CH 25: Skin Health Flashcards
effects of aging on the skin
Flattening of dermal-epidermal junction, reduced thickness and vascularity of the dermis, decreased rate of epidermal turnover, degeneration of elastic fibers, increased coarseness of collagen, and reduction in melanocytes _ lines and wrinkles, thicker nails, and graying hair
Increased fragility of skin _ heightened risk of skin tears, bruising, pressure injury, and skin infections
Affects body image, self-concept, reactions from others, socialization, and other psychological factors
Other problems in body _ poor skin health
Photoaging _ loss of elasticity and wrinkling of skin; sun-induced premature aging of skin
promotion of skin health
Practices in early life influence later life
Avoid drying agents, rough clothing, highly starched linens, and other irritating items
Good skin nutrition and hydration with activity, bath oils, lotions, and massages
Excessive bathing is hazardous to skin
Early attention to and treatment of pruritus
Sunscreen with SPF >15 applied to entire face and body 15 min before exposure Q2 hours
Cosmetic surgery
–Explore reasons
–Encourage safe practices
promotion - skin
Skin inspection regularly
Asymmetry
Border irregularity
Color
Diameter
Elevation
Change in the feeling
promotion - look
Look their best and make the most of their appearance
promotion - remove
NO cream, lotion, or miracle drug will remove wrinkles, lines, or return youthful skin
promotion - encourage
Encourage cosmetics to protect skin and maintain an attractive appearance
promotion - improve
Improve society’s thoughts and acceptance on aging; appreciation of natural beauty
most common skin condition with older adults
PRURITUS
pruritus it due to:
Due to atrophic changes; precipitated by anything drying the skin (excessive bathing, dry heat, DM, liver disease, uremia, cancer, mental health, hyperthyroidism)
if pruritus is not corrected:
traumatizing scratching leading to breakage of skin and infection
tx for pruritus
Bath oils, moisturizing lotions, massage, vitamin supplements, topical zinc, antihistamines
Small, light-colored lesions on exposed areas
accumulated keratin
keratosis
precancerous: close observation for changes
Dark, wart-like projections of skin
seborrheic keratosis
occurence of seborrheic keratosis
Occur on various parts of the body and can increase in size and number with age
Medical eval to differentiate if precancerous
tx of seborrheic keratosis
gauze pad with oil (small)
freezing agents or curettage and cauterization (large)
vascular lesions in older adults
Weak vein walls decrease ability to respond to increased venous pressure _ varicose veins
Poor venous return and congestion _ edema and poor tissue nutrition _ pigmented, cracked, exudate _ stasis dermatitis
Easily leads to leg ulcers
tx of vascular lesions
good nutrition (diet with vitamins & protein)
weight reduction
elevation of legs
avoid sitting with crossed legs and standing for long
elastic support hose helpful but may be difficult for older adult
ligation and stripping of veins
characteristics of basal cell skin cancer
Most common form; commonly on face
Risk increases with age, sun exposure, UV radiation, therapeutic radiation
Flesh-colored moles with pearly appearance
Grows slowly, doesn’t metastasize
characteristics of squamous cell skin cancer
From sun exposure, arsenic and radiation exposure, and suppression of immune system
Firm, skin-colored or red nodules
Can metastasize to lip
characteristics of melanoma skin cancer
Metastasizes and more deadly if not caught early
Increased incidence with age; sun exposure
prevention of skin cancer
Suspicious lesions should be evaluated and biopsied! Early detection is key!
Teach to assess skin
complications of pressure injury
Tissue anoxia and ischemia from pressure necrosis, sloughing, and ulceration
older adults are high risk of pressure injuries due to:
Fragile skin
Poor nutritional state
Reduced sensation of pressure and pain
Immobile and edematous
require a longer time to heal
Assessment done on admission and Qshift
Braden Scale (Sensory Perception, Activity, Mobility, Moisture, Nutrition, and Friction and Shear)
Norton Scale
Pressure Sore Status Tool
Review individual risk
State the highest stage at which the injury was assessed to be
hyperemia
Redness of skin appears quickly and disappear quickly when pressure is removed; no break in skin
tx of hyperemia
use of a square adhesive foam; protect skin with tegaderm
ischemia
Redness of skin, edema, and induration from 6 hours of unrelieved pressure
Epidermis may blister
tx of ischemia
clean with NS or product by agency protocol
necrosis
Unremitting pressure >6 hours with ulceration with a necrotic base
tx of necrosis
transparent dressing to protect from bacteria but permeable to oxygen and water vapor; thorough irrigation; topical antibiotics
deep tissue damage
If not relieved in necrosis stage, it can extend to fascia and bone; eschar present with possible bone destruction and infection
tx of deep tissue damage
debridement
most important of pressure injury
PREVENT them
nursing considerations for pressure injuries
Prevent unrelieved pressure
Encourage activity/turning
Prevent shearing (not allowing client to slide down in bed)
Lift instead of pull
Disperse pressure with pillows, alternating pressure mattresses, and flotation pads
Keep bed wrinkle free and free of foreign objects
Move and shift weight if in a chair
Heel protectors and Lamb’s wool to prevent irritation
High-protein, vitamin-rich diet
Keep skin clean and dry; blot to dry
Massage bony prominences and ROM
Incontinence care
Treatment depends on type of injury
Understand the unique risks and prevention measures for each person
promoting normalcy with skin conditions in older adults
Patient has normal needs and feelings
Be aware of reactions from others; reassure visitors and provide instruction for any special precautions
Prevent wrinkles with decreased sun exposure and increased sunscreen use
Seek reputable providers
Use of alternative therapies for skin conditions in older adults
Aloe vera, chamomile extract, witch hazel, thyme, sage, lemon, lavender, rosewood, cinnamon
Biofeedback, guided imagery, relaxation, acupuncture
Zinc, magnesium, Vitamin A/B/B6/E
Discuss with provider
ABCDEF
asymmetry
border irregularity
color
diameter
elevation
change in feeling
SOAP
*Subjective – The complaint, problem, issue, concern, history, what makes it better or worse?
How did the skin issue begin? Had before? Just one location or where else?
Medications? Allergies? Etc?
Work history – Outdoor, Indoor
Use of starched linens or clothes, irritating clothes
Use of oils, lotions, etc
How often they bath?
Use of sunscreen?
What the patient Tells you.
*Objective – Observations, Vital signs, (remember fever in older adults aren’t always high temp), facial expressions, body language
*Assessment - ABCDEF – Skin inspection
*Plan – Nursing Care Plans
biggest skin risk for older adults
ex:
trauma
Abrasions, Lacerations, Bruises/Contusions, Hematomas
mechanical force exerted when skin is dragged across a coarse surface- will be visible
friction
mechanical force that acts on an area of skin in a direction parallel to the body’s surface with pressure exerted. - will not be visible at first (Pressure Injuries)
shearing
