OS PO3 - Skin integrity Flashcards
What is trans-epidermal water loss?
Water that diffuses through the skin and evaporates.
How is the skin a mechanical barrier?
It blocks pathogens, so if the skin is damaged it provides an opening for pathogens.
How is the skin a biological barrier?
Has trillions of harmless bacteria that protect against pathogens.
How does the skin control fluid loss?
Via sweat glands (sudoriferous, eccrine and approcrine glands are sweat glands at different parts of the body.
These allow the body regulate its temperature through fluid loss.
What does sweat contain?
- Mainly water
- Salt
- Dermcidin (an anti microbial peptide that protects the skin from pathogens)
- Uric acid
How does the skin protect against UV rays?
UV activates the melanin in the dermis, and radiation oxidises melanin, absorbing its harmful rays.
Over exposure to UV can result in sunburn.
Why does skin loose elasticity with age?
Elastin is a protein that combines with microfibrils to form elastic fibres, allowing the skin to stretch and retract.
The protein collagen supports cell structure and oestrogen stimulates the production of oil to keep the skin supple, smooth and plump looking.
As we age, hormones change and collagen production decreases.
Why does our skin thin as we age?
Due to less collagen production, in particular the epidermis thins.
Skin is then more fragile and prone to damage.
Why do we regenerate slower as we age?
Our cell cycle slows to 60-90 days in a persons 50’s, slowing the healing process.
Collagen also decreases, which has an impact on wound healing.
Why do we loose fat as we age?
Subcutaneous fat decreases.
Why do we experience a reduction in the nutrients we absorb as we age?
Our body systems slow down.
The digestive system absorbs less nutrients because the capillaries have less muscle strength to coordinate vasodilation and vasoconstriction.
How does nicotine impact skin integrity?
Nicotine damages the capillaries, reducing the flow of oxygenated blood to the skin cells.
Nicotine also changes the structure of the skins fibroblasts, which contain collagen, causing the skin to age prematurely and slow healing.
How does alcohol affect skin integrity?
It is a diuretic, dehydrating the skin and damaging its composition.
It can worsen psoriasis and cause skin yellowing due to liver damage from over consumption.
What is a diuretic?
It causes water to be lost from the body.
How diet impact skin integrity?
A lack of fat and protein can damage the skin as the skin is made up of this.
How does pollution impact skin integrity?
Smoke and car exhaust contain complex chemical compounds, reducing the skins barrier effect, allowing chemicals to be absorbed and act as irritants.
How do blood thinners, anticoagulants and statins affect skin integrity?
Blood thinners diminish the dermis and cause you to bleed longer.
Anticoagulants make wounds hard to heal and it’s harder for blood to clot.
Statins affect the subcutaneous fat.
What is an irritant?
A substance that damages the outer layer of the skin.
What is an allergen?
A substance that cases the immune system to overreact.
What is contact dermatitis?
A non allergic reaction in contact with an irritant, causing. rash, blisters, itching and burning sensation.
This may appear red on light skin and darker, purple or grey on darker skin.
How do you treat contact dermatitis?
- Avoid the irritant
- Emollient
- For severe symptoms a topical corticosteroid or oral one if it’s affecting a larger area
What is a petechial rash?
Petechiae are tiny purple, red or brown spots on the skin (typically the arms, legs, stomach and buttock).
These are little spots of bleeding under the skin that won’t turn colour when pressed.
What causes a petechial rash?
- Medication like phenytoin and penicillin
- Infectious diseases like covid, rubella, strep and endocarditis
- Vitamin D deficiency
How do you treat a petechial rash?
Dependant on cause.
Home remedies include rest, fluids and a cold compress.
If it’s caused by a bacterial infection give them antibiotics.
Corticosteroids can reduce swelling in vessels.
Vitamin C and K supplements for deficiencies.
Cancer treatment if it’s caused by leukaemia.
What are chicken pox?
An itchy, spotty rash with a fever, headache, sore throat, stomach ache and loss of appetite.
When is chicken pox contagious?
From 24 hours before the rash appears to when it scars over.
What are the stages of chicken pox?
Stage 1 - Spots appear
Stage 2 - Spots fill with fluid and become itchy blisters that may burst
Stage 3 - Blisters scab over.
How do you treat chicken pox?
- Paracetamol
- Calamine lotion to relieve itching
- Cool baths with oat for itchiness
- Rest
- Fluids
What are hives?
Itchy raised bumps, or blotches of red or darker than the skin surrounding.
They happen in contact with an allergen.
Hives are caused by the release of histamine, causing blood vessels to leak fluid and swell.
How do you treat hives?
- Non drowsy antihistamines
- Cold cloth to the area
- Cool baths
- Anti itch cream
- Loose clothes
- SPF
What is a blister?
The form under the dermis as a fluid filled sac, filled with clear liquid, blood or a milky white puss if it’s infected.
