Funciones y Estructura de la Piel

Skin Functions

• Protection against external aggressions and sun damage.
• Thermoregulation through vasodilation (gives a red color) and vasoconstriction (for cold), sweating, and adipose tissue for thermal insulation.
• Secretion of sweat and sebum.
• Absorption of medications and creams.
• Reception through nervous receptors related to touch and pressure.
• Synthesis of melanin, and production of vitamin D.
• Excretion of waste through sweat.

Skin Structure

• Thickness varies from 0.5 to 2 mm.
• Epidermis: Epithelial tissue, thicker in palms and soles, contains melanocytes that produce melanin, which provides dark color to the skin.
• Dermis or corion: The thickest layer of connective tissue under the epidermis containing blood vessels, lymphatic vessels, nerve endings, sebaceous glands, sweat glands, and hair follicles.
• Hypodermis: Subcutaneous cellular tissue composed of adipose connective tissue crossed by collagen bands, blood vessels and nerves.

Hair

• Keratin shaft formed in hair follicles.
• Bulb: Basal part formed in the root.
• Shaft: Passes through the epidermis and projects outwards, with discontinuous and cyclical growth; each follicle is associated with a sebaceous gland and erector pili muscle, which causes "goosebumps" when contracted.

Nails

• Epidermal appendages formed by flattened keratin sheets.
• Matrix: Part where the nail grows, under the skin where the nail originates.
• Eponychium: Cuticle.
• Paronychium
• Hyponychium
• Nail body
• Nail bed
• Lunula

Primary Skin Lesions

• Alterations in skin color that cause spots or macules, not perceptible to the touch.
• Erythematous macule: Reddish spot of vascular origin; exanthema is the simultaneous appearance of various macules, such as in measles, scarlet fever, and rubella; they disappear with vitropression.
• Purpuric macule: Extravasation of blood; does not disappear with vitropression; petechiae are red pinpoint spots; vibices are linear; ecchymosis appears as a sheet.
• Telangiectasia: Vascular spider.
• Hyperchromic pigmentary macule: Due to excess melanin caused by sun exposure, tattoos, etc.; examples are ephelides, freckles, moles, or pigmented nevi.
• Hypochromic or achromatic pigmentary macule: Absence of melanin in areas of the skin, typical of vitiligo.
• Papule: Solid, circumscribed, and elevated, with variable color, e.g., acne.
• Wheal or hive: Solid, slightly protuberant with variable shape and size, surrounded by edema; typical of common allergies.
• Nodule: Lesion of 1 to 2 cm in diameter that affects the dermis and hypodermis.
• Tumor: Solid mass, non-inflammatory and protuberant, larger than a nodule and tends to grow.
• Vesicle: Liquid-filled, elevation of the epidermis with transparent, serous, or hemorrhagic liquid inside.
• Bulla: Liquid-filled, similar to a vesicle but larger in size, more than 0.5 cm.
• Pustule: Liquid-filled, similar to a vesicle but with yellow or brown color.

Secondary Skin Lesions

• Scale: Whitish or greyish sheets.
• Crust: Condensation of blood, pus, or serum.
• Fissure: Cut or crack of the epidermis and dermis.
• Erosion or excoriation: Loss of substance that affects the epidermis, which heals without leaving a scar, e.g., produced by scratching.
• Scar: Tissue neoformation that repairs a loss of substance.
• Ulcer: loss of substance in the skin due to destruction of the epidermis, dermis, and sometimes hypodermis.
• Eschar: Elemental secondary skin lesion.

Skin Infections

• Bacterial:
  • Folliculitis: Inflammation of hair follicles, e.g., beard.
  • Furuncle: Infection of one or more follicles due to sweating, friction, pressure areas, and axillae.
• Viral:
  • Herpes simplex and herpes zoster.
• Fungal:
  • Tinea pedis (Athlete's foot).
  • Cutaneous candidiasis Folliculitis: Infection of hair follicles, e.g., beard.
  • Furuncle: Infection of one or more follicles due to sweating, friction, pressure areas, and axillae.

