Download Chapter 28 Integumentary Function

Chapter 28
Integumentary Function
Introduction
Most obvious effects of aging are the
changes involving the integumentary system
Past health practices greatly influence the
integumentary system
Problems involving other body systems can
result from an unhealthy integumentary
system
Nursing can play important role in
promoting healthy skin
Effects of Aging on the Integument
Flattening of the dermal‒epidermal junction
Reduced thickness and vascularity of the
dermis
Reduction of epidermal turnover
Degeneration of elastic fibers
Increased coarseness of collagen
Reduction in melanocytes
Effects of Aging on the Integument—
(cont.)
Atrophy of hair bulbs and decline in the
rate of hair and nail growth
Increased fragility of the skin
Changes potentially affecting body image,
self-concept, reactions from others,
socialization, and other psychosocial
factors
Question
Is the following statement True or
False?
Special attention must be taken
when caring for older adults as they
have a heightened risk for skin
tears.
True
Answer
The increased fragility of the skin
poses challenges to older adults and
their caregivers in that there are
heightened risks for skin tears,
bruising, ulcer formation, and skin
infections.
Integumentary Health Promotion
Avoid agents irritating to the skin
Good skin nutrition
Promote activity
Hydration using bath oils, lotion, and
massage
Avoid excessive bathing
Early treatment of pruritus and skin lesions
Integumentary Health Promotion—
(cont.)
Avoid exposure to UV rays
Use sun-screening lotions
Wear sun glasses
Skin damage can occur on overcast days
Encourage self-inspection of entire body on
a regular basis
Importance of Skin Inspection
Detect abnormalities
A: Asymmetry
B: Border irregularity
C: Color
D: Diameter
Elevation in height
Bleeding tendency
Integumentary Health Promotion—
(cont.)
Encourage to look best and make most of
appearance
Efforts to avoid normal outcomes of aging
can be fruitless and frustrating
Clarify misconceptions regarding
rejuvenating products
Informed use of cosmetics to protect skin
Integumentary Health Promotion—
(cont.)
Accurate information about types of
cosmetic surgery available
Assess reasons for seeking cosmetic
surgery
Referral to competent cosmetic surgeons in
community
Nursing Assessment
Nurses have the best opportunity with the
most direct contact to assess the skin
Components of physical examination
Skin surface
Lesions
Turgor
Pressure
Tolerance
Temperature
Nursing Assessment—(cont.)
Nursing diagnoses
Astute attention to skin status
essential to prevent complications
Referral to skin professional
(dermatologist) when appropriate
Pruritus
 Most common dermatologic problem among
older adults
 Causes: precipitated by any circumstance that
dries the skin (excessive bathing and dry heat,
diabetes, liver disease, cancer, etc.)
 Potential for skin breakdown and infection due
to traumatizing scratching
 Prompt recognition
 Assess/correct the underlying cause
 Treatment/management: bath oils, moisturizing
lotions, vitamin supplements, antihistamines
Keratosis
 Also referred to as actinic or solar keratoses
 Description of appearance: small light
colored lesions (gray or brown) on exposed
areas of the skin, formation of a cutaneous horn
 Assessment: very important to observe for
changes (these lesions are precancerous)
 Treatment: freezing agents and acids can be
used; electrodesiccation or surgical excision
ensures a more thorough removal
Seborrheic Keratosis
Description of appearance: dark, wart like
projections on the skin; dark and oily or dry
and light in color
Increase in size and number with age: small
as a pinhead to size of quarter
Body locations: sebaceous areas (trunk,
face, & neck)
Benign lesion
Medical evaluation to differentiate from
precancerous lesions
Treatment/management: may be removed
by freezing or curettage and cauterization
Seborrheic keratosis. (From Rosenthal, T. C., Williams, M. E., &
Naughton, B. J. [2007] Office care geriatrics. Philadelphia, PA:
Lippincott Williams & Wilkins.)
Skin Cancer
 Basal cell carcinoma:
Most common form
Grows slowly
Rarely metastasized
Risk factors: advanced age, and exposure
to the sun, ultraviolet radiation, therapeutic
radiation
Description of appearance: small, domedshaped elevation, covered by small blood
vessels resembling moles w/”pearly” surface
Skin Cancer—(cont.)
 Squamous cell carcinoma: surface of the skin,
the lining of the hollow organs, the passages of
the respiratory and digestive tracts, also scar
tissue
Contributing factors
Sun exposure
Other factors that facilitate growth
Common locations: usually stays in the
epidermis, can metastasize; lower lip most
common site of mets
Description of appearance: firm, skin-colored
or red nodules
Skin Cancer—(cont.)
