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12 Lecture Note PowerPoint Presentation The Integument.

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1 12 Lecture Note PowerPoint Presentation The Integument

2 Describe normal skin changes associated with aging.
24/04/2011 LEARNING OUTCOME 1 Describe normal skin changes associated with aging.

3 Normal Structure and Function of the Skin
24/04/2011 Skin consists of 15–20% of the total body weight Epidermis Consists of five continually regenerating and shedding layers Dermis

4 Figure 12-1 Corpuscles and their distribution in the skin.
24/04/2011 Figure 12-1 Corpuscles and their distribution in the skin.

5 Normal Structure and Function of the Skin
24/04/2011 Subcutaneous layers A specialized connective tissue attached to muscles Contains blood vessels, lymphatic channels, hair follicles, and sweat glands

6 Normal Structure and Function of the Skin
24/04/2011 Accessory structures Hair Nails Glands Sebaceous glands Apocrine sweat glands

7 Normal Structure and Function of the Skin
24/04/2011 Function Protection Regulation of immune functions Thermoregulation Vitamin synthesis Sensory receptor for CNS

8 Skin Changes Associated with Aging
24/04/2011 Intrinsic factors Genetic makeup and the normal aging process Extrinsic factors UV lighting Smoking Environmental pollutants

9 Figure 12-2 Normal changes of aging in the integumentary system.
24/04/2011 Figure 12-2 Normal changes of aging in the integumentary system.

10 Skin Changes Associated with Aging
24/04/2011 Epidermal changes Thinning Reduced moisture leading to a dry, rough appearance Mitosis slows after age 50 by 30% Increased healing time Increased risk of infection

11 Skin Changes Associated with Aging
24/04/2011 Epidermal changes Rete 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 breakdown Reduced melanocytes Paler complexion Increased risk of UV damage

12 Skin Changes Associated with Aging
24/04/2011 Epidermal changes Scattered pigmented areas Nevi (skin moles) Age spots Liver spots Increased 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.

13 Skin Changes Associated with Aging
24/04/2011 Dermal changes Decreased thickness and function begin in 3rd decade of life Elastin decreases in quality Wrinkling and sagging Collagen less organized Loss of turgor

14 Skin Changes Associated with Aging
24/04/2011 Dermal changes Reduced vascularity Paler complexion Capillaries thin and are easily damaged Senile purpura Easy skin bruising in older people Reduced touch and pressure sensations

15 Skin Changes Associated with Aging
24/04/2011 Subcutaneous layer Tissue thins in the face, neck, hands, and lower legs Visible veins in exposed areas Hypertrophy of tissue in certain body areas Increased body fat Increased body fat in abdomen and thighs

16 Hair Changes with Aging
24/04/2011 Reduced number of functioning melanocytes Replacement of pigmented strands of hair with nonpigmented hair Hormone levels decline Loss of hair in pubic and axillary areas Growth of facial hair in women Growth of nasal and ear hair in men Increased baldness

17 Nail Changing with Aging
24/04/2011 Color changes Dull Yellowing or grayness Slowed growth Thicker nails prone to splitting Longitudinal striations Related to damage at the nail matrix (the ROOT of the nail)

18 Nail Changing with Aging
24/04/2011 Longitudinal pigmented bands Single or multiple brown or black bands on thumb and index finger Frequently seen in African-Americans over age 20 Increased visibility in the older adult

19 Glandular Changes with Aging
24/04/2011 Eccrine or sweat glands Decreased number; decreased ability to regulate body temperature Sebaceous glands Increased size; decreased activity; increased water evaporation causes cracked, dry skin

20 Identify risk factors related to common skin problems of older adults.
24/04/2011 LEARNING OUTCOME 2 Identify risk factors related to common skin problems of older adults.

21 “The Sun Never Forgets”
24/04/2011 Ultraviolet radiation (UVR) Ultraviolet A (UVA)

22 “The Sun Never Forgets”
24/04/2011 Responsible for premature aging and decreased immune function Ultraviolet B (UVB): The elderly have reduced capacity to synthesize vitamin D in skin when exposed to UVB radiation. Intense, intermittent exposures Basal cell carcinoma Malignant melanoma Chronic sun exposure Squamous cell carcinoma Photoaging: refers to the damage that is done to the skin from prolonged exposure, over a person's lifetime, to UV radiation Actinic keratosis: is a premalignant condition of thick, scaly, or crusty patches of skin

23 Skin Tears Traumatic separation of the epidermis from the dermis
24/04/2011 Traumatic separation of the epidermis from the dermis