Skin Infestations

• Pediculosis: Lice.
• Scabies: Mites.

Skin Tumors

• Benign:
  • Warts (caused by viruses).
  • Angiomas (hyperplasia of blood or lymphatic vessels).
  • Moles or pigmented nevi (accumulation of melanocytes).
• Malignant:
  • Carcinomas.
  • Melanomas.

Hair Lesions

• Alopecia: Decrease or loss of hair.
• Hypertrichosis: Increased hair localized or generalized (werewolf syndrome); hirsutism is the same in women.

Nail Disorders

• Structural:
  • Ingrown nail.
  • Spoon nails.
  • Broken nail.
  • Split nail.
  • Peeling nail.
  • Pitted nail.
• Chromatic:
  • Leukonychia (white spots).
  • Nigronychia (black nail).
• Periungual:
  • Onycholysis: Detachment of the nail in the distal/lateral part.
  • Onychoschizia: Separation in layers of the nails.
  • Leuconychia: White spots.
  • Chromonychia: Alteration of nail color.
  • Anonichia: Absence of a nail.
  • Coiloniquia: Inward curvature.
  • Onychomadesis: Separation of a nail portion proximal to the nail matrix.
  • Hangnail: Skin piece that breaks and stands out on the edge of the nail.
  • Paronychia: Inflammation of the soft tissues surrounding the nails.
  • Onychomycosis: Fungal infection of the nails.
  • Onycalgia: Pain in the nail.
  • Onychocryptosis: ingrown nail.
  • Onychophagia: Nail biting.
  • Onychomalacia: Softening of the nails.
  • Onycodystrophy: Thick nail
  • Onychogryphosis: Ram's horn nail.
  • Onychoauxis: thick nail.

General Purpose of Hygiene and Grooming

• Observe any sign that may indicate a health problem (skin, musculoskeletal system, behavior, etc.).
• Maintain the integrity of the skin for proper function.
• Prevent accumulation of secretions and bacterial proliferation, which favors infections.
• Eliminate dead cells and dirt, and prevent bad odor.
• Stimulate blood circulation.
• Lower body temperature in cases of hyperthermia.
• Contribute to maintaining or improving the patient's self-esteem.
• Improve their comfort and well-being.
• Favor the helping relationship due to the proximity required by the procedures.

Rules for Performing Hygiene Procedures

• Maintain a suitable room temperature (between 22 and 24°C).
• Check the water temperature, which will be between 38° and 40°C unless otherwise indicated.
• Avoid drafts.
• Prepare all equipment before starting everything needed for grooming, the patient, the bed, and the nursing assistant.
• Isolate the patient from the environment, using a screen if necessary.
• Use soaps that do not irritate the skin.
• In bedridden patients, avoid leaving them completely naked, covering them with a towel or putting on a dressing gown or pajamas, to respect their modesty.
• Do not wet the bed unnecessarily, protect it by placing a towel under the patient and thoroughly wring out the sponge.

Skin injuries

• Wheal or hive: Firm, slightly raised lesion with variable shape and size, surrounded by edema, often itchy; appears in common allergic reactions.
• Nodule: raised lesion 1 to 2 cm in diameter that affects the dermis and hypodermis.
• Tumor: solid mass, non-inflammatory and raised. It tends to grow and is larger than the nodule.
• Vesicle: It is an elevation of the epidermis, with a thin wall, which contains a transparent, serous, or hemorrhagic liquid.
• Blister: lesion similar to the vesicle but of greater size (diameter greater than 0.5 cm).
• Pustule: It is similar to the vesicle but of brownish or yellowish color. Its content is purulent.

Actuation Rules for Asepsis

• Environment temperature: 22°-24°
• Water temperature: 38°-40°
• Put a towel under to prevent getting the bed wet.
• Order: lathering, rinsing, rinsing, drying
• Improving regular blood flow with a massage.
• Asepsis once a dy and as often as necessary.
• Two towels: face and head.
• The auxiliary nurse will help if needed.

