CH 25: Skin Health Flashcards by Tyece Henry

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

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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

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promotion - skin

Skin inspection regularly
Asymmetry
Border irregularity
Color
Diameter
Elevation
Change in the feeling

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promotion - look

Look their best and make the most of their appearance

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promotion - remove

NO cream, lotion, or miracle drug will remove wrinkles, lines, or return youthful skin

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promotion - encourage

Encourage cosmetics to protect skin and maintain an attractive appearance

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promotion - improve

Improve society’s thoughts and acceptance on aging; appreciation of natural beauty

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most common skin condition with older adults

PRURITUS

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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)

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if pruritus is not corrected:

traumatizing scratching leading to breakage of skin and infection

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tx for pruritus

Bath oils, moisturizing lotions, massage, vitamin supplements, topical zinc, antihistamines

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Small, light-colored lesions on exposed areas
accumulated keratin

keratosis

precancerous: close observation for changes

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Dark, wart-like projections of skin

seborrheic keratosis

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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

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tx of seborrheic keratosis

gauze pad with oil (small)
freezing agents or curettage and cauterization (large)

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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

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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