HCAP 1210 Integumentary System PDF

HCAP 1210  Identify the structures of the integumentary system Describe the functions of the integumentary system Learning Objectives Describe the changes that occur in the body’s integumentary systems during aging and the...

HCAP 1210  Identify the structures of the integumentary system Describe the functions of the integumentary system Learning Objectives Describe the changes that occur in the body’s integumentary systems during aging and the care required Describe the common diseases and conditions associated with the integumentary system Integumentary System Structure  The integumentary system is the largest system.  There are two skin layers:  Epidermis is the outer layer.  Dermis is the inner layer.  It is the body’s protective covering Nerve endings in and prevents the skin sense both microorganisms and pleasant and Integumentary other substances from entering the unpleasant stimulation. body. System Functions It helps regulate body temperature. It is an organ of elimination through perspiration. Observations of Skin Colour of skin can indicate a physical condition Physical Changes in the Aging Process Skin become dry Skin becomes fragile and easily injured Skin loses its strength Skin thins and sags Skin becomes less elastic Skin becomes itchy Brown spots appear on wrists and hands Nails become thick and tough Hair whitens or greys Hair thins Facial hair appears in some women Blood vessels decreases in number Nerve ends decrease in number Fatty tissue layer is lost Integumentary Disorders Many skin disorders cause discomfort Examples of skin disorders: Hives Dermatitis Eczema Shingles Scabies Psoriasis Boil Cyst Impetