CH 25: Skin Health

Question 1

effects of aging on the skin

Answer 1

Flattening of dermal-epidermal junction, reduced thickness and vascularity of the dermis, decreased rate of epidermal turnover, degeneration of elastic fibers, increased coarseness of collagen, and reduction in melanocytes _ lines and wrinkles, thicker nails, and graying hair
Increased fragility of skin _ heightened risk of skin tears, bruising, pressure injury, and skin infections
Affects body image, self-concept, reactions from others, socialization, and other psychological factors
Other problems in body _ poor skin health
Photoaging _ loss of elasticity and wrinkling of skin; sun-induced premature aging of skin

Question 2

promotion of skin health

Answer 2

Practices in early life influence later life
Avoid drying agents, rough clothing, highly starched linens, and other irritating items
Good skin nutrition and hydration with activity, bath oils, lotions, and massages
Excessive bathing is hazardous to skin
Early attention to and treatment of pruritus
Sunscreen with SPF >15 applied to entire face and body 15 min before exposure Q2 hours
Cosmetic surgery
–Explore reasons
–Encourage safe practices

Question 3

promotion - skin

Answer 3

Skin inspection regularly
Asymmetry
Border irregularity
Color
Diameter
Elevation
Change in the feeling

Question 4

promotion - look

Answer 4

Look their best and make the most of their appearance

Question 5

promotion - remove

Answer 5

NO cream, lotion, or miracle drug will remove wrinkles, lines, or return youthful skin

Question 6

promotion - encourage

Answer 6

Encourage cosmetics to protect skin and maintain an attractive appearance

Question 7

promotion - improve

Answer 7

Improve society’s thoughts and acceptance on aging; appreciation of natural beauty

Question 8

most common skin condition with older adults

Answer 8

PRURITUS

Question 9

pruritus it due to:

Answer 9

Due to atrophic changes; precipitated by anything drying the skin (excessive bathing, dry heat, DM, liver disease, uremia, cancer, mental health, hyperthyroidism)

Question 10

if pruritus is not corrected:

Answer 10

traumatizing scratching leading to breakage of skin and infection

Question 11

tx for pruritus

Answer 11

Bath oils, moisturizing lotions, massage, vitamin supplements, topical zinc, antihistamines

Question 12

Small, light-colored lesions on exposed areas
accumulated keratin

Answer 12

keratosis

precancerous: close observation for changes

Question 13

Dark, wart-like projections of skin

Answer 13

seborrheic keratosis

Question 14

occurence of seborrheic keratosis

Answer 14

Occur on various parts of the body and can increase in size and number with age
Medical eval to differentiate if precancerous

Question 15

tx of seborrheic keratosis

Answer 15

gauze pad with oil (small)
freezing agents or curettage and cauterization (large)

Question 16

vascular lesions in older adults

Answer 16

Weak vein walls decrease ability to respond to increased venous pressure _ varicose veins
Poor venous return and congestion _ edema and poor tissue nutrition _ pigmented, cracked, exudate _ stasis dermatitis
Easily leads to leg ulcers

Question 17

tx of vascular lesions

Answer 17

good nutrition (diet with vitamins & protein)
weight reduction
elevation of legs
avoid sitting with crossed legs and standing for long
elastic support hose helpful but may be difficult for older adult
ligation and stripping of veins

Question 18

characteristics of basal cell skin cancer

Answer 18

Most common form; commonly on face
Risk increases with age, sun exposure, UV radiation, therapeutic radiation
Flesh-colored moles with pearly appearance
Grows slowly, doesn’t metastasize

Question 19

characteristics of squamous cell skin cancer

Answer 19

From sun exposure, arsenic and radiation exposure, and suppression of immune system
Firm, skin-colored or red nodules
Can metastasize to lip

Question 20

characteristics of melanoma skin cancer

Answer 20

Metastasizes and more deadly if not caught early
Increased incidence with age; sun exposure

Question 21

prevention of skin cancer

Answer 21

Suspicious lesions should be evaluated and biopsied! Early detection is key!
Teach to assess skin