They’re painful and itchy.
How do blood blisters form?
If the skin is pinched, blood floods that area from the broken vessels.
There is also damage to lower layers of the skin, forming a blister.
How do friction blisters form?
Rubbing in the skin causes clear fluid to build up in the upper layer of the skin.
How do heat blisters form?
From burns or sunburns.
How do you treat blisters?
They general heal on their own in a few days.
- Wash with mild soap
- Antibacterial cream or ointment
- Bandage or gauze changed once a day.
Don’t pop or peal it and the skin on top is protecting the deeper layers.
What is psoriasis?
Red, pink or purple patches on the skin that are dry and scaly.
This occurs when the immune system overreacts, causing skin cells to multiple too quickly.
This can be genetic or caused by environmental factors.
How do you treat psoriasis?
Mild - Vitamin D creams to slow the production of skin cells and anti inflammatory medication.
More severe - Phototherapy 2-3 times a week for 6 weeks (natural and artificial light).
Extreme - Oral mediation that dampens the immune system like biological treatments or oral retinol drugs.
What is hyperkeratosis?
A skin condition that causes the outer layer of the skin to thicken due to be excess keratin.
There is various types:
- Eczema
- Corns
- Calluses
- Warts
- Actinic keratosis
- Litchen plannus
What causes hyperkeratosis?
- Chronic inflammation
- Pressure
- Irritation
- Cheek biting
What is the difference between a burn and scald?
A burn is caused by dry heat and a scald is caused by wet heat.
What are the symptoms of a burn?
- Red
- Peeling
- Blisters
- Swelling
- Charred skin
- Pain (pain does not = severity of the burn)
What immediate does a burn need?
- Remove from heat source
- Remove anything from the burn unless it’s stuck to the skin
- Cool it down with cool water for 20-30 minutes
- Keep them warm with a blanket
- Cover the burn with cling film
- Pain killers
- Raise the area to reduce swelling
How would a burn be treated in hospital?
- Fluids to prevent dehydration
- Pain relief
- Cream to speed healing (ingredients like silver and Manuka honey)
- Low adhesive wound dressing
- Potentially IV antibiotics
- Skin grafts for severe burns
Explain the depth classification ‘full thickness’.
Similar to a 3rd degree burn.
Destruction of the the dermis and epidermis and in some cases destruction of the underlying tissue, muscle and bone.
Explain the depth classification ‘deep partial thickness’.
Similar to a 2nd degree burn.
Destruction of the epidermis and upper layer of the dermis and injury to the deeper portion of the dermis.
Explain the depth classification ‘superficial partial thickness’?
Similar to 1st degree burn.
The epidermis is destroyed or injured and a portion of the dermis may be injured.
What are the early symptoms of a pressure injury?
- Colour change
- Burning or transient pain (lasts for a short time)
- Itchiness
- Different torture to other parts of the body due to lack of blood flow
What is the ASSKING bundle?
A way to prevent pressure injuries.
A - Assess risks
S - Skin assessment and care
S - Surface selection and use
K- Keep moving
I - Incontinence and increased moisture
N - Nutrition and hydration
G - Give information
What equipment can be used to prevent pressure injuries?
- Pillows
- Memory foam mattress, containing gel or water to help redistribute pressure
- Air flow mattress that constantly redistributes points of pressure
How do urine and faeces damage the skin?
They cause soreness and irritation after prolonged exposure.
This is because it causes dermatitis, which presents as inflammation, redness, swelling and possible blisters.
Dermatitis is a rash caused by an increase in the skins PH.
Diarrhoea can cause burns because bile and stomach acid can be present in the stool.
This can be prevented with barrier creams to prevent skin contact. This has to be prescribed.
When will a patient have a skin integrity assessment?
Upon admission.
What should you look for in a skin integrity assessment?
- Skin damage
- Colouring
- Temperature
- Texture
- Moisture susceptibility
- Integrity
- Wounds
- Bruising
How is a skin integrity assessment carried out?
- Identify who is at risk by checking their braden or waterlow
- Introduce self
- Explain procedure
- Gain informed consent
- Ask to remove layers of clothing
- Hand hygiene and PPE
- Body map and care plan
- Inform senior staff
How is a skin integrity assessment carried out?
- Identify who is at risk by checking their braden or waterlow
- Introduce self
- Explain procedure
- Gain informed consent
- Ask to remove layers of clothing
- Hand hygiene and PPE
- Body map and care plan
- Inform senior staff
What is SSKIN?
A care bundle for the management to skin integrity.
S - Skin inspection (braden and waterlow)
S - Surface (positioning)
K - Keep moving (mobility)
I - Incontinence
N - Nutrition (MST and monitoring)
What is the purpose of a barrier cream?
It creates a physical moisture repellent while soothing irritation.
