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Questions and Answers
Shear forces occur when layers of skin slide over each other, damaging blood vessels and tissues.
Shear forces occur when layers of skin slide over each other, damaging blood vessels and tissues.
True (A)
Moisture from excessive sweating does not affect the skin barrier.
Moisture from excessive sweating does not affect the skin barrier.
False (B)
Harsh cleaners can enhance skin integrity.
Harsh cleaners can enhance skin integrity.
False (B)
Age is a systemic factor affecting wound healing.
Age is a systemic factor affecting wound healing.
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Anticoagulants decrease the risk of skin tears.
Anticoagulants decrease the risk of skin tears.
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Nutritional deficiencies can negatively impact the healing process.
Nutritional deficiencies can negatively impact the healing process.
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Wound drainage does not irritate the surrounding skin.
Wound drainage does not irritate the surrounding skin.
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Obese individuals are less likely to experience wound complications.
Obese individuals are less likely to experience wound complications.
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Elderly patients should not have their foot inspections encouraged.
Elderly patients should not have their foot inspections encouraged.
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Critically ill patients require advanced support surfaces to prevent pressure ulcers.
Critically ill patients require advanced support surfaces to prevent pressure ulcers.
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Proper footwear is irrelevant for elderly patients.
Proper footwear is irrelevant for elderly patients.
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Age-related skin changes include increased elasticity.
Age-related skin changes include increased elasticity.
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Monitoring for early signs of pressure ulcers is optional for critically ill patients.
Monitoring for early signs of pressure ulcers is optional for critically ill patients.
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Nutrition plays a significant role in the management of pressure ulcers.
Nutrition plays a significant role in the management of pressure ulcers.
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Skin changes in elderly patients can lead to a higher risk of injury.
Skin changes in elderly patients can lead to a higher risk of injury.
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The Registered Nurses' Association of Ontario does not provide guidelines for pressure injuries.
The Registered Nurses' Association of Ontario does not provide guidelines for pressure injuries.
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Elderly, immobile, or critically ill patients are considered at high risk for pressure ulcers.
Elderly, immobile, or critically ill patients are considered at high risk for pressure ulcers.
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Fluid intake is not important for maintaining skin elasticity.
Fluid intake is not important for maintaining skin elasticity.
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Using pH-balanced cleansers helps to avoid skin irritation.
Using pH-balanced cleansers helps to avoid skin irritation.
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Reassessing the skin should be done only once a week for optimal skin health.
Reassessing the skin should be done only once a week for optimal skin health.
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Barrier creams containing zinc oxide can protect against moisture and irritation.
Barrier creams containing zinc oxide can protect against moisture and irritation.
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It is unnecessary to collaborate with dietitians in developing care plans for skin integrity.
It is unnecessary to collaborate with dietitians in developing care plans for skin integrity.
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Applying emollients can help prevent dryness and cracking of the skin.
Applying emollients can help prevent dryness and cracking of the skin.
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Patients with diabetes do not require special monitoring for skin health.
Patients with diabetes do not require special monitoring for skin health.
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Stage 1 pressure injuries present as intact skin with a localized area of non-blanchable erythema.
Stage 1 pressure injuries present as intact skin with a localized area of non-blanchable erythema.
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Elevating the extremity of a patient with an arterial ulcer is recommended to promote healing.
Elevating the extremity of a patient with an arterial ulcer is recommended to promote healing.
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Patients with diabetes should avoid wearing well-fitting shoes as it can lead to further foot injuries.
Patients with diabetes should avoid wearing well-fitting shoes as it can lead to further foot injuries.
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Managing blood sugar levels is important for optimal healing in patients with diabetes mellitus.
Managing blood sugar levels is important for optimal healing in patients with diabetes mellitus.
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Exposure to alcohol can impair wound healing.
Exposure to alcohol can impair wound healing.
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Smoking has no effect on the inflammatory phase of wound healing.
Smoking has no effect on the inflammatory phase of wound healing.
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Compression dressings are used to control edema in patients with arterial ulcers.
Compression dressings are used to control edema in patients with arterial ulcers.
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Repositioning a patient with a pressure injury should occur at least every two hours to minimize pressure.
Repositioning a patient with a pressure injury should occur at least every two hours to minimize pressure.
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Diabetes can lead to delayed wound healing due to neuropathy and decreased immune resistance.
