Skin

Pressure Ulcers

• Pressure ulcers are caused by tissue damage from skin and underlying soft tissue compression between a bony prominence and an external surface for an extended period.
• Mechanical forces that create ulcers include pressure, friction, and shear.

Identification of High-Risk Clients

• Mental status and decreased sensory perception increase the risk of pressure ulcers.
• Other risk factors include:
  • Activity and mobility limitations
  • Nutritional status
  • Incontinence

Pressure-Relieving Techniques

• Adequate pressure relief is key to preventing pressure ulcers.
• Techniques include:
  • Positioning away from mattresses and pillows
  • Using pressure relief products and devices
  • Capillary closing pressure

Wound Assessment

• Pressure ulcers are classified into four stages:
  • Stage I: Non-blanchable erythema
  • Stage II: Partial-thickness skin loss
  • Stage III: Full-thickness skin loss
  • Stage IV: Full-thickness skin and tissue loss

Interventions for Impaired Skin Integrity

• Interventions include:
  • Dressings
  • Physical therapy
  • Drug therapy
  • Diet therapy
  • New technologies
  • Electrical stimulation
  • Vacuum-assisted wound closure
  • Hyperbaric oxygen therapy

Surgical Management

• Preoperative care involves:
  • Debridement
  • Dressing changes
  • Prevention of infection
• Operative procedures include:
  • Skin grafts
  • Pedicle flaps
  • Possible closure or skin grafts
• Postoperative care involves:
  • Ensuring rest of grafted area
  • Caring for pedicle flap
  • Providing postoperative care of donor sites
  • Ensuring correct client positioning

Prevention of Infection and Wound Extension

• Interventions include:
  • Monitoring the ulcer's progress
  • Providing timely treatment with topical and systemic antibiotics
  • Reducing the introduction of pathogenic organisms to the ulcer
• Reporting to the primary health care provider is necessary for:
  • Sudden deterioration of the ulcer
  • Increase in size or depth of the lesion
  • Changes in color or texture of granulation tissue

Bacterial Infections

• Folliculitis: superficial infection involving the upper portion of the follicle
• Furuncles: deeper infection in the follicle
• Carbuncles: a group of infected hair follicles
• Cellulitis: generalized infection involving deeper connective tissue

Viral Infections

• Warts: lesions caused by human papillomavirus (HPV)
• Herpes Simplex viruses:
  • HSV-1: majority are above the waist, found on lips, waist, and mouth
  • HSV-2: classified as sexually transmitted by physical contact, oral sex, or kissing
• Herpes Zoster: Shingles

Fungal Infections

• Dermatophyte infections can differ in lesion appearance, anatomic location, and species of the infecting organism
• Examples include:
  • Tinea capitis
  • Tinea corporis
  • Tinea pedis
  • Candidiasis infections caused by Candida albicans

Sunburn

• First-degree burns: superficial injury
• Second-degree burns: partial-thickness injury
• Third-degree burns: full-thickness injury
• Treatment includes:
  • Cool baths
  • Soothing lotions
  • Antibiotic ointments for blistering and infected skin
  • Topical corticosteroids for pain

Urticaria

• Presence of white or red edematous papules or plaques of varying sizes
• Removal of triggering substances
• Antihistamines are helpful
• Avoidance of overexertion, alcohol consumption, and warm environments

Wound Healing

• Phases of wound healing:
  • Inflammatory phase
  • Fibroblastic, or connected tissue repair phase
  • Maturation or remodeling phase
• Wound closure:
  • First intention: resulting in a thin scar
  • Second intention: granulation and contraction—a deeper tissue injury or wound
  • Third intention: delayed closure—with a resultant scar