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The Integument 12 Lecture Note PowerPoint Presentation.

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Presentation on theme: "The Integument 12 Lecture Note PowerPoint Presentation."— Presentation transcript:

1 The Integument 12 Lecture Note PowerPoint Presentation

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

3 N ORMAL S TRUCTURE AND F UNCTION OF THE S KIN Skin consists of 15–20% of the total body weight Epidermis Consists of five continually regenerating and shedding layers Dermis 24/04/2011 3


5 N ORMAL S TRUCTURE AND F UNCTION OF THE S KIN Subcutaneous layers A specialized connective tissue attached to muscles Contains blood vessels, lymphatic channels, hair follicles, and sweat glands 24/04/2011 5

6 N ORMAL S TRUCTURE AND F UNCTION OF THE S KIN Accessory structures Hair Nails Glands Sebaceous glands Apocrine sweat glands 24/04/2011 6

7 N ORMAL S TRUCTURE AND F UNCTION OF THE S KIN Function Protection Regulation of immune functions Thermoregulation Vitamin synthesis Sensory receptor for CNS 24/04/2011 7

8 S KIN C HANGES A SSOCIATED WITH A GING Intrinsic factors Genetic makeup and the normal aging process Extrinsic factors UV lighting Smoking Environmental pollutants 24/04/2011 8


10 S KIN C HANGES A SSOCIATED WITH A GING 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 24/04/

11 S KIN C HANGES A SSOCIATED WITH A GING 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 24/04/

12 S KIN C HANGES A SSOCIATED WITH A GING 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. 24/04/

13 S KIN C HANGES A SSOCIATED WITH A GING 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 24/04/

14 S KIN C HANGES A SSOCIATED WITH A GING 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 24/04/

15 S KIN C HANGES A SSOCIATED WITH A GING 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 24/04/

16 H AIR C HANGES WITH A GING 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 24/04/

17 N AIL C HANGING WITH A GING 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) 24/04/

18 N AIL C HANGING WITH A GING 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 24/04/

19 G LANDULAR C HANGES WITH A GING 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 24/04/

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

21 “T HE S UN N EVER F ORGETS ” Ultraviolet radiation (UVR) Ultraviolet A (UVA) 24/04/

22 “T HE S UN N EVER F ORGETS ” 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 radiationUV radiation Actinic keratosis: is a premalignant condition of thick, scaly, or crusty patches of skin 24/04/

23 S KIN T EARS Traumatic separation of the epidermis from the dermis 24/04/

24 P RESSURE U LCERS 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 24/04/

25 P RESSURE U LCERS High-risk populations Hospitalized patients Individuals over age 65 24/04/

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

27 C ONDITIONS OF THE F INGER AND T OE N AILS Risk factors Trauma Age-related changes Systemic diseases 24/04/

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

29 S KIN C ANCER IS THE L EADING C ANCER IN THE U NITED S TATES 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 24/04/

30 A CTINIC K ERATOSIS 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 24/04/

31 24/04/ Actinic Keratosis

32 B ASAL C ELL C ARCINOMA Most common skin cancer for Caucasians Metastasis rare Originates in lowest layer epidermis Manifests as small, fleshy bumps 24/04/

33 S QUAMOUS C ELL C ARCINOMA 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 24/04/

34 M ELANOMA 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 24/04/

35 S KIN T EARS 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 24/04/

36 P RESSURE U LCERS 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 24/04/

37 P RESSURE U LCERS 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 24/04/

38 P RESSURE U LCERS 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 24/04/

39 W OUND H EALING Phases Inflammation and destruction Proliferation Maturation 24/04/

40 D ELAYED W OUND H EALING 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 24/04/

41 D ELAYED W OUND H EALING Causes Aging Inadequate nutrition Inadequate blood supply Immunocompetence Damage to wound 24/04/

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

43 N AIL P ROBLEMS Fungal infection Inflammation of the nail matrix Hypertrophy of the nail plate 24/04/

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

45 T HREE M AJOR N URSING D IAGNOSES FOR I NTEGUMENT P ROBLEMS Risk for Impaired Skin Integrity Impaired Tissue Integrity Damage to integument, cornea, or mucous membranes Impaired Skin Integrity Damage to epidermal or dermal tissue 24/04/

46 N URSING D IAGNOSES FOR I NTEGUMENT P ROBLEMS 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 24/04/

47 N URSING D IAGNOSES FOR I NTEGUMENT P ROBLEMS 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 24/04/

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

49 D IAGNOSTIC T ESTS FOR I NTEGUMENTARY D ISORDERS 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 24/04/

50 P HARMACOLOGIC T REATMENT O PTIONS Topical antifungal agents Topical antibiotics Systemic antibiotics Selected antimicrobials Aminoglycosides Prescription creams 24/04/

51 N ONPHARMACOLOGICAL I NTERVENTIONS Patient education Awareness and reporting of skin cancer Characteristics of darker skin Prevention Guidelines on sun exposure Wearing protective clothing 24/04/

52 N ONPHARMACOLOGICAL I NTERVENTIONS 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 24/04/

53 N ONPHARMACOLOGICAL I NTERVENTIONS 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 24/04/

54 N ONPHARMACOLOGICAL I NTERVENTIONS 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 24/04/

55 N ONPHARMACOLOGICAL I NTERVENTIONS Managing cellulitis Treat acute infection Immobilization Elevate limb Pain relief Possible anticoagulant therapy Prevent further complications 24/04/

56 N ONPHARMACOLOGICAL I NTERVENTIONS 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.fungalinfectionnail 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 24/04/

57 24/04/ OnychomycosisChronic paronychia

58 N ONPHARMACOLOGICAL I NTERVENTIONS 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 24/04/

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

60 T HE B RADEN S CALE 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 24/04/

61 M OBILITY AND A CTIVITY C ONSIDERATIONS 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. 24/04/

62 S KIN C ARE FOR O LDER P ERSONS Correct bathing procedures Keep skin clean and dry Lubricate with non–alcohol-containing moisturizer Prevent injury Evaluate and manage incontinence Provide dietary support 24/04/

63 N URSING C ARE OF P RESSURE U LCERS Assess and stage the wound Debride necrotic tissue Cleanse 24/04/

64 T REATMENT 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 24/04/

65 N URSING C ARE AND D OCUMENTATION OF S KIN P ROBLEMS Assess risk factors Provide nursing interventions to minimize skin breakdown Document care Evaluate patient status 24/04/

66 K NOWLEDGE -B ASED D ECISION M AKING Current literature Share with colleagues, patients, and their significant others 24/04/

67 H ELPFUL Q UESTIONS W HEN A SSESSING W OUND C ARE P RODUCTS What is the stage, drainage, moisture, or eschar? What are the wound needs? What products are available to manage the wound? 24/04/

68 O NGOING E VALUATION OF N URSING C ARE Family situation Available resources Patient needs and requests Patient and family understanding of the teaching and plan of care 24/04/

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