Question 22

complications of pressure injury

Answer 22

Tissue anoxia and ischemia from pressure  necrosis, sloughing, and ulceration

Question 23

older adults are high risk of pressure injuries due to:

Answer 23

Fragile skin
Poor nutritional state
Reduced sensation of pressure and pain
Immobile and edematous

require a longer time to heal

Question 24

Assessment done on admission and Qshift

Answer 24

Braden Scale (Sensory Perception, Activity, Mobility, Moisture, Nutrition, and Friction and Shear)
Norton Scale
Pressure Sore Status Tool
Review individual risk
State the highest stage at which the injury was assessed to be

Question 25

hyperemia

Answer 25

Redness of skin appears quickly and disappear quickly when pressure is removed; no break in skin

Question 26

tx of hyperemia

Answer 26

use of a square adhesive foam; protect skin with tegaderm

Question 27

ischemia

Answer 27

Redness of skin, edema, and induration from 6 hours of unrelieved pressure
Epidermis may blister

Question 28

tx of ischemia

Answer 28

clean with NS or product by agency protocol

Question 29

necrosis

Answer 29

Unremitting pressure >6 hours with ulceration with a necrotic base

Question 30

tx of necrosis

Answer 30

transparent dressing to protect from bacteria but permeable to oxygen and water vapor; thorough irrigation; topical antibiotics

Question 31

deep tissue damage

Answer 31

If not relieved in necrosis stage, it can extend to fascia and bone; eschar present with possible bone destruction and infection

Question 32

tx of deep tissue damage

Answer 32

debridement

Question 33

most important of pressure injury

Answer 33

PREVENT them

Question 34

nursing considerations for pressure injuries

Answer 34

Prevent unrelieved pressure
Encourage activity/turning
Prevent shearing (not allowing client to slide down in bed)
Lift instead of pull
Disperse pressure with pillows, alternating pressure mattresses, and flotation pads
Keep bed wrinkle free and free of foreign objects
Move and shift weight if in a chair
Heel protectors and Lamb’s wool to prevent irritation
High-protein, vitamin-rich diet
Keep skin clean and dry; blot to dry
Massage bony prominences and ROM
Incontinence care
Treatment depends on type of injury
Understand the unique risks and prevention measures for each person

Question 35

promoting normalcy with skin conditions in older adults

Answer 35

Patient has normal needs and feelings
Be aware of reactions from others; reassure visitors and provide instruction for any special precautions
Prevent wrinkles with decreased sun exposure and increased sunscreen use
Seek reputable providers

Question 36

Use of alternative therapies for skin conditions in older adults

Answer 36

Aloe vera, chamomile extract, witch hazel, thyme, sage, lemon, lavender, rosewood, cinnamon
Biofeedback, guided imagery, relaxation, acupuncture
Zinc, magnesium, Vitamin A/B/B6/E
Discuss with provider

Question 37

ABCDEF

Answer 37

asymmetry
border irregularity
color
diameter
elevation
change in feeling

Question 38

SOAP

Answer 38

*Subjective – The complaint, problem, issue, concern, history, what makes it better or worse?
How did the skin issue begin? Had before? Just one location or where else?
Medications? Allergies? Etc?
Work history – Outdoor, Indoor
Use of starched linens or clothes, irritating clothes
Use of oils, lotions, etc
How often they bath?
Use of sunscreen?
What the patient Tells you.
*Objective – Observations, Vital signs, (remember fever in older adults aren’t always high temp), facial expressions, body language
*Assessment - ABCDEF – Skin inspection
*Plan – Nursing Care Plans

Question 39

biggest skin risk for older adults
ex:

Answer 39

trauma

Abrasions, Lacerations, Bruises/Contusions, Hematomas

Question 40

mechanical force exerted when skin is dragged across a coarse surface- will be visible

Answer 40

friction

Question 41

mechanical force that acts on an area of skin in a direction parallel to the body’s surface with pressure exerted. - will not be visible at first (Pressure Injuries)

Answer 41

shearing