10. Integumentary function & Sleep Flashcards
Age-related changes
Risk factors
affecting integumentary function
- exposure to UV light
- adverse med effects
- personal hygiene habits
- conditions that increase risk for pressure ulcers, skin tears
Negative functional consequences affect integumentary wellness
- wrinkles
- dry skin
- slower wound healing
- reduced sweating, shivering, tactile sensitivity
- increased susceptibility for skin cancer
- increased susceptibility to burns, bruises, skin breakdown
2 Pathologic conditions
affecting integumentary function
- Skin cancer- 3 types
General warning signs:
-new skin lesions that grow in size
-new wounds that don’t heal within 2 months
-flat patch of scaly skin that won’t go away - Basal cell carcinoma
-most common
-often on head, neck
-can be treated well if caught early
-if left untreated, it will invade surrounding tissue
Appearance:
-flat
-firm
-pale
-small
-pink or red
-skiny, waxy
-bleeds easily
-depression in center
-blue, black, or brown patches
-one or more abnormal blood vessels visible - Squamous cell carcinoma:
-on head, neck, arms, hands
-early detection and treatment is important
Appearance:
-firm, red nodule
-flat sore with a scaly crust
-on an old scar or ulcer: new sore or raised area
-on lip: rough, scaly patch that may develop to an open sore
-in mouth: red sore or rough patch
-on or in anus or on genitals: red, raised patch or wart-like sore - Melanoma
-most serious type of skin cancer
-more common in men
Risk factors:
-light hair
-fair skin
-family hx
-sunburn susceptibility
-multiple severe sunburns
-multiple nevi on extremities
Appearance:
-most important: a new spot on the skin that is changing in size, shape, colour
-another important sign is that is looks different from all the other spots on our skin
-get checked by a doc if true
A- asymmetry
B- borders
C- colour
D- diameter
E- evolving - Pressure Ulcers
-any lesion caused by unrelieved pressure that results in damage to underlying tissue
-usually occur at a bony prominence
-are staged to classify the degree of tissue damage
Stage 1:
-persistent redness
-reposition q2h
-use moisture creams
Stage 2:
- partial-thickness skin looss
- superficial
Stage 3:
- full-thickness skin loss
- measure with qtip for tunneling open wound
Stage 4:
- full-thickness tissue loss
- necrotic tissue
Unstageable:
-base of wound is covered by dead tissue so you cannot estimate how deep
Suspected deep tissue injury:
- looks bruised, maroon colour
- damaged tissue but do not see open wound or extent of depth
Assessment: Braden Sacle
-used to predict risk for pressure ulcers
-prompts early intervention for high risk scores
6 criteria:
-sensory perception
-moisture
-activity
-mobility
-nutrition
-friction and shear
0-23
23=good, less risk
want a high score
Interventions
Teach about self care of healthy skin:
- sun exposure
- hydration
- inspection for changes
Teach about skin cancer detection and treatment
Prevent and manage pressure ulcers
- reposition q2h
- towels, clothes, pillows under bony prominences
Age-related changes
to sleep and rest
- decreased time in deep sleep
- increased time in light sleep
- reduced time spent dreaming
Risk factors
- pain
- nocturia
- anxiety, depression
- beliefs, attitudes, myths
- adverse medication effects
- pathologic conditions (ex nocturnal myoclonus. - jerky, uncontrollable movements)
- environmental factors
Negative consequences
- increased time to fall asleep
- being roused from sleep more frequently
- increased difficulty returning to sleep
- increased time in bed with reduced sleep
- poor quality of sleep
Restless Leg Syndrome
-common neurological disorder
-intense urge to move legs
-no cure
-more common in women
-unknown cause, perhaps reduced iron to brain
Symptoms:
-aching
-burning
-painful
-itchy
-tense
-discomfort
- pathologic conditions
affecting sleep
- Restless Leg Syndrome
-common neurological disorder
-intense urge to move legs
-no cure
-more common in women
-unknown cause, perhaps reduced iron to the brain
Symptoms:
-aching
-burning
-painful
-itchy
-tense
-discomfort
Risk Factors:
-family hx
-use of antipsychotics, antidepressants, antiemetic, and neuroleptics
-iron and B12 deficiency
-herbal and OTC can worsen symptoms
Interventions for RLS:
- avoid caffeine, alcohol
- massage, acupuncture
- daily exercise, stretching
- apply heat/cold
- small dose oof melatonin - 3mg
- vitamins to correct specific anemia
- relaxation techniques
- Obstructive Sleep Apnea (OSA)
-involuntary cessation of airflow for 10 sec+, 5-8x/hr
-causes: the muscles that hold the throat open start to relax during sleep and block the airway
Symptoms:
-daytime fatigue
-morning headaches
-diminished mental acuity
-loud snoring and brief periods of silence
- OSA is bad because it can cause CV damage such as:
- HTN
- stroke
- CAD
- arythmias
Risk Factors:
-biggest factor- craniofacial anatomic features (nose)
-obesity
-diabetes
-stroke
-Parkinson’s disease
-CHF
-genetic predisposition
-alcohol or meds that depress the respiratory
center
Treatment:
-continuous positive airway pressure (CPAP) “gold standard”
-arranged through resp. services after diagnosis
-non-adherence is common because the device is uncomfortable at night
Interventions for sleep
Teach about interventions for sleep wellness:
- make a bedtime ritual
- maintain the same schedule for waking, resting, sleeping
- avoid caffeine after 1pm
- pre-bedtime food that promotes sleep
- regular PA
Environmental modifications:
- dimly lit room
- comfy bed
Relaxation and mental imagery
Teaching about medications and risk factors
Addressing obstructive sleep apnea (OSA)
Ask what they experience. - what disrupts or is necessary for THEIR sleep?
