Skin tissue integrity
plays a major role in protection by protecting the body against invasion of the pathogenic organisms by providing first, second, and third lines of defense.
Specialized cells in the skin
engulf foreign substances (antigens) that invade the body when tissue integrity is lost and then alert the immune system to the presence of the invader.
Localized tissue inflammation and swelling
work to contain the invading pathogen until the white blood cells can respond and remove this threat.
Intact skin helps
regulate the body temperature and maintains fluid and electrolyte balance.
The skin's sensory function allows
the use of touch as an intervention to provide comfort, relieve pain, and communicate caring.
Subcutaneous fat (adipose tissue) is
the innermost layer of the skin, lying over muscle and bone.
The dermis (corium) is
the layer above the fat layer and contains no skin cells but does contain some protective mast cells and macrophages.
The dermis is composed of
interwoven collagen and elastic fibers that give the skin flexibility and strength.
Collagen is the main component of
dermal tissue, is a protein produced by fibroblast cells.
Epidermis is the outermost skin layer
anchored to the dermis by fingerlike projections (rete pegs) that interlock with dermal structures called dermal papillae.
Epidermal layer is
the first line of defense between the body and the environment
Freckles, birthmarks, and age spots are
lesions caused by patches of increased melanin production.
Melanin production also increases in areas that have endocrine changes or inflammation.
Hair growth varies with
race, age, gender and genetic predisposition.
Hair follicles are
located in the dermal layer of the skin but are actually extensions of the epidermal layer.
Permanent baldness, such as male pattern baldness
is inherited
Nails protect and enhance
sensation of the fingertips and toe tips, have cosmetic value, and are useful for grasping and scraping.
The nail body is translucent
and the pinkish hue reflects a rich blood supply beneath the nail surface.
Sebum
lubricates the skin and reduces water loss from the skin surface.
Eccrine sweat glands arise from the epithelial cells
found over the entire skin surface and are not associated with hair follicle.
the odorless, colorless secretions of these glands are important in body temperature regulation.
can lose 10 to 12L of fluid daily
Apocrine sweat glands
are in direct contact with the hair follicle and are found in the axillae, nipple, umbilical, and perineal body areas.
Interaction of skin bacteria with the secretions of these glands causes body odor.
Skins location on the outside of the body
makes it an important way to communicate a patients state of health and body image.
Genetic factors, hormonal changes, and disease may
change skin appearance over time, chronic sun exposure is the single most important factor leading to degeneration of the skin components.
Take an accurate history from the patient so
skin problems can be readily identified.
STUDY CHART 24-2
Changes in the Integumentary System Related to Aging
Demographic data includes
age, race, occupation, and hobbies or recreational activities.
This info can identify causative or aggravating factors for skin problems
Socioeconomic status data helps identify
environmental factors that might contribute to skin disease.
Unhealthy or crowded living conditions promote the spread of contagious skin pathogens.
Regardless of skin color always ask
the patient about the amount of time spent in the sun and tanning booths and identify skin problems caused by sun exposure.
Use this time to teach about harmful aspects of sun exposure and how to reduce risk by avoiding time in the sun and wearing sunscre
STUDY CHART 24-2
Questions to Obtain...
Teach individuals that
keeping skin and hair clean by bathing and shampooing regularly helps maintain the skin's health.
Info on drug use is important because
prescribed drugs, over the counter drugs, herbal preparations or remedies, and tobacco use can cause skin reactions or affect skin function.
A drug history helps identify
skin changes that result from management of other health problems, such as changes that occur with long term steroid or anticoagulant therapy.
Incorporate skin exams as a
routine part of the daily care during the bath or when assisting with hygiene.
Always inspect skin in a well lit room
Assess each skin surface
systematically, including the scalp, hair, nails, and mucous membranes.
Pay close attention to skinfolds!
Observe and document obvious changes in
color and vascularity, moisture presence or absence, edema, skin lesions, and skin integrity
Skin color is affected by
blood flow, gas exchange, body temperature, and pigmentation.
STUDY CHART 24-2
Common Alterations in skin Color
Color changes are visible in the areas of
least pigmentation, such as the oral mucosa, sclera, nail beds, and palms and soles.
Primary lesions
develop as a direct result of a disease process
Secondary Lesions
evolve from primary lesions or develop as a consequence of the patients activities.
Describe lesions by
color, size, location and shape.
Notate if they are isolated or are grouped and form a distinct pattern.
Rashes only limited to skinfold areas
(on the axillae, beneath the breasts, in the groin) may reflect problems related to friction, heat, and excessive moisture.
Moisture content is assessed by
noting the thickness and consistency of secretions.
Dampness of skinfold areas occurs with
reduced air circulation where the skin surfaces touch.
Excess moisture can cause impaired tissue integrity with skin breakdown in bedridden and debilitated patients.
Dry skin usually has
scaling and flaking any may be especially marked in areas of limited circulation such as the feet and lower legs.
Normal vascular markings include
birthmarks, cherry angiomas, spider angiomas, and venous stars.
Bleeding into the skin is abnormal and results in purpura (bleeding under skin that may progress from red to purple to brown-ish yellow), petechiae, and ecchymosis.
Petechiae of the lower extremities often occur with
stasis dermatitis- a condition usually seen with chronic venous insufficiency.
Petechiae found below the nipple line may be indicative of a
serious underlying medication problem such as disseminated intravascular coagulation.
Ecchymoses (brusies)
are larger areas of hemorrhage.
Certain drugs (aspirin, warfarin, corticosteroids) and low platelet counts lead to easy or excessive bruising.
Anticoagulants and decreased numbers of platelets disrupt clotting action, resulting in ecchymosis.
Skin tissue integrity is assessed by
first examining areas with actual breaks or open areas.
Look for skin tears where
clothing rubs against the skin, on upper extremities where skin is grasped to assist in ambulation, and where adhesive tapes or dressings have been applied and removed.
Document breaks in the
skin tissue integrity by describing their location, size, color, and distribution and by the presence and characteristics of drainage or infection.
Cleanliness of the skin is
evaluated to learn about self care needs.
Assess the cognition of any patient whose hygiene of the skin, hair, or nails appears inadequate.
Closely examine any areas where
tattoos have been removed.
Skin cancer is more likely to occur in these areas.
Use palpation to gather
additional information about skin lesions, moisture, temperature, texture, and turgor.
Use standard precautions when skin areas are draining
Palpation confirms
lesion size and whether the lesions are flat or slightly raised.
Changes in skin temperature
are detected by placing the back of your hand on the skin surface with warm hands.
Areas of long-term sun exposure have rougher texture
Increased skin thickness from
scarring, lichenfication, or edema usually decreases elasticity.
Skin tugor can be
altered by water and aging.
Normal turgor will immediately return to its normal state.
Poor turgor is seen as "tenting"of the skin, with a gradual return to the original state.
Usually checked on the back of the hand of older adults
you may also check for turgor on the abdomen, forehead, or radial aspect of the wrist.
***To avoid mistaking dehydration for dry skin in an older adult,
always assess skin turgor on the forehead or chest.