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Applied- Anatomy And Physiology > The Skin > Flashcards

The Skin Flashcards

1
Q

5- Describe the skin as an organ

A

Largest organ on the body
Extremely vascular- ability to heal quickly but easily infected
Visible- good indicator of haemodynamic state of the patient
Accessory structures- hair, skin and nails
Constructed of layers
Regenerates completely every 7 years
Dynamic organ- constantly sheds, regenerates and matures

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2
Q

5- name the layers of the skin

A

Epidermis
Dermis
Subcutaneous fat

Soft tissue
Bone

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3
Q

5- how much does pressure area care cost the NHS?

A

£1.4 million every single day

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4
Q

5- what percentage of hospitalised patients will develop a pressure ulcer?

A

4-10%
This is even higher in the community

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5
Q

5- What age range of people can develop pressure ulcers?

A

Anybody!
Adults and children
It’s a myth that only older people can develop pressure ulcers

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6
Q

5- name as many types of skin damage as you can that we see in nursing practise

A

Pressure ulcers
Surgical wounds
Traumatic wounds
Ulcerating cancers (fungating wounds)
Burns
Non-infectious/infectious conditions
Chronic long term conditions
Allergies

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7
Q

5- in one sentence, what is the overarching role of the nurse in skin care?

A

Prevention > cure

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8
Q

5- list the roles of the nurse in skin care

A

Assess and monitor the skin- skin mapping
Identify risk factors- use appropriate techniques to reduce risk
Wound care- dressings, removal of sutures etc
Personal hygiene and continence assistance
Reposition patients according to care plan
Escalate or refer patients to MDT
Administer prescription medications

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9
Q

5- What model is used for pressure ulcer prevention in nursing practise?

A

SSKIN

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10
Q

5- What does SSKIN stand for? Describe the five elements

A

Surface
-do patients have the right support?

Skin
-early inspection = early detection
-show the patient and their carers what to look for

Keep patients moving
-reposition as much as possible or needed

Incontinence/moisture
-need to be clean and dry

Nutrition/hydration
-help patients have the right diet and plenty of fluids

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11
Q

5- what assessment tool is the SSKIN bundle used alongside?

A

The Waterlow Assessment Tool

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12
Q

5- Describe the Waterlow Assessment Tool

A

It is a key thing we will need to do to patients
It calculates the risk of pressure ulcers developing on an individual basis using risk factors based on a simple points-based system
10-14 ‘at risk’
15-20 ‘high risk’
20+ ‘very high risk’

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13
Q

5- name some of the factors identified in the Waterlow Assessment Tool that put someone at high risk of pressure ulcers

A

High BMI
Low BMI
Women (hormone related)
Malnourishment
Elderly age groups
Low mobility
Incontinence
Organ failure
Smoking
Diabetes
Anaemia
Orthopaedic and spinal surgery
Certain medications

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14
Q

5- what assessment tool is used for paediatric pressure assessment? Describe it briefly

A

Braden Q

Focuses on the occipital area (back of the head)
Children tend to lay in the supine position (flat on their back)- NS injury, heart disease, injury
44.9% of all pressure ulcers in children are occipitally located

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15
Q

5- Name the eight elements of skin assessment and identifying risk

A

Observe
Touch
Positioning
Clothing
Current medications
Skin condition
Malnutrition
Skin map

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16
Q

5- Briefly describe how we conduct ‘observe’ skin assessment

A

Colour
Mottling
Dry
Loose
Oedematous
Wounds (any history of wounds?)
Abrasions or bruises
Deformity
Burns
Flakiness
Self hygiene
Safeguarding
Erythema (redness)

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17
Q

5- Briefly describe how we conduct ‘touch’ skin assessment

A

Clammy or sweaty
Soiled or wet
Sensitive
Capillary refill time- should be less than 2 seconds (peripheral or central?)

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18
Q

5- Briefly describe how we conduct ‘positioning’ skin assessment

A

Able to reposition?
Pain when movement is conducted?
Why are they in pain and how long has this been going on for?