Diabetes can lead to delayed wound healing due to neuropathy and decreased immune resistance.
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Stress can enhance the immune response, improving wound healing.
Stress can enhance the immune response, improving wound healing.
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Partial-thickness loss of skin in pressure injuries is classified as Stage 3.
Partial-thickness loss of skin in pressure injuries is classified as Stage 3.
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Incontinence can increase the risk of skin vulnerability due to prolonged exposure to moisture from urine and stool.
Incontinence can increase the risk of skin vulnerability due to prolonged exposure to moisture from urine and stool.
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The first phase of wound healing is called Inflammation.
The first phase of wound healing is called Inflammation.
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The proliferation phase involves closing the wound with new tissue and blood vessels.
The proliferation phase involves closing the wound with new tissue and blood vessels.
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Epithelial cells multiply to cover the wound during the maturation phase.
Epithelial cells multiply to cover the wound during the maturation phase.
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Signs of localized wound infection include erythema and purulent exudate.
Signs of localized wound infection include erythema and purulent exudate.
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The epidermis is the thicker layer of skin that houses blood vessels and nerve fibers.
The epidermis is the thicker layer of skin that houses blood vessels and nerve fibers.
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The hypodermis is responsible for protection from mechanical and thermal injuries.
The hypodermis is responsible for protection from mechanical and thermal injuries.
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The skin serves three main functions: protection, thermoregulation, and sensation.
The skin serves three main functions: protection, thermoregulation, and sensation.
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Skin conditions like blisters and skin cancer are examples of conditions that affect skin integrity.
Skin conditions like blisters and skin cancer are examples of conditions that affect skin integrity.
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Skin acts as a barrier against moisture loss, harmful agents, and UV radiation.
Skin acts as a barrier against moisture loss, harmful agents, and UV radiation.
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Sensation is not an important function of the skin.
Sensation is not an important function of the skin.
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Thermoregulation refers to the skin's role in maintaining a constant core temperature of the body.
Thermoregulation refers to the skin's role in maintaining a constant core temperature of the body.
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The skin is considered the body’s internal protection system.
The skin is considered the body’s internal protection system.
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Study Notes
Skin Integrity and Wound Healing
- Skin is composed of two main layers: epidermis and dermis.
- The epidermis is the outermost, thin layer.
- The dermis is the inner, thick layer that contains blood vessels, hair follicles, sweat glands, and nerve fibers.
- The hypodermis lies beneath the dermis, containing connective tissue and adipose tissue.
- The skin's functions include protection, thermoregulation, and sensation.
Functions of the Skin
- Protection: Protects against mechanical, thermal, physical injuries, harmful agents, excessive moisture/protein loss, and UV radiation.
- Thermoregulation: Protects the body from cold or heat, maintaining a constant core temperature.
- Sensation: The skin is the sense organ for touch and triggers a response to stimuli, including pain.
Conditions and Disorders Affecting the Skin
- Allergies (e.g., contact dermatitis)
- Blisters
- Bug bites (e.g., spider, mosquito)
- Skin cancer (e.g., melanoma)
- Skin infections (e.g., cellulitis)
- Skin rashes and dryness
- Skin disorders (e.g., acne, eczema, psoriasis, vitiligo)
- Wounds, burns (including sunburns), and scars
Definition of Skin Integrity
- Skin integrity is the maintenance of healthy, intact skin functioning as a protective barrier against external threats.
- Preserves skin's structure, function, and ability to repair itself after damage.
Risk Factors for Impaired Skin Integrity
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(Intrinsic Risk Factors - Internal)*
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Age-related changes:
- Thinning of the skin (reduced collagen and elastin),
- Decreased subcutaneous fat (increasing pressure injury risk),
- Slower healing.
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Chronic medical conditions:
- Diabetes (poor circulation and neuropathy increase skin breakdown risk, especially in feet)
- Vascular diseases (e.g., PAD, reducing blood flow)
- Immunosuppression (weakening the immune system, increasing infection risk)
- Renal failure (can cause dry skin, increasing susceptibility to injury)
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(Extrinsic Risk Factors - External)*
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Pressure: Prolonged pressure on bony prominences (e.g., sacrum, heels, elbows) reduces blood flow, leading to tissue ischemia and pressure ulcers.