Bed Bathing

• Check temperature.
• Necessary items: liquid soap and sponge, two tubs, 3 towels (2 for the patients body/legs and 1 for the patients face), blunt edge scissors, alcohol, wedge cushion, humidifier, a brush or comb for the patients teeth or hair.
• Bag for dirty items.
• Nurse wears gloves and scrubs
• Water temperature: 40°- 46°
• Ask if the patient has to use the bathroom before start.
• Disinfect and clean the area being cleaned.
• The patients feet and hands are submerged in the tub.
• Change the water used as much as necessary, and change the water before and after the patients legs and genital region is cleansed.
• Patient should be facing same direction for the entire procedure.
• Make sure to work in order from the least dirty to the dirtiest areas.

Genital Area

• Clean from top to bottom in women from the urethral opening to the perianal opening
• Emphasize labia. Yogurt like discharge is smegma
• Men should remember to get between the thighs, scrotum and inside the area, and finally the anal opening
• Use the face soap on all things but the eyes.
• Wash in the following order: shaved face, eyes, face, ears, head, shoulders, arms, hands, armpits, abdomen, legs, genitals (front to back).

Cleanings

• Guedel cannula is a mayo tube.
• Ears cleaned everyday using alcohol.
• Nose cleaned everyday with a wet towel using suero fisiologico.
• Dentures on top should be connected first when placing, then lower ones.
• Only use gloves when assisting.

Miscellaneous laundry

• Wash hair with a towel.
• Every 1-2 times a week do the laundry at night.
• Wash and place correctly.

Stomatological Valorations

• Anti coagulation: If the patient uses such meds, avoid brushing and scrubbing hard.
• Immunodepression: the patient shouldn't use sink water.
• Unconscious/Intubet Patients: Aspirate any nasal fluids.
• Intubed Patients: Properly placing of the breathing tube and protecting the lips from scraping.
• Mucosal injuries: Do not place denture at least until all the wounds are properly closed.
• Aerozol Use: Rinse mouth immediately after
• Alloys Allergy: Be careful about metallic or laxing components

Prothesis

• Keep boxes safe and sanitary.
• Name of patient or unit label is attached.
• Check box is sterile.
• After every food brushing teeth for cleaness purposes.
• Each night use clean liquid to maintain hygiene purposes.

Procedure for cleanliness of the perioral area:

• Place the pillow under the patient
• Irrogate the face with low pressure of water
• Dry off the patients face and make sure that the patient can utilize the emergency call button.

Unconscious Patinets

• Place a towel across the head and neck for safety purposes
• The patients mouth should be kept open
• Be extra careful when cleaning internal mucosa
• Use face cream post cleaning.
• Avoid scrubbing the face

Protocol for Daily Care

• Preparation of operatory: Be sanitized
• Perform hygiene protocols for safety measures
• Take safety measures.
• Material List: protection gear, dental floss, lubricant, bandages, Q-tips, cleaning items, toothpaste, and brush.
• Complentary: Cleaners , antibacterial, water flusher

Collaboration Grade

• Autonomous patient: Should be able to complete the procedure alone.
• Dependent patient: Needs a person to enjuage and aide.

Implementation:

• Check all facial regions, including mucosa for any damages.

Assisting others:

• Follow the position of those with Semi Fowler grade, to ensure that all areas are well cleaned and sanitized
• Protect the facial areas, including eyes , with bandage, etc, to ensure safe cleaning area.
• Deposit the right amount of cleaner to the surface .
• Inside mucosa should be cleaned completely.

Miscellaneous protocols

• Clean the eyes.
• Cut the nails every week. Round off the hands, and straight edge the feet.

Massages

• 5-15 minutes.
• Manipulation types are friction, petting, stirring, massaging, and surface massages.

Bed Linens

• Linen Order-
• Colchon and sheet, lower sheets, sheets, linens, upper linens.
• Keep the surface wide open, and aligned.
• Remember to take the widest position.

Vestments

• Dimentions: Functional, aesthetics, socials, personal.

EVOAS

• Health Assessment for Social Purposes.