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19
Q

5- Briefly describe how we conduct ‘clothing’ skin assessment

A

Loose
Restricted
Soiled

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20
Q

5- Briefly describe how we conduct ‘current medications’ skin assessment

A

Creams
Steroid
Allergies

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21
Q

5- Briefly describe how we conduct ‘skin conditions’ skin assessment

A

Chronic
Acute
Infectious

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22
Q

5- Briefly describe how we conduct ‘malnutrition’ skin assessment

A

Should be assessed alongside SSKIN

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23
Q

5- Briefly describe how we conduct ‘skin map’ skin assessment

A

Document
Photograph if necessary (with consent)
Repeat full skin assessment weekly

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24
Q

5- What is a pressure ulcer (PU)?

A

Localised injury to the skin or underlying tissue
Usually over a bony prominence
Result of pressure or pressure combined with shear
Number of factors contribute to prevalence of PU’s- e.g. friction, excessive moisture

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25
Q

5- What is a medical device related pressure ulcer (MDRPU)?

A

When a pressure ulcer develops after sustained pressure from a medical device

Examples…
Plaster casts
Splints
Tracheostomy tubing
Urinary catheters
Oxygen masks (common in COPD patients)

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26
Q

5- What is moisture associated skin damage (MASD)?

A

When the skin reacts chemically to chronic exposure or excessive moisture
Sweat, fecal matter, urine, wound exudate
Normally looks like inflammation and erythema with or without erosion
Normally a loss of epidermis- skin looks red, broken and painful
Common in obese patients (e.g. under skin folds, under breasts)

27
Q

5- describe the process of wound assessment

A

Type of wound will affect treatment and healing
Bacterial loading= how much bacteria is present in the infected area?
-Due to: temp, humidity, poor ventilation, unhygienic surface contact
Appearance- active bleeding, necrosis (tissue death- black), slough (dead WBCs- yellow/white)
Map the wound/ photograph the wound with consent

28
Q

5- why do we map and photograph wounds?

A

To allow for comparison
With consent- if no consent is given then document why

29
Q

5- describe how we categorise wounds

A

Vascular- arterial or venous or both (common in legs)
Neuropathic (diabetic)
Moisture associated dermatitis
Skin tear (common in older patients with thinned skin)
Pressure ulcer

Finally think about what the cause will be- it could be multifactorial

30
Q

5- describe and name some national campaigns to help prevent pressure ulcers

A

-NHS Improvement 2016
Cultural shift towards improving PU care
SSKIN framework rolled out
Emphasised PU education for all staff
#StopThePressure
‘Stop the Pressure’ Day- worldwide, 16th Nov 2023

31
Q

6- How many stages are used to classify pressure sores?

A

Stage 1
Stage 2
Stage 3
Stage 4
Unstageable
Deep Tissue Injury (DTI)

32
Q

6- what is meant by supine? Name some common pressure ulcer locations associated with this

A

The position where a patient is laying flat on their back
In this position they are very susceptible to developing pressure wounds
Occipital- back if the head
Sacrum- bottom of the spine
Scapula- shoulder blades
Calcaneus- heels

33
Q

6- when a patient is in a sitting position, name some locations on the body where they are susceptible to pressure wounds

A

Spinal bones close to skin surface
Shoulder blades
Sacrum
Elbows
Bony part of buttocks
Heels

34
Q

6- describe a stage 1 pressure wound

A

Intact skin
Localised area of non-blanchable erythema (looks different in more pigmented skin)
Changes in sensation, temperature or firmness
Colour changes taken with caution- maroon or purple colour may indicate a DTI

35
Q

6- describe a stage 2 pressure wound

A

Partial loss in skin thickness
Dermis exposed
Wound bed is moist, pink or red, or a ruptured serum-filled blister
Subcutaneous tissue/fat- not visible
Slough- not visible
Granulation tissue- not visible

36
Q

6- describe a stage 3 pressure wound

A

Full thickness skin loss
Subcutaneous tissue/fat may be visible
Bone, tendon or muscle not visible
Slough may be present- doesn’t obscure the depth of tissue loss, may include undermining and tunnelling
Depth varies with anatomical location
Bridge of nose, ear, occipital don’t have subcutaneous tissue- stage 3 ulcers may be shallow
Adipose dense areas- stage 3 ulcers may very deep

