Gero- skin care-chapter 13 Flashcards
What are the functions of skin?
- Protect underlying structure (heart, lungs, bones, keep out bacteria)
- Regulate body temp.
- Sensory input (vehicle for sensation)
- Store fat
- Metabolism of salt/ water
- Gas exchange (2 way gas exchange O2-CO2)
- Production of vitamin in the presence of sunlight
What is xerosis?
- Extremely dry, cracked, and itchy skin (due to dryness)
What is the most common skin problem associated with aging?
Xerosis
What causes xerosis?
decrease in epidermal filaggrin, which is a protein required for binding of keratin into macrofibrils (leads to separation of the dermal/epidermal surfaces compromising nutrients transfer between skin)
Where xerosis found?
Mostly on the legs, may affect trunk and face
What is pruritis?
Itchy skin (symptom of dry skin)
What does pruritis cause?
Skin injury secondary to scratching b/c of paper-like skin
Leads to increase risk for eczema, excoriations, cracks, and infection
What aggravates (do not use) pruritis?
perfumed detergents, fabric softeners, heat, sweating, restrictive clothing, fatigue, exercise, and medications
What systemic diseases cause pruritis?
Chronic renal failure
Biliary Disease
Hepatic disease
What interventions are done to treat pruritis?
- 60% humidity
- fluid intake (water rehydrates the skin)
- Creams, lubricants, emollients (towel-patted dry/ damp skin after bath), water-laden emulsions w/o alcohol or perfume
- Mineral oils and Vaseline
- Tepid water for bathing or sponge bathing (short durations)
- Use super-fatted soaps (dove, cetaphil, caress, Neutrogena, Oil of Olay bath washes)
- Petroleum Jelly (applied to affected areas before bed)
What is Scabies?
- Pink dots on skin that in circles things like the wrist, knee, ankles, most often around the waste no need to scrape skin (visible).
- Contagious, easily transmitted through close physical contact, intimate or casual, clothing , linen, furniture.
What causes scabies?
Sarcoptes Scabiei
How do you treat scabies?
- Treated ONCE with prescribed lotions and creams
- Clothing/Linens must be washed in hot soapy water and dried with high heat.
- Rooms must be cleaned, vacuumed, and wiped down
What is purpura?
- blood vessel have gotten fragile their thinning we do not have as much blood flow to skin so they are easier to rupture
- little purple dots seen on dorsal forearms and hands (sometimes on face and over eyelids)
Who are susceptible for Purpura?
Person on BLOOD THINNERS (anticoagulants)
What causes skin tears?
- Skin is thin and fragile
- pain, acute, accidental in nature (falls/moving pt.)
- skin shear/tears (if patient on anticoagulants they will bleed uncontrollably)
How are skin tears categorized?
Payne-Martin Classification system
How do you manage skin tears?
- Proper assessment
- Control of bleeding
- Cleanse with nontoxic solution
- Appropriate dressing
- Manage exudate
- prevention of infection/wounds
What are common preventions of skin tears?
- Non adherent dressings
- Lubricants (hypoallergenic)
- Wearing long sleeves/pants on extremities
- Use non-rinse bathing products
- Hydration/nutrition
- Use lift sheet to turn patient.
(what you put on know how to take it off tegaderm, paper tape…etc think of skin being paper thin)
What is keratosis?
Benign growth (non cancerous)
Mainly seen on trunk, face, and neck
White, Waxy, stuck on appearance
Flesh colored, pigmented, various sizes
What is Actinic keratoses?
- Precancerous
- age-related light colored complexion
- rough scaly and paper-like
- pink-to- reddish brown w/ erythematous base
What is herpes zoster (shingles)?
- reactivation of varicella-zoster (chicken pox) virus
- itching, tingling, rash w/ dermatome prior to outbreak of vesicular lesions
- lesions rupture (infectious), crust over (non-infectious), heal (only on one side either left or right unilateral following dermatome only from front-back & back to front)
What cause herpes zoster (shingles) to reactivate?
- stress (emotional or physical) by other illnesses
What treatments are used for Herpes Zoster (Shingles)?
- analgesics, calamine lotion, antiviral agents( causes liver toxicity impact liver function), Zoster vaccine in patients > 60 yrs.
If left untreated (Herpes Zoster) what complications arise?
- postherpetic neuralgia, eye involvement
- get patient to optomologist immediately (notify provider)
What causes Candidiasis (Yeast)?
- fungus Candidas albicans found on the skin
What are the risk factors for Candidiasis? (may be a select all that apply)
- Obesity
- malnourishment
- Antibiotics (knock out the good bacteria instead of bad)
- Steroid use (will feed the bacteria)
- Immunocompromised
- Chemotherapy
- Diabetes (diabetics)
Where is candidiasis found?
