, rough, scaly, erythematous papules or plaques
32Basal Cell Carcinoma Most common skin cancer for Caucasians 24/04/2011Most common skin cancer for CaucasiansMetastasis rareOriginates in lowest layer epidermisManifests as small, fleshy bumps
33Squamous Cell Carcinoma 24/04/2011Second most common skin cancer for CaucasiansMost common skin cancer for persons with dark skinOriginates in upper levels of epidermisManifests as flesh-colored erythematous, scaly plaques, papules or nodulesMetastasis can occur
34Melanoma24/04/2011Most dangerous skin cancer; responsible for more than three quarters of all skin cancer deathsOriginates in the melanocytesLesions may be brown, black, or multicolored; develop nodules or; plaques (a broad papule ) and have a black, irregular spreading outline
35Skin Tears Caused by friction or shearing forces 24/04/2011Caused by friction or shearing forcesPayne-Martin classification for skin tearsCategory 1Linear or flap tear without tissue lossCategory 2Tears with partial tissue lossCategory 3Tears with full thickness complete tissue loss
36Pressure Ulcers The majority occur in persons over age 70 Stages 24/04/2011The majority occur in persons over age 70StagesStage I: Nonblanchable erythema of intact skinStage II: Partial-thickness skin loss involving dermis and/or epidermisStage III: Full-thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend to underlying fascia
37Pressure Ulcers Stages Types of pressure ulcers 24/04/2011StagesStage IV: Full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supportive structuresTypes of pressure ulcersNecrosis of epidermis and dermisDeep or malignant pressure ulcersFull-thickness wounds
38Pressure Ulcers Mechanisms of Tissue Breakdown 24/04/2011Mechanisms of Tissue BreakdownOcclusion of blood flow to the skinDamage to the lining of the arterioles and smaller vesselsDirect occlusion of blood vessels by long periods of pressure
39Wound Healing Phases Inflammation and destruction Proliferation 24/04/2011PhasesInflammation and destructionProliferationMaturation
40Delayed Wound Healing24/04/2011A wound that does not heal within 6 weeks is termed chronicSignsWound size is increasingExudate, slough, or eschar is presentTunnels, fistula, or undermining has developedEpithelial edge is not smooth and continuous and does not move toward wound
42Cellulitis Acute bacterial infection of skin 24/04/2011Acute bacterial infection of skinCharacterized with inflammation, intense pain, heat, redness, and swelling
43Nail Problems Fungal infection Inflammation of the nail matrix 24/04/2011Fungal infectionInflammation of the nail matrixHypertrophy of the nail plate
44List nursing diagnoses related to common skin problems. 24/04/2011LEARNING OUTCOME 4List nursing diagnoses related to common skin problems.
45Three Major Nursing Diagnoses for Integument Problems 24/04/2011Risk for Impaired Skin IntegrityImpaired Tissue IntegrityDamage to integument, cornea, or mucous membranesImpaired Skin IntegrityDamage to epidermal or dermal tissue
46Nursing Diagnoses for Integument Problems 24/04/2011Impaired Skin Integrity related to lesions and inflammatory responseRisk for Impaired Skin Integrity related to physical immobilityRisk for Impaired Skin Integrity related to decrease skin turgor
47Nursing Diagnoses for Integument Problems 24/04/2011Risk for Impaired Skin Integrity related to the effects of pressure, friction, or shearRisk for Impaired Tissue Integrity related to decreased circulationRisk for Infection related to pressure ulcer
4824/04/2011LEARNING OUTCOME 5Discuss the nursing responsibilities related to pharmacological and nonpharmalogical treatment of common skin problems.
49Diagnostic Tests for Integumentary Disorders 24/04/2011Total body photography: is established techniques for detecting and monitoring dysplastic and atypical nevi for early detection of malignant cutaneous melanomasSkin biopsyWound culturesLaboratory testsSerum albuminSerum transferrinLymphocyte count
51Nonpharmacological Interventions 24/04/2011Patient educationAwareness and reporting of skin cancerCharacteristics of darker skinPreventionGuidelines on sun exposureWearing protective clothing
52Nonpharmacological Interventions 24/04/2011TreatmentBasal cell carcinoma and squamous cell carcinomaMalignant melanomaExcisional biopsy for diagnosisWide excision for cureAdjuvant therapyChemotherapyChemoimmunotherapyRegional radiation therapyBiotherapy
53Nonpharmacological Interventions 24/04/2011Preventing skin tearsAvoid pulling or slidingPad surfacesKeep environment free of obstaclesMaintain safe environmental lightingKeep skin moistUse tape cautiouslyEncourage long sleeves and pants
54Nonpharmacological Interventions 24/04/2011Managing skin tearsClean with normal saline or other nontoxic cleanerPat or air dryGently place torn skin in its approximate normal positionApply dressings and change per protocol or product requirementsPhotograph if permittedDocument all findings
56Nonpharmacological Interventions 24/04/2011Management of Fingernail and Toenail ProblemsOnychomycosis: means fungal infection of the nail. It is the most common disease of the nails and constitutes about a half of all nail abnormalities.Pain managementPatient educationOral antifungal agentsChronic paronychia: Paronychia is one of the most common infections of the hand. Clinically, paronychia presents as an acute or a chronic condition. It is a localized, superficial infection or abscess of the paronychial tissues of the hands or, less commonly, the feetKeep affected nails dryAntibiotics
58Nonpharmacological Interventions 24/04/2011Management of Fingernail and Toenail ProblemsOnychogryphosis:is a hypertrophy that may produce nails resembling claws or a ram's horn, possibly caused by traumaKeep nails shortPodiatry consultation: is a branch of medicine devoted to the study, diagnosis and treatment of disorders of the foot, ankle and lower leg.Surgical intervention
5924/04/2011LEARNING OUTCOME 6Explain the nursing management principles related to the care of pressure ulcers.
60The Braden Scale Used to assess pressure ulcer risk 24/04/2011Used to assess pressure ulcer riskAssesses mobility, activity, sensory perception, skin moisture, friction, shear, and nutritional statusUsed as an adjunct tool to nursing assessment and clinical judgmentCan be found at this link pdf
61Mobility and Activity Considerations 24/04/2011Repositioning q2hEnsure proper positioningAvoid prolonged sittingIncrease activityChoose a mattress surface based on the assessment and diagnosis* a low air loss bed is indicated for all pressure ulcers in any stage* a water mattress for stage 1, 2 and 3* an alternating pressure mattress for stage 1 and 2.
62Skin Care for Older Persons 24/04/2011Correct bathing proceduresKeep skin clean and dryLubricate with non–alcohol-containing moisturizerPrevent injuryEvaluate and manage incontinenceProvide dietary support
63Nursing Care of Pressure Ulcers 24/04/2011Assess and stage the woundDebride necrotic tissueCleanse
64Treatment Avoid contamination 24/04/2011Avoid contaminationColonization: presence and proliferation of organism in the wound with no signs of infection.Infection: presence and proliferation of organism in the wound with signs of infectionTopical antibioticsSystemic antibiotics
65Nursing Care and Documentation of Skin Problems 24/04/2011Assess risk factorsProvide nursing interventions to minimize skin breakdownDocument careEvaluate patient status
66Knowledge-Based Decision Making 24/04/2011Current literatureShare with colleagues, patients, and their significant others
67Helpful Questions When Assessing Wound Care Products 24/04/2011What is the stage, drainage, moisture, or eschar?What are the wound needs?What products are available to manage the wound?
68Ongoing Evaluation of Nursing Care 24/04/2011Family situationAvailable resourcesPatient needs and requestsPatient and family understanding of the teaching and plan of care