37
Q

6- describe a stage 4 pressure wound

A

Full thickness tissue loss
Exposed bone, tendon or muscle
Slough- may be present on the bed of the wound
Often find there’s undermining and tunnelling
Depth varies with anatomical location…
Bridge of nose, ear, occipital- no subcutaneous tissue so stage 4 ulcers can be shallow
Can extend onto muscle or supporting structures, makes osteomyelitis possible, bone directly palleable- stage 4 ulcers can be very deep

38
Q

6- describe an unstageable pressure wound

A

Unknown depth
Full thickness tissue loss
Base of ulcer is green, brown, black, yellow or white
Base of ulcer is covered in Slough or necrotic tissue
When Slough removed it exposes the base of the wound, therefore category and true depth can’t be determined
Stable eschar on the heels- ‘body’s natural biological cover’ so shouldn’t be removed

39
Q

6- describe a deep tissue injury (DTI)

A

Persistent and non-blancheable
Purple or maroon areas of intact skin
Blood filled blisters or non intact skin caused by damage to underlying soft tissues
Common for thin blister to form over the dark wound bed
Wound may further develop to be covered with thin eschar
Serious pressure injury- often not visible till they’re advanced past the point of treatment
Deteriorate quickly even under optimal care
Often dismissed as a bruise
Always record any marks! Safeguarding and DTI reasons

40
Q

6- describe why prevention is far more effective than cure

A

Identifying at an early stage means it’s easier to manage the wound and prevent it from arising in the first place
Lives are saved
Money is saved
Less strain on NHS resources and staff
Less suffering for the patient

41
Q

6- describe the most commonly used methods of prevention for pressure wounds

A

Creams- to moisture lesions and barrier the skin
Pressure relieving devices- mattresses, cushions, overlays, hospital beds, limb protectors, seating
Skin massage
Repositioning
Nutritional interventions- stops deficiencies, keeps hydration up
Education- for the patient, carer and healthcare professional
Assessment and grading of pressure ulcers
Debridement
Larval therapy
Negative pressure wound therapy
Hyperbaric oxygen therapy

42
Q

6- what are the two primary risk factors for developing a chronic wound?

A

Age
Diabetes
= more than 12 weeks to heal!

43
Q

6- define wound healing

A

Skins response to closing breaches in its barrier

44
Q

6- what is haemostasis?

A

The body’s normal reaction to an injury that causes bleeding

45
Q

6- outline the rices of haemostasis in wound healing

A

Contraction of blood vessels
Causes blood to clot and decreases vascular damage
Thrombin triggers platelet activation- coagulation and clotting
Platelets recruit immune cells to the site too

46
Q

6- describe the role of the plug (eschar) in haemostasis and wound healing

A

Secondary functions (after heamostasis)
Shields from bacteria
Provides scaffold for incoming immune cells
Harbours a reservoir of cytokines and growth factors
Shapes behaviour of wound cells for early repair

Once plug is sufficient- coagulation is switched off to prevent excessive thrombosis

47
Q

6- name the three stages of wound healing

A

Inflammation
Proliferation
Maturation

48
Q

6- name the two main WBCs involved in wound healing

A

Fibroblasts
Phagocytes

49
Q

6- describe the first stage of wound healing

A

INFLAMMATION
1-5 days
Vasodilation
Release of histamine
Primary defence against pathogenic wound invasion
Histamine= capillary wall permeability. Plasma proteins, leucocytes, antibodies and electrolytes exude into the surrounding tissues
Wound gets red, swollen, hot and tender (1-3 days)
Sometimes mistaken for an infection
Neutrophils, macrophages and lymphocytes- debris, bacteria, secrete cytokines and growth factor
Debris= osmolality and swelling increase
Wound swabs may reveal high levels of neutrophils= infected
Diabetic patients have reduced macrophages= delayed healing (hypoxia and malnourished wounds)

