Chapter 13 Skin Flashcards
- Decreased protection against UV rays
- Slower wound healing
Epidermis
-20% Loss of thickness – skin tears and bruises
more easily
-Dermal blood vessels decrease – cooler skin temp, and increase susceptibility to skin cancer
Dermis
Extremely dry, cracked, and itchy skin
Most common skin problem associated with aging
Caused by decrease in epidermal filaggrin, which is a protein required for binding of keratin into
macrofibrils
Seen primarily on the extremities, mostly legs, but may affect trunk and face.
Best practices : Hydration
Xerosis
Itchy skin (not a disease, but a symptom)
Can cause skin injury secondary to scratching
Aggravated by perfumed detergents, fabric softeners, heat, sweating, restrictive clothing, fatigue, exercise, and medications
May result from systemic disease such as chronic renal failure, biliary, or hepatic disease
Failure to control itching increases risk for eczema, excoriations, cracks, infection
Pruritis
Causes intense itching
Caused by tiny mite, Sarcoptes scabiei
Contagious, easily transmitted through close physical contact; intimate or casual
Scabies with thick crust contain large number of mites and eggs
May be transmitted on clothing, linen, furniture
Diagnosed visually or via skin scraping
Treated with prescribed lotions and creams; clothes and linens need
to be washed in hot, soapy water and dried with high heat; rooms cleaned and vacuumed
Scabies
Fragility of dermal capillaries secondary to dermal thinning causing blood vessels to rupture
Extravasation of blood into surrounding tissue is
called purpura
Commonly seen on dorsal forearm and hands
Increases with age
Persons on blood thinners are more susceptible
Purpura
Occurs because skin is thin and fragile
Painful, acute, accidental in nature
Categorized according to the Payne-Martin classification system
Management: proper assessment, control of bleeding, cleanse with nontoxic solution, appropriate dressing, management of exudate, and prevention of infection/wounds
(consider the patient on anticoagulants).
Skin tears
Benign growth Mainly see on trunk, face, scalp, and neck Waxy, raised, stuck-on appearance Flesh colored or pigmented, various sizes
Keratosis
Seborrheic Keratosis
Precancerous Related to exposure to UV light Risk: increased age, fair complexion Rough scaly sandpaper patches Pink to reddish brown with erythematous base
Actinic Keratosis
Viral infection caused by reactivation of the varicella-zoster (chicken pox) virus
Preceded by itching, tingling, rash along the
dermatome prior to outbreak of vesicular lesions
Lesions rupture, crust over, and heal
Infectious until it crusts over
Treatment: analgesics, calamine lotion, antiviral agents, Zoster vaccine if greater than 60 years
Complications: postherpetic neuralgia, eye involvement
Herpes zoster (Shingles)
Caused by fungus Candida albicans found on the skin
Risk factors for infection: obesity, malnourishment, antibiotic or steroid use, immunocompromised, chemotherapy, and diabetes
Found in warm, moist areas of skin, like skinfolds, axilla, groin
Commonly called “thrush” when inside the mouth
Candidiasis
Skin Cancer
Cancer of the skin is the most common cancer
Major public health problem on the rise
One in five Americans will develop skin cancer in
the course of a lifetime
Caucasian populations are at a higher risk
All skin types should minimize sun exposure
Most common malignant skin cancer Mainly in older persons Slow growing and metastasis rare Triggered by extensive sun exposure, burns, chronic irritation, or ulceration Early detection and treatment minimizes damage
Basal cell
Second most common Aggressive and high incidence of metastasis Major risk factors are sun exposure, fair skin, immunosuppression Slightly different clinical presentations and may be overlooked Treatment depends on size, histology, and patient preference
Squamous cell
Neoplasm of the melanocytes
Accounts for less than 2% of all skin cancers
Highest incidence in Caucasians
Multicolored, raised, asymmetrical, irregular borders
More common in men than women
Risk factors: more than 50 moles, sun sensitivity, history
excessive sun exposure, severe sunburns, tanning
beds.
Melanoma
Indoor tanning
Melanoma is most common cancer in people less than 30 years
Indoor tanning increases risk of melanoma by 75% when started before age 35
2.5 times more likely to develop than squamous cell
1.5 times more likely to develop than basal cell
Goal of Healthy People 2020 is to reduce the use of indoor tanning devices
Pressure Ulcers
70% of pressure ulcers (PU) occur in older adults
A PU is a “localized injury” to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear
Affects health and quality of life
Considered a geriatric syndrome
Major cause of morbidity and mortality worldwide
National Pressure Ulcer Advisory Panel has developed a PU registry to track the problem
Pressure Ulcers Characteristics
Most frequently occur on the posterior aspects of the body, especially sacrum, heels, and greater
trochanter
May also be seen on lateral knees and ankles, pinna of the ears, occiput, elbows, and scapulae
25%-35% of PU are on the heels
Persons with peripheral vascular disease at greatest risk for development of heel ulcers
Pressure Ulcers Classification
Pressure injuries are always classified by the
highest stage “achieved”
Reverse staging is never used
Pressure Ulcers Risk Factors
Changes in skin Comorbid illnesses Nutrition status * Frailty * Surgical procedure (orthopedic/cardiac) Cognitive deficits* Incontinence* Reduced mobility*
-Redness or blanching may NOT be the first sign of PU in darker pigmented persons, but may look purplish in color or look like a bruise
Pressure Ulcers; Prevention of PU
Prevention is key
A comprehensive PU program with multiple interventions
appears to improve outcomes
Significant interventions include addressing limited
mobility, compromised skin integrity, and nutritional
support
A team approach is best when addressing this complex problem.
Position the patient every two hours Prevent friction and shearing when re- positioning and moving the patient Assess the skin often – when moving the patient, bathing, changing brief, etc. Use the Braden Scale
-Pressure Ulcers Can significantly impair recovery and
rehabilitation and impact quality of life
Increased risk of mortality
High prevalence of health care litigation
Centers for Medicare and Medicaid consider
PU a preventable adverse event and do not
reimburse treatment for PU acquired during
admission
Assessment of PU
Thorough assessment of skin • Braden Scale Nutritional evaluation Laboratory studies Positioning Incontinence care -Wound specialist nursing consult when indicated
Which is the most common malignant skin cancer?
a. Melanoma
b. Squamous cell carcinoma
c. Basal cell carcinoma
d. Actinic keratosis
c. Basal cell carcinoma
What is the #1 treatment of PU?
a. Prevention
b. Early identification
c. Thorough patient history
d. Risk assessment
a. Prevention