Melanoma:
Tends to more easily metastasize
Rising incidence in the United States
probably due to sun-exposure
Risk factors: fair-skinned, incidence
increases with age
Classifications: lentigo maligna, superficial
spreading, nodular
Biopsy and excision
Prognosis: depends on the depth rather
than the type
Common types of skin cancer. (A) Basal cell carcinoma. (B) Melanoma.
(From Rosenthal, T. C., Williams, M. E., & Naughton, B. J. [2007]. Office
care geriatrics. Philadelphia, PA: Lippincott Williams & Wilkins.)
Question
Which of the following types of skin
cancers grows slowly, rarely
metastasizes, and includes small, domeshaped elevations covered by small blood
vessels?
a. Basal cell carcinoma
b. Squamous cell carcinoma
c. Melanoma
d. Lymphoma
Answer
a. Basal cell carcinoma
Basal cell carcinoma is the most common
form of skin cancer; it grows slowly and
rarely metastasizes. The growths tend to be
small, dome-shaped elevations covered by
small blood vessels that often resemble
benign, flesh-colored moles with a “pearly”
surface.
Vascular Lesions
Age-related change: weakened vein walls
Reduce ability of veins to respond to
increased venous pressure
Obesity and hereditary factors compound
problem
Pathophysiology
Varicose veins
Lower extremity edema
Pigmented appearance
Stasis Dermatitis
Inflammatory condition due to scratching,
irritation, or other trauma
Chronic venous insufficiency
Signs/symptoms: pigmented, cracked,
exudative appearance
Potential for stasis ulcer formation
Treatment/management
Need special attention to facilitate healing
Good nutrition, high in vitamins and protein
Interventions to enhance venous return:
elevating legs, support stockings
Question
Assessment of chronic venous
insufficiency demonstrates which of the
following findings in the lower
extremities?
a. Pigmented and cracked appearance
b. Smooth and shiny appearance
c. Shiny and flat appearance
d. Soft and spongy appearance
Answer
a. Pigmented and cracked appearance
Poor venous return and congestion results
in edema of the lower extremities, which
leads to poor tissue nutrition. Poorly
nourished legs accumulate debris and the
legs gain a pigmented, cracked, and
exudative appearance.
Pressure (Decubitus) Ulcers
Tissue anoxia and ischemia result in
necrosis, sloughing, and tissue ulceration
Common sites: sacrum, greater trochanter,
ischial tuberosities
Predisposing factors; older persons due to
fragile skin, poor nutritional state, reduced
sensation, immobility and edema
Longer healing periods
Stages I-IV
STAGE I
A persistent area of skin redness
(without a break in the skin) that
does not disappear when pressure
is relieved.
STAGE II
A partial thickness loss of skin
layers involving the epidermis that
presents clinically as an abrasion,
blister, or shallow crater.
continues
STAGE III
A full thickness of skin is lost
extending through the epidermis
and exposing the subcutaneous
tissues; presents as a deep crater
with or without undermining
adjacent tissue.
continues
STAGE IV
A full thickness of skin and
subcutaneous tissue is lost,
exposing muscle, bone, or
both; presents as a deep crater
that may include necrotic
tissue, exudate, sinus tract
formation, and infection.
continued
Pressure Ulcers—(cont.)
 Prevention is the priority intervention
 Essential to avoid unrelieved pressure
 Nursing interventions: encourage activity,
turning, pillows, HOB @ 30 degrees or less
 Signs of pressure ulcers: hyperemia, ischemia,
necrosis, ulceration
 Frequent assessment: upon admission, depends
on patient population and facility, but @ least
daily and preferably q shift
 Tools to assess pressure ulcer risk: several
types depends on patient population and facility
Common locations for pressure sores when supine and sitting.
(From Miller, C. [2009] Nursing for wellness in older adults.
[5th ed.] Philadelphia, PA: Lippincott Williams & Wilkins.)
Question
Which of the following assessment tools
is used to determine the risk of pressure
ulcers?
a. Folstein Scale
b. Braden Scale
c. Geriatric Skin Scale
d. Pressure Sore Status Tool
Answer
b. Braden Scale
Risk of pressure ulcer formation is high
among older adults, so gerontological
nurses need to assess patient risk for
pressure ulcers. The Braden Scale can assist
in the objective assessment of pressure
ulcer risk. The Pressure Sore Status Tool is
an instrument to assess and monitor
existing pressure ulcers.
Promoting Normalcy
Psychological support
Reassure visitors regarding the safety of
contact
Provide instructions for any special
precautions
Older adults have normal needs and
feelings, including social interaction and
contact
Alternative Therapies
 Herbs
 Plant products
 Essential oils
 Homeopathic and naturopathic remedies
 Nutritional supplements
 Biofeedback
 Guided imagery
 Relaxation exercises