50
Q

6- describe the second stage of wound healing

A

PROLIFERATION

3-24 days
Macrophages initiate fibroblasts to divide and produce collagen
Collagen formation- sutured wounds may feel like they have a ridge below suture line
Angiogenesis- formation of existing blood vessels join existing ones to form loops. They’re fragile and held with a collagen matrix
Granulation tissue- wound edges contract
Mitosis and epithelial migration- re-epithelizitation spans the wound bed. Keratinocytes change polarity and span the wound migrating from front to back
Optimal nutrition is vital- oxygen, protein, carbs, vitamins A and C
Hair follicles- can regrow from damaged appendages but only grow around the outside in full thickness wounds (why scars are hairless)

51
Q

6- describe the third stage of wound healing

A

MATURATION (RE-MODELLING)

Up to 21 days
Collagen rich scar remains for several years
Collagen re-models in order to replicate the skin prior to injury
Scar tissue is avascular and blood vessels are rationalised- scar tissue thins and fades
Only reaches up to 80% of original strength
Contracture- when myo-fibroblasts adhere to one another via desmosomes
Elastin- makes scar tissue more flexible, can take months to appear

52
Q

6- name the three wound healing methods

A

Primary intention
Secondary intention
Tertiary intention

53
Q

6- describe primary intention as a wound healing method

A

Union of wound edges
Aseptic conditions
Using clips, sutures and skin adhesion

54
Q

6- describe secondary intention as a wound healing method

A

Left open
Heals through contraction and epithelialization
Less cosmetic (appealing to the eye)
Prone to infection

55
Q

6- describe tertiary intention as a wound healing method

A

Delayed primary closure
Allows swelling and bleeding to reduce before primary closure

56
Q

6- what rule is used for burns classifications? Describe it

A

Rule of 9’s
To do with body’s surface area

Front and back of head and neck- 9% SA
Front and back of each arm and hand- 9% SA
Chest- 9% SA
Stomach- 9% SA
Upper back- 9% SA
Lower back- 9% SA

57
Q

6- how are burns classified?

A

By degree depending on how deeply and severely they penetrate the layers of the skins surface
It’s sometimes impossible to classify a burn immediately when it occurs, it develops over a period of days

First degree- superficial
-affect the epidermis

Second degree- partial thickness
-affect the epidermis and part of the dermis

Third degree- full thickness
-destroy the epidermis and the dermis. May reach the subcutaneous tissue

Fourth degree
-go through the epidermis, dermis, subcutaneous tissue and deeper tissue possibly effecting muscle and bone. Nerve endings destroyed so there’s no feeling

58
Q

6- describe thermoregulation

A

=How mammals maintain a stable body temperature

Skin looses heat and insulates against heat loss
Evaporation, conduction, convection and radiation
Hypothalamus responds to the temperature of circulation blood
Arterioles on dermis restrict- decrease the blood flow
Arterioles on dermis dialate- cool the body and stimulate sweat glands
Inflammatory cells will increase hypothalamus ‘thermostat’- body will retain heat until the increased temp is reached, then by sweating the body cools down
Temp regulation is less effective in babies and infants
Hypothermia- cause of cardiac arrest but is reversible!

59
Q

6- describe the formation of vitamin D and other vitamins in the skin. List some complications associated with this

A

Lipid based
Dehydrocholesterol in skin is converted to vitamin D by sunlight
Calcium and phosphate= bone formation

Calcium supplements help bone formation
Light therapy increases vitamin D
Diet helps vitamin levels increase

Complications:
At risk- Lactose and milk intolerance, vegans
Rickets
Increased risk of CHD
Older adults may experience cognitive impairments
Cancer
Childhood asthma
… the nurses role is to identify, manage and promote vitamin D uptake

60
Q

6- describe the function of absorption

A

Absorption is limited
Transdermal patches- HRT, nicotine replacement
Toxicity- mercury

61
Q

6- describe the function of excretion

A

Sweat-
Sodium chloride
Low levels= hyponatraemia

Urea-
Be more aware if kidney function is impaired

62
Q

6- list the common disorders of the skin

A

HPV
Herpes
Impetigo
Cellulitis
Ringworm
Dermatitis and excezma
Psoriasis
Acne
Melanoma

63
Q

6- how treatable are most skin conditions?

A

Most are very much treatable, manageable and preventable
Some are infectious- caution!
Nurses role- early identification and treatment to manage the symptoms

Applied- Anatomy And Physiology (10 decks)

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