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Applied- Anatomy And Physiology > The Skin > Flashcards

The Skin Flashcards

(63 cards)

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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
5- What is a medical device related pressure ulcer (MDRPU)?
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)
26
5- What is moisture associated skin damage (MASD)?
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
5- describe the process of wound assessment
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
5- why do we map and photograph wounds?
To allow for comparison With consent- if no consent is given then document why
29
5- describe how we categorise wounds
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
5- describe and name some national campaigns to help prevent pressure ulcers
-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
6- How many stages are used to classify pressure sores?
Stage 1 Stage 2 Stage 3 Stage 4 Unstageable Deep Tissue Injury (DTI)
32
6- what is meant by supine? Name some common pressure ulcer locations associated with this
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
6- when a patient is in a sitting position, name some locations on the body where they are susceptible to pressure wounds
Spinal bones close to skin surface Shoulder blades Sacrum Elbows Bony part of buttocks Heels
34
6- describe a stage 1 pressure wound
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
6- describe a stage 2 pressure wound
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
6- describe a stage 3 pressure wound
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
6- describe a stage 4 pressure wound
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
6- describe an unstageable pressure wound
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
6- describe a deep tissue injury (DTI)
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
6- describe why prevention is far more effective than cure
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
6- describe the most commonly used methods of prevention for pressure wounds
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
6- what are the two primary risk factors for developing a chronic wound?
Age Diabetes = more than 12 weeks to heal!
43
6- define wound healing
Skins response to closing breaches in its barrier
44
6- what is haemostasis?
The body’s normal reaction to an injury that causes bleeding
45
6- outline the rices of haemostasis in wound healing
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
6- describe the role of the plug (eschar) in haemostasis and wound healing
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
6- name the three stages of wound healing
Inflammation Proliferation Maturation
48
6- name the two main WBCs involved in wound healing
Fibroblasts Phagocytes
49
6- describe the first stage of wound healing
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
6- describe the second stage of wound healing
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
6- describe the third stage of wound healing
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
6- name the three wound healing methods
Primary intention Secondary intention Tertiary intention
53
6- describe primary intention as a wound healing method
Union of wound edges Aseptic conditions Using clips, sutures and skin adhesion
54
6- describe secondary intention as a wound healing method
Left open Heals through contraction and epithelialization Less cosmetic (appealing to the eye) Prone to infection
55
6- describe tertiary intention as a wound healing method
Delayed primary closure Allows swelling and bleeding to reduce before primary closure
56
6- what rule is used for burns classifications? Describe it
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
6- how are burns classified?
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
6- describe thermoregulation
=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
6- describe the formation of vitamin D and other vitamins in the skin. List some complications associated with this
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
6- describe the function of absorption
Absorption is limited Transdermal patches- HRT, nicotine replacement Toxicity- mercury
61
6- describe the function of excretion
Sweat- Sodium chloride Low levels= hyponatraemia Urea- Be more aware if kidney function is impaired
62
6- list the common disorders of the skin
HPV Herpes Impetigo Cellulitis Ringworm Dermatitis and excezma Psoriasis Acne Melanoma
63
6- how treatable are most skin conditions?
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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