24 Pressure Ulcers 24/04/2011 Impact between 1 and 3 million people annually in the United States Localized injury to the skin and underlying tissue Usually over a bony prominence Results from pressure or pressure and shear force and/or friction

25 Pressure Ulcers High-risk populations Hospitalized patients
24/04/2011 High-risk populations Hospitalized patients Individuals over age 65

26 Cellulitis 24/04/2011 Acute bacterial infection of the skin and subcutaneous tissue Risk factors Skin breaks Chronic illness Age-related skin changes

27 Conditions of the Finger and Toe Nails
24/04/2011 Risk factors Trauma Age-related changes Systemic diseases

28 24/04/2011 LEARNING OUTCOME 3 Delineate skin changes associated with benign and malignant skin types.

29 Skin Cancer is the Leading Cancer in the United States
24/04/2011 Malignancies are associated with the time spent in the sun Older and light-skinned persons are at an increased risk Darker-skinned persons may be at risk

30 Actinic Keratosis 24/04/2011 Most common precancerous lesion; it is seen more in men than women 1:1,000 will progress to skin cancer Also known as solar keratosis or senile keratosis Sore, rough, scaly, erythematous papules or plaques

31 24/04/2011 Actinic Keratosis

32 Basal Cell Carcinoma Most common skin cancer for Caucasians
24/04/2011 Most common skin cancer for Caucasians Metastasis rare Originates in lowest layer epidermis Manifests as small, fleshy bumps

33 Squamous Cell Carcinoma
24/04/2011 Second most common skin cancer for Caucasians Most common skin cancer for persons with dark skin Originates in upper levels of epidermis Manifests as flesh-colored erythematous, scaly plaques, papules or nodules Metastasis can occur

34 Melanoma 24/04/2011 Most dangerous skin cancer; responsible for more than three quarters of all skin cancer deaths Originates in the melanocytes Lesions may be brown, black, or multicolored; develop nodules or; plaques (a broad papule ) and have a black, irregular spreading outline

35 Skin Tears Caused by friction or shearing forces
24/04/2011 Caused by friction or shearing forces Payne-Martin classification for skin tears Category 1 Linear or flap tear without tissue loss Category 2 Tears with partial tissue loss Category 3 Tears with full thickness complete tissue loss

36 Pressure Ulcers The majority occur in persons over age 70 Stages
24/04/2011 The majority occur in persons over age 70 Stages Stage I: Nonblanchable erythema of intact skin Stage II: Partial-thickness skin loss involving dermis and/or epidermis Stage III: Full-thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend to underlying fascia

37 Pressure Ulcers Stages Types of pressure ulcers
24/04/2011 Stages Stage IV: Full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supportive structures Types of pressure ulcers Necrosis of epidermis and dermis Deep or malignant pressure ulcers Full-thickness wounds

38 Pressure Ulcers Mechanisms of Tissue Breakdown
24/04/2011 Mechanisms of Tissue Breakdown Occlusion of blood flow to the skin Damage to the lining of the arterioles and smaller vessels Direct occlusion of blood vessels by long periods of pressure

39 Wound Healing Phases Inflammation and destruction Proliferation
24/04/2011 Phases Inflammation and destruction Proliferation Maturation

40 Delayed Wound Healing 24/04/2011 A wound that does not heal within 6 weeks is termed chronic Signs Wound size is increasing Exudate, slough, or eschar is present Tunnels, fistula, or undermining has developed Epithelial edge is not smooth and continuous and does not move toward wound

41 Delayed Wound Healing Causes Aging Inadequate nutrition
24/04/2011 Causes Aging Inadequate nutrition Inadequate blood supply Immunocompetence Damage to wound

42 Cellulitis Acute bacterial infection of skin
24/04/2011 Acute bacterial infection of skin Characterized with inflammation, intense pain, heat, redness, and swelling

43 Nail Problems Fungal infection Inflammation of the nail matrix
24/04/2011 Fungal infection Inflammation of the nail matrix Hypertrophy of the nail plate

44 List nursing diagnoses related to common skin problems.
24/04/2011 LEARNING OUTCOME 4 List nursing diagnoses related to common skin problems.

