Lecture 3 Integument - changes that affect the skin

Question 1

The best way to prevent skin wrinkles is to _

Answer 1

Avoid exposure to ultraviolet light.

Question 2

Functions of the skin

Answer 2

1. Thermoregulation.
2. Excretion of metabolic wastes.
3. Protection of underlying structures.
4. Synthesis of vitamin D.
5. Maintenance of fluid and electrolyte balance.
6. Sensation of pain, touch, pressure, temperature, and vibration.

Question 3

Age-related changes that may impact skin wellness

Answer 3

1. ↓ epidermal proliferation.
2. Thinner dermis, flattened dermal-epidermal junction.
3. ↓ moisture content.
4. ↓ sweat and sebaceous glands.

Question 4

Epidermis

Answer 4

The relatively impermeable outer layer of skin that serves as a barrier, preventing both the loss of body fluids and entry of substances from the environment.

Question 5

Langerhans cells

Answer 5

1. Antigen-presenting immune cells in the epidermis that serve as macrophages and thus prevent infection.
2. Decrease in quantity with age, particularly in sun-exposed skin (decrease of 50-70% in these areas).

Question 6

Dermis

Answer 6

The layer of skin beneath the epidermis, made up primarily of collagen and serving the functions of temperature regulation, sensory perception, and nourishment for all skin layers.

Question 7

Dermal-epidermal junction

Answer 7

1. Region between the dermis and epidermis; connected by papillae.
2. Flattens with age, slowing the transfer of nutrients and oxygen between the dermis and epidermis.

Question 8

The _ is the inner layer of fat tissue that protects the underlying tissues from trauma.

Answer 8

Subcutis.

Question 9

_ sweat glands, which are important for thermoregulation, open directly onto the skin surface and are most abundant on the palms, soles, and forehead.

Answer 9

Eccrine.

Question 10

_ sweat glands, whose sole function is to produce secretions, open into hair follicles, primarily in the axillae and genital area.

Answer 10

Apocrine.

Question 11

_ glands continually secrete sebum, which prevents the loss of water and serves as a mild retardant of bacterial and fungal growth.

Answer 11

Sebaceous.

Question 12

Xerosis

Answer 12

1. Dry skin; likely to be exacerbated when relative humidity is below 30%, or as a result of fluid loss from diuretics.
2. Found in up to 85% of non-institutionalized older people.

Question 13

_ agents are the type of drug most commonly associated with hair loss.

Answer 13

Cytotoxic (e.g., methotrexate).

Question 14

General skin characteristics

Answer 14

1. Largest body organ (21 square feet).
2. Normally dry, supple, and acidic (pH 4-6) - helps fight bacteria.
3. “Brick and mortar” construction (cells are bricks, skin oils are the mortar).
4. Proper hydration required for prevention of Trans Epidermal Water Loss (TEWL).
5. Total thickness of the epidermis and dermis varies, but averages just over 2 mm.

Question 15

Flattening of the dermal-epidermal junction places older adults at increased risk for _

Answer 15

Skin tears.

Question 16

The stratum lucidum is the layer of skin that is found only on _

Answer 16

The palms of the hands and soles of the feet.

Question 17

Epidermal mitosis is inhibited by the administration of _

Answer 17

Steroids, chemotherapy, and NSAIDs (at high doses).

Question 18

Older adults tend to have more allergic reactions because the number of _ increases with age.

Answer 18

Mast cells.

Question 19

The point of origin for a pressure ulcer is _

Answer 19

Where the bone hits the muscle (not on the surface of the skin).

Question 20

Lunula

Answer 20

The pale half-moon shape at the base of a fingernail; decreases in size with age.

Question 21

Most soaps are _, which results in the removal of skin lipids, increases water loss, and compromises the barrier function of the skin.

Answer 21

Alkaline.

Question 22

A substance that softens the skin is referred to as a(n) _

Answer 22

Emollient.

Question 23

A substance that attracts moisture to the skin is referred to as a(n) _

Answer 23

Humectant.

Question 24

The primary ingredient in skin barrier creams is _

Answer 24

Dimethicone.

Question 25

Older adults who are incontinent of stool should utilize a barrier cream that contains _

Answer 25

Zinc oxide.

Question 26

Positive _ balance is essential for wound repair.

Answer 26

Nitrogen.

Question 27

Infection prolongs the _ and causes additional tissue damage.

Answer 27

Inflammatory phase (wounds cannot heal in this phase).