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Shear and Friction: Skin sliding over each other (e.g., sliding down in bed), damaging blood vessels and tissues.
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Moisture: Prolonged exposure to urine/feces (incontinence), excessive sweating creates a moist environment, weakening skin barrier.
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Poor hygiene: Inadequate cleaning, harsh cleansers.
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Medical devices: Tubes (e.g., nasogastric), catheters and oxygen masks.
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Environmental factors: Heat/humidity (excessive sweating), cold weather (drying).
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Medications: Corticosteroids (skin thinning, impaired healing), chemotherapy (skin sensitivity, increased infection risk), anticoagulants (bruising, skin tears).
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Nutritional deficiencies: Protein deficiency impairs tissue repair, and vitamin/mineral deficiencies affect healing.
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Impaired mobility: Prolonged pressure on bony areas increases pressure ulcer risk.
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Skin conditions: Eczema or psoriasis (inflammation weakens the skin barrier), dermatitis (irritation or allergic reactions damaging skin), fragile skin.
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Obesity or low body weight: Increased pressure, reduced blood flow or lack of subcutaneous fat.
Factors Affecting Wound Healing
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(Local factors)*
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Localized blood flow
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Tissue oxygenation
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Infection or foreign bodies
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Venous insufficiency
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(Systemic factors)*
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Age (alters inflammatory response, impairing healing)
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Obesity (infection, hematoma, pressure and venous injuries)
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Medications (corticosteroids impair granulation tissue formation)
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Nutrition (deficiencies can impact healing)
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Alcohol consumption (impair wound healing, increases infection)
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Smoking (impairs inflammatory phase, poor healing, increased infection)
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Stress (impaired immune response delays healing)
Phases of Wound Healing
- Hemostasis: Blood clotting to stop bleeding.
- Inflammation: White blood cells fight infection and remove debris.
- Proliferation: New tissue (connective tissue and blood vessels) grows, the wound tightens towards its center.
- Maturation: New tissue strengthens and gains flexibility.
Signs of Wound Infection
- Erythema (redness)
- Induration (hardened tissue)
- Pain
- Edema (swelling)
- Purulent exudate (yellow/green drainage)
- Wound odor
Nursing Care to Promote Wound Healing
- Minimize Pressure and Shear: Reposition patients frequently to relieve pressure on bony prominences, use support surfaces.
- Educate Patients: Teach patients about preventing injury, as appropriate (e.g., diabetics and neuropathy)
- Control Edema: Use compression dressings for venous ulcers.
- Promote Adequate Perfusion: Avoid elevating extremities for arterial ulcers.
- Manage Blood Sugar and Nutrition: Ensure proper nutrition and hydration
- Document and Communicate: Document assessments and interventions and communicate with the multidisciplinary health team.
- Referral: Refer to specialized wound care nurses, when appropriate.
Pressure Ulcers
- Pressure injuries are localized damages to the skin or underlying tissues, usually over bony prominences, caused by prolonged pressure combined with shear.
- Stages of pressure ulcers:
- Stage 1: Intact skin with localized non-blanchable erythema
- Stage 2: Partial-thickness skin loss with exposed dermis
- Stage 3: Full-thickness skin loss with visible fat
- Stage 4: Full-thickness skin and tissue loss with exposed bone/tendon.
Risk factors of pressure ulcers
- Immobility
- Incontinence
- Lack of sensory perception
- Poor nutrition and hydration
- Medical conditions affecting blood flow
Nursing Interventions to Protect Skin Integrity and Prevent Pressure Ulcers
- Conduct regular skin assessments (looking for redness, swelling, dryness, or breakdown).
- Use validated tools (e.g., Braden Scale, Norton Scale) to assess pressure ulcer risk.
- Identify high-risk patients (elderly, immobile, critically ill, diabetics, incontinence, or malnutrition).
- Reposition patients regularly; use pressure-relieving devices
- Use moisture management strategies and barrier creams to prevent skin damage.
- Educate patients and families about proper skin care and nutrition.
- Work with a multidisciplinary team (dieticians, physical therapists, and wound care specialists).
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Description
Explore the essential aspects of skin structure, functions, and healing processes. This quiz covers the layers of the skin, their functions, and the common conditions that affect skin integrity. Test your knowledge on how the skin protects the body and responds to various stimuli.