- warm, moist areas of skin, like skin fold, axilla, groin
- breast of females/larger males
Prevention/Treatment of Candidiasis?
- Provide adequate drying (hair dryers in low setting for hard-reach areas)
- Dry folded washcloth or cotton sanitary pad (under breast/skin folds)
- Loose fitting underwear/clothing (Damp? change!)
- Avoid incontinent products that are tight/touches skin
- Optimize nutrition/glycemic control
- Treatment: Anti-fungal creams especially OTC use 7-14 days or until symptoms subside
- AVOID POWDERS, CREAMS, LOTIONS
What is the most common cancer?
- Cancer of the skin
- Caucasian population at higher risk (all skin types can get it)
- Minimize sun exposure
- 2.5 times more likely to develop before age 35
What is basal cell?
- mainly in older people
- slow growing metastasis rare
- triggered by extensive sun exposure/burns
- early detection/treatment minimizes damage
- 1.5 times more likely to develop before age 35
What is squamous cell?
- aggressive/high incidence metastasis
- Risk factor: sun exposure, skin (fair),
- immunosuppression
- maybe overlooked
- treatment: depends on size, histology, presentation
What is Melanoma?
- Neoplasm of Melanocytes
- Highest in caucasians
How’s does Melanoma presents?
- Multicolored, raised, asymmetrical, irregular borders (may not have completely round shape)
- let provider know
- most common In men
- most common cancer in people less than 30 years
What are risk factors for Melanoma?
- more than 50 moles
- sun sensitivity
- history of excessive sun exposure
- severe sunburns
- tanning beds (increase risk by 75% when started before age 35)
What are the danger signs of melanoma?
A- Asymmetry of mail (one that is not regularly round/oval)
B- Border irregular
C- Color variation (area of black, brown, tan, blue, red, white, or combination)
D- Diameter greater than size of pencil eraser
E- Elevation and enlargement
What are pressure ulcers?
“localized injury” over bony prominence (sacrum, lateral ankles, lateral knees, heels(25-35%), greater trochanter, pinna of ear, occiput, scapulae, elbows where weight comes down on the bony areas (bed/chair), as a result from pressure, or pressure combines with shear.
- pressure injury take up body’s energy and ability to heal
- major cause of morbidity/ mortality worldwide
- person w/ PVD at greater risk of PU
- If PU is found on heels (get heels off of bed, tint blanket)
What is Stage I PU?
Red, purple, discoloration of INTACT SKIN
What is Stage II PU?
Red discoloration of skin with OPEN AREAS (first layer of skin broken-epidermis)
What is Stage III PU?
EXCORIATED, red, SANGUINEOUS TISSUE
What is Stage IV PU?
ULCER showing MUSCLE
What is Unstageable?
BLACK NECROSIS IN CENTER
How are pressure injuries classified?
-Highest stage achieved although it is getting better it is still considered the stage it was prior.
-
What are the risk factors for PU?
- Changes in skin
- Comorbid illnesses
- Nutrition Status
- Frailty
- Surgical procedure (orthopedic/cardiac)
- Cognitive deficits
- Incontinence
- Reduced mobility
- Consider intensity and duration of pressure and tissue tolerance (How long can that person sit in position before skin become negatively effected)
- Redness or blanching may NOT be the first sign of PU in darker pigmented persons, but may look purplish incisor or look like a bruise
What is the treatment for PU?
- Prevention:
+ position patient q2hrs use a draw sheet (prevent shear and friction) / soft pillow between knees and other bony prominences.
+ Assess the skin during activities, moving patient, bathing, change briefs …etc
- Intervention: addressing limited mobility, compromised skin integrity, and nutritional support
- Team approach (Multiple people)
What scale do you use to assess the skin?
Braden Scale Nutritional Evaluation Positioning Incontinence Care Wound Specialist (call at stage I for early prevention) Labs
Why is skin the nursing sensitive quality indicator?
- maintenance of skin is an indicator of if pt’s are receiving quality care or not.
- impair recovery and rehabilitation (think about pt. w/ knee sepsis it impaired his recovery and prolonged rehabilitation)
- increase of mortality (death)
- medicare/medicaid do not reimburse treatment for PU acquired during admission
Which is the most common malignant skin cancer? Melanoma Squamous Basal Actinic keratosis
- Basal Cell carcinoma (How?)
What is the #1 treatment for PU? Prevention Early Identification Thorough patient history Risk assessment
- Prevention (How?)