Question 28

There is some evidence that topical _ can be used to partially counteract the negative effect of corticosteroids.

Answer 28

Vitamin A.

Question 29

Burow’s solution

Answer 29

An aqueous solution of aluminum acetate that can be used to relieve the itching and stinging of irritated, inflamed skin and helps stop the growth of bacteria and fungi.

Question 30

Interventions for dry, scaly skin

Answer 30

1. Soak in a 1:3 vinegar/water solution.
2. Urea-based products - Atrac-Tain.
3. Modified petrolatum products - Elta, Aquaphor.

Question 31

Friction vs. shear

Answer 31

1. Dragging a patient across a surface generates friction - heat and blisters.
2. A patient sliding down a bed generates shear - the skin stays in one place while the muscle and bone move downward, and the layers of skin begin to separate from one another.
   (A patient who uses a wheelchair is prone to both friction and shear injuries.)

Question 32

Intertrigo

Answer 32

1. Inflammatory condition of the skin folds, induced or aggravated by heat, moisture, maceration, friction, and lack of air circulation.
2. Frequently worsened or colonized by infection, which most commonly is candida (yeast). Treatment: Nystatin powder (not cream, which keeps the skin moist).

Question 33

Skin tear with a flap - intervention

Answer 33

Rinse with wound cleanser, roll flap back into place and secure with Steri-Strips or similar tape. Select dressing based on planned frequency of dressing changes and amount of drainage.

Question 34

Skin tear with tissue loss - intervention

Answer 34

Avoid additional damage (no adhesive dressings); absorb exudate and maintain a moist wound surface. Use Mepilex, Mepitel, or Vaseline gauze (never Tegaderm).

Question 35

Stage I pressure ulcer - non-blanchable erythema

Answer 35

1. Intact skin with non-blanchable redness of a localized area usually over a bony prominence. The area may be painful, firm, soft, warmer or cooler as compared with adjacent tissue.
2. May be difficult to detect in dark skin tones - darkly pigmented skin may not have visible blanching; its color may differ from the surrounding area.
3. May indicate “at risk” persons.

Question 36

Stage II pressure ulcer - partial thickness

Answer 36

1. Partial-thickness loss involving epidermis and possibly dermis.
2. Presents as shallow, superficial, open ulcer with a red-pink wound bed, without slough.
3. May also present as an intact or open/ruptured serum filled blister.
4. This stage is often incorrectly applied to skin tears, tape burns, perineal dermatitis, maceration, or excoriation.

Question 37

Stage III pressure ulcer - full thickness skin loss

Answer 37

1. Full-thickness skin and tissue loss. Subcutaneous fat may be visible; however, muscle, tendon, or bone are not exposed.
2. Slough may be present, but does not obscure depth of tissue loss.
3. May include tunneling and undermining.

Question 38

Stage IV pressure ulcer - full thickness tissue loss

Answer 38

1. Full-thickness tissue loss with exposed muscle, tendon, or bone.
2. Slough or eschar may be present on some parts of the wound bed.
3. Often includes undermining and tunneling.

Question 39

Unstageable pressure ulcer - full thickness skin or tissue loss - depth unknown

Answer 39

Full-thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green, or brown) and/or eschar (tan, brown, or black) in the wound bed. The bottom of the wound is not visible.

Question 40

Suspected deep tissue injury - depth unknown

Answer 40

Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue.

Question 41

When using the Braden Scale for Predicting Pressure Ulcer Risk, interventions begin at _

Answer 41

A score of 15 or below (end of mild-risk category; 14 indicates moderate risk).

Question 42

The skin receptors that respond to vibration are _

Answer 42

Pacinian and Meissner’s corpuscles.

Question 43

The most common type of skin cancer is _

Answer 43

Basal cell carcinoma.

Question 44

_ is the most serious type of skin cancer and the one most likely to be fatal.

Answer 44

Melanoma.

Question 45

The outer “horny” layer of the skin is called the _

Answer 45

Stratum corneum.

Question 46

The layer of the skin where nerve endings are found is called the _

Answer 46

Stratum granulosum.

Question 47

Areas of the skin that never regenerate after injury include _

Answer 47

1. Hair follicles.
2. Sebaceous glands.
3. Subcutaneous tissue.

Question 48

Specific nutrients required for wound repair include _

Answer 48

1. Protein.
2. Carbohydrates and fats.
3. Ascorbic acid (vitamin C).
4. Iron.
5. Zinc.