45 Three Major Nursing Diagnoses for Integument Problems
24/04/2011 Risk for Impaired Skin Integrity Impaired Tissue Integrity Damage to integument, cornea, or mucous membranes Impaired Skin Integrity Damage to epidermal or dermal tissue

46 Nursing Diagnoses for Integument Problems
24/04/2011 Impaired Skin Integrity related to lesions and inflammatory response Risk for Impaired Skin Integrity related to physical immobility Risk for Impaired Skin Integrity related to decrease skin turgor

47 Nursing Diagnoses for Integument Problems
24/04/2011 Risk for Impaired Skin Integrity related to the effects of pressure, friction, or shear Risk for Impaired Tissue Integrity related to decreased circulation Risk for Infection related to pressure ulcer

48 24/04/2011 LEARNING OUTCOME 5 Discuss the nursing responsibilities related to pharmacological and nonpharmalogical treatment of common skin problems.

49 Diagnostic Tests for Integumentary Disorders
24/04/2011 Total body photography: is established techniques for detecting and monitoring dysplastic and atypical nevi for early detection of malignant cutaneous melanomas Skin biopsy Wound cultures Laboratory tests Serum albumin Serum transferrin Lymphocyte count

50 Pharmacologic Treatment Options
24/04/2011 Topical antifungal agents Topical antibiotics Systemic antibiotics Selected antimicrobials Aminoglycosides Prescription creams

51 Nonpharmacological Interventions
24/04/2011 Patient education Awareness and reporting of skin cancer Characteristics of darker skin Prevention Guidelines on sun exposure Wearing protective clothing

52 Nonpharmacological Interventions
24/04/2011 Treatment Basal cell carcinoma and squamous cell carcinoma Malignant melanoma Excisional biopsy for diagnosis Wide excision for cure Adjuvant therapy Chemotherapy Chemoimmunotherapy Regional radiation therapy Biotherapy

53 Nonpharmacological Interventions
24/04/2011 Preventing skin tears Avoid pulling or sliding Pad surfaces Keep environment free of obstacles Maintain safe environmental lighting Keep skin moist Use tape cautiously Encourage long sleeves and pants

54 Nonpharmacological Interventions
24/04/2011 Managing skin tears Clean with normal saline or other nontoxic cleaner Pat or air dry Gently place torn skin in its approximate normal position Apply dressings and change per protocol or product requirements Photograph if permitted Document all findings

55 Nonpharmacological Interventions
24/04/2011 Managing cellulitis Treat acute infection Immobilization Elevate limb Pain relief Possible anticoagulant therapy Prevent further complications

56 Nonpharmacological Interventions
24/04/2011 Management of Fingernail and Toenail Problems Onychomycosis: 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 management Patient education Oral antifungal agents Chronic 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 feet Keep affected nails dry Antibiotics

57 24/04/2011 Chronic paronychia Onychomycosis

58 Nonpharmacological Interventions
24/04/2011 Management of Fingernail and Toenail Problems Onychogryphosis:is a hypertrophy that may produce nails resembling claws or a ram's horn, possibly caused by trauma Keep nails short Podiatry consultation: is a branch of medicine devoted to the study, diagnosis and treatment of disorders of the foot, ankle and lower leg. Surgical intervention

59 24/04/2011 LEARNING OUTCOME 6 Explain the nursing management principles related to the care of pressure ulcers.

60 The Braden Scale Used to assess pressure ulcer risk
24/04/2011 Used to assess pressure ulcer risk Assesses mobility, activity, sensory perception, skin moisture, friction, shear, and nutritional status Used as an adjunct tool to nursing assessment and clinical judgment Can be found at this link pdf

61 Mobility and Activity Considerations
24/04/2011 Repositioning q2h Ensure proper positioning Avoid prolonged sitting Increase activity Choose 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.

62 Skin Care for Older Persons
24/04/2011 Correct bathing procedures Keep skin clean and dry Lubricate with non–alcohol-containing moisturizer Prevent injury Evaluate and manage incontinence Provide dietary support

63 Nursing Care of Pressure Ulcers
24/04/2011 Assess and stage the wound Debride necrotic tissue Cleanse

64 Treatment Avoid contamination
24/04/2011 Avoid contamination Colonization: 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 infection Topical antibiotics Systemic antibiotics

65 Nursing Care and Documentation of Skin Problems
24/04/2011 Assess risk factors Provide nursing interventions to minimize skin breakdown Document care Evaluate patient status

66 Knowledge-Based Decision Making
24/04/2011 Current literature Share with colleagues, patients, and their significant others

67 Helpful Questions When Assessing Wound Care Products
24/04/2011 What is the stage, drainage, moisture, or eschar? What are the wound needs? What products are available to manage the wound?

68 Ongoing Evaluation of Nursing Care
24/04/2011 Family situation Available resources Patient needs and requests Patient and family understanding of the teaching and plan of care


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