the integument 12 lecture note powerpoint presentation
TRANSCRIPT
The Integument
12Lecture Note PowerPoint Presentation
LEARNING OUTCOME 1Describe normal skin changes associated with
aging.
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NORMAL STRUCTURE AND FUNCTION OF THE SKIN
Skin consists of 15–20% of the total body weight
Epidermis Consists of five continually regenerating and
shedding layers Dermis
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FIGURE 12-1CORPUSCLES AND THEIR DISTRIBUTION IN THE SKIN.
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NORMAL STRUCTURE AND FUNCTION OF THE SKIN
Subcutaneous layers A specialized connective tissue attached to
muscles Contains blood vessels, lymphatic channels, hair
follicles, and sweat glands
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NORMAL STRUCTURE AND FUNCTION OF THE SKIN
Accessory structures Hair Nails Glands
Sebaceous glands Apocrine sweat glands
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NORMAL STRUCTURE AND FUNCTION OF THE SKIN
Function Protection Regulation of immune functions Thermoregulation Vitamin synthesis Sensory receptor for CNS
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SKIN CHANGES ASSOCIATED WITH AGING
Intrinsic factors Genetic makeup and the normal aging process
Extrinsic factors UV lighting Smoking Environmental pollutants
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FIGURE 12-2NORMAL CHANGES OF AGING IN THE INTEGUMENTARY SYSTEM.
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SKIN CHANGES ASSOCIATED WITH AGING
Epidermal changes Thinning Reduced moisture leading to a dry, rough
appearance Mitosis slows after age 50 by 30% Increased healing time Increased risk of infection
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SKIN CHANGES ASSOCIATED WITH AGING
Epidermal changes Rete ridges flatten: in the dermal layer, less
collagen is being produced. The elastin fibers also wear out. Such factors will cause the skin to sag and wrinkle. The rete ridges, meanwhile, will flatten out. This will cause the skin to be fragile.
Increased risk of skin breakdown Reduced melanocytes
Paler complexion Increased risk of UV damage
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SKIN CHANGES ASSOCIATED WITH AGING
Epidermal changes Scattered pigmented areas
Nevi (skin moles) Age spots Liver spots Increased number and size of freckles (clusters of
concentrated melanin) Age spots — also called liver spots and solar lentigines
— are flat gray, brown or black spots. They vary in size and usually appear on the face, hands, shoulders and arms — areas most exposed to the sun. Though age spots are very common in adults older than age 40, they can affect younger people as well.
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SKIN CHANGES ASSOCIATED WITH AGING
Dermal changes Decreased thickness and function begin in 3rd
decade of life Elastin decreases in quality
Wrinkling and sagging Collagen less organized
Loss of turgor
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SKIN CHANGES ASSOCIATED WITH AGING
Dermal changes Reduced vascularity
Paler complexion Capillaries thin and are easily damaged
Senile purpura Easy skin bruising in older people Reduced touch and pressure sensations
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SKIN CHANGES ASSOCIATED WITH AGING
Subcutaneous layer Tissue thins in the face, neck, hands, and lower
legs Visible veins in exposed areas
Hypertrophy of tissue in certain body areas Increased body fat Increased body fat in abdomen and thighs
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HAIR CHANGES WITH AGING Reduced number of functioning melanocytes Replacement of pigmented strands of hair
with nonpigmented hair Hormone levels decline
Loss of hair in pubic and axillary areas Growth of facial hair in women Growth of nasal and ear hair in men
Increased baldness
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NAIL CHANGING WITH AGING
Color changes Dull Yellowing or grayness
Slowed growth Thicker nails prone to splitting
Longitudinal striations Related to damage at the nail matrix (the ROOT
of the nail)
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NAIL CHANGING WITH AGING
Longitudinal pigmented bands Single or multiple brown or black bands on
thumb and index finger Frequently seen in African-Americans over age
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GLANDULAR CHANGES WITH AGING
Eccrine or sweat glands Decreased number; decreased ability to regulate
body temperature Sebaceous glands
Increased size; decreased activity; increased water evaporation causes cracked, dry skin
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LEARNING OUTCOME 2Identify risk factors related to common skin
problems of older adults.
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“THE SUN NEVER FORGETS”
Ultraviolet radiation (UVR) Ultraviolet A (UVA)
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“THE SUN NEVER FORGETS” Responsible for premature aging and
decreased immune function Ultraviolet B (UVB): The elderly have reduced
capacity to synthesize vitamin D in skin when exposed to UVB radiation. Intense, intermittent exposures
Basal cell carcinoma Malignant melanoma
Chronic sun exposure Squamous cell carcinoma
Photoaging: refers to the damage that is done to the skin from prolonged exposure, over a person's lifetime, to UV radiation
Actinic keratosis: is a premalignant condition of thick, scaly, or crusty patches of skin
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SKIN TEARS
Traumatic separation of the epidermis from the dermis
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PRESSURE ULCERS
Impact between 1 and 3 million people annually in the United States
Localized injury to the skin and underlying tissue Usually over a bony prominence Results from pressure or pressure and shear
force and/or friction
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PRESSURE ULCERS
High-risk populations Hospitalized patients Individuals over age 65
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CELLULITIS
Acute bacterial infection of the skin and subcutaneous tissue
Risk factors Skin breaks Chronic illness Age-related skin changes
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CONDITIONS OF THE FINGER AND TOE NAILS
Risk factors Trauma Age-related changes Systemic diseases
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LEARNING OUTCOME 3Delineate skin changes associated with benign and
malignant skin types.
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SKIN CANCER IS THE LEADING CANCER IN THE UNITED STATES
Malignancies are associated with the time spent in the sun
Older and light-skinned persons are at an increased risk
Darker-skinned persons may be at risk
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ACTINIC KERATOSIS
Most common precancerous lesion; it is seen more in men than women 1:1,000 will progress to skin cancer
Also known as solar keratosis or senile keratosis
Sore, rough, scaly, erythematous papules or plaques
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BASAL CELL CARCINOMA
Most common skin cancer for Caucasians Metastasis rare Originates in lowest layer epidermis Manifests as small, fleshy bumps
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SQUAMOUS CELL CARCINOMA
Second most common skin cancer for Caucasians
Most common skin cancer for persons with dark skin
Originates in upper levels of epidermis Manifests as flesh-colored erythematous,
scaly plaques, papules or nodules Metastasis can occur
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MELANOMA
Most dangerous skin cancer; responsible for more than three quarters of all skin cancer deaths
Originates in the melanocytes Lesions may be brown, black, or
multicolored; develop nodules or; plaques (a broad papule ) and have a black, irregular spreading outline
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SKIN TEARS
Caused by friction or shearing forces Payne-Martin classification for skin tears
Category 1 Linear or flap tear without tissue loss
Category 2 Tears with partial tissue loss
Category 3 Tears with full thickness complete tissue loss
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PRESSURE ULCERS
The majority occur in persons over age 70 Stages
Stage I: Nonblanchable erythema of intact skin Stage II: Partial-thickness skin loss involving
dermis and/or epidermis Stage III: Full-thickness skin loss involving
damage or necrosis of subcutaneous tissue that may extend to underlying fascia
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PRESSURE ULCERS
Stages Stage IV: Full-thickness skin loss with extensive
destruction, tissue necrosis, or damage to muscle, bone, or supportive structures
Types of pressure ulcers Necrosis of epidermis and dermis Deep or malignant pressure ulcers Full-thickness wounds
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PRESSURE ULCERS
Mechanisms of Tissue Breakdown Occlusion of blood flow to the skin Damage to the lining of the arterioles and
smaller vessels Direct occlusion of blood vessels by long periods
of pressure
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WOUND HEALING
Phases Inflammation and destruction Proliferation Maturation
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DELAYED WOUND HEALING
A wound that does not heal within 6 weeks is termed chronic
Signs Wound size is increasing Exudate, slough, or eschar is present Tunnels, fistula, or undermining has developed Epithelial edge is not smooth and continuous and
does not move toward wound
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DELAYED WOUND HEALING
Causes Aging Inadequate nutrition Inadequate blood supply Immunocompetence Damage to wound
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CELLULITIS
Acute bacterial infection of skin Characterized with inflammation, intense
pain, heat, redness, and swelling
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NAIL PROBLEMS
Fungal infection Inflammation of the nail matrix Hypertrophy of the nail plate
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LEARNING OUTCOME 4List nursing diagnoses related to common skin
problems.
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THREE MAJOR NURSING DIAGNOSES FOR INTEGUMENT PROBLEMS
Risk for Impaired Skin Integrity Impaired Tissue Integrity
Damage to integument, cornea, or mucous membranes
Impaired Skin Integrity Damage to epidermal or dermal tissue
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NURSING DIAGNOSES FOR INTEGUMENT PROBLEMS
Impaired Skin Integrity related to lesions and inflammatory response
Risk for Impaired Skin Integrity related to physical immobility
Risk for Impaired Skin Integrity related to decrease skin turgor
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NURSING DIAGNOSES FOR INTEGUMENT PROBLEMS
Risk for Impaired Skin Integrity related to the effects of pressure, friction, or shear
Risk for Impaired Tissue Integrity related to decreased circulation
Risk for Infection related to pressure ulcer
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LEARNING OUTCOME 5Discuss the nursing responsibilities related to
pharmacological and nonpharmalogical treatment of common skin problems.
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DIAGNOSTIC TESTS FOR INTEGUMENTARY DISORDERS
Total body photography: is established techniques for detecting and monitoring dysplastic and atypical nevi for early detection of malignant cutaneous melanomas
Skin biopsy Wound cultures Laboratory tests
Serum albumin Serum transferrin Lymphocyte count
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PHARMACOLOGIC TREATMENT OPTIONS
Topical antifungal agents Topical antibiotics Systemic antibiotics Selected antimicrobials Aminoglycosides Prescription creams
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NONPHARMACOLOGICAL INTERVENTIONS
Patient education Awareness and reporting of skin cancer Characteristics of darker skin
Prevention Guidelines on sun exposure Wearing protective clothing
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NONPHARMACOLOGICAL INTERVENTIONS Treatment
Basal cell carcinoma and squamous cell carcinoma
Malignant melanoma Excisional biopsy for diagnosis Wide excision for cure Adjuvant therapy
Chemotherapy Chemoimmunotherapy Regional radiation therapy Biotherapy
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NONPHARMACOLOGICAL INTERVENTIONS
Preventing skin tears Avoid pulling or sliding Pad surfaces Keep environment free of obstacles Maintain safe environmental lighting Keep skin moist Use tape cautiously Encourage long sleeves and pants
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NONPHARMACOLOGICAL INTERVENTIONS Managing skin tears
Clean with normal saline or other nontoxic cleaner
Pat or air dry Gently place torn skin in its approximate normal
position Apply dressings and change per protocol or
product requirements Photograph if permitted Document all findings
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NONPHARMACOLOGICAL INTERVENTIONS
Managing cellulitis Treat acute infection Immobilization Elevate limb Pain relief Possible anticoagulant therapy Prevent further complications
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NONPHARMACOLOGICAL INTERVENTIONS
Management of Fingernail and Toenail Problems Onychomycosis: means fungal infection of the nail
. It is the most common disease of the nails and constitutes about a half of all nail abnormalities. Pain management Patient education Oral antifungal agents
Chronic paronychia: Paronychia is one of the most common infections of the hand. Clinically, paronychia presents as an acute or a chronic condition. It is a localized, superficial infection or abscess of the paronychial tissues of the hands or, less commonly, the feet Keep affected nails dry Antibiotics
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OnychomycosisChronic paronychia
NONPHARMACOLOGICAL INTERVENTIONS
Management of Fingernail and Toenail Problems Onychogryphosis:is a hypertrophy that may
produce nails resembling claws or a ram's horn, possibly caused by trauma Keep nails short Podiatry consultation: is a branch of medicine devoted
to the study, diagnosis and treatment of disorders of the foot, ankle and lower leg.
Surgical intervention
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LEARNING OUTCOME 6Explain the nursing management principles related
to the care of pressure ulcers.
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THE BRADEN SCALE
Used to assess pressure ulcer risk Assesses mobility, activity, sensory
perception, skin moisture, friction, shear, and nutritional status
Used as an adjunct tool to nursing assessment and clinical judgment
Can be found at this link http://www.bradenscale.com/images/bradenscale.pdf
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MOBILITY AND ACTIVITY CONSIDERATIONS
Repositioning q2h Ensure proper positioning Avoid prolonged sitting Increase activity Choose a mattress surface based on the
assessment and diagnosis * a low air loss bed is indicated for all
pressure ulcers in any stage * a water mattress for stage 1, 2 and 3 * an alternating pressure mattress for stage 1
and 2.
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SKIN CARE FOR OLDER PERSONS
Correct bathing procedures Keep skin clean and dry Lubricate with non–alcohol-containing
moisturizer Prevent injury Evaluate and manage incontinence Provide dietary support
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NURSING CARE OF PRESSURE ULCERS
Assess and stage the wound Debride necrotic tissue Cleanse
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TREATMENT
Avoid contamination Colonization: presence and proliferation of
organism in the wound with no signs of infection.
Infection: presence and proliferation of organism in the wound with signs of infection
Topical antibiotics Systemic antibiotics
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NURSING CARE AND DOCUMENTATION OF SKIN PROBLEMS
Assess risk factors Provide nursing interventions to minimize
skin breakdown Document care Evaluate patient status
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KNOWLEDGE-BASED DECISION MAKING
Current literature Share with colleagues, patients, and their
significant others
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HELPFUL QUESTIONS WHEN ASSESSING WOUND CARE PRODUCTS
What is the stage, drainage, moisture, or eschar?
What are the wound needs? What products are available to manage the
wound?
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ONGOING EVALUATION OF NURSING CARE
Family situation Available resources Patient needs and requests Patient and family understanding of the
teaching and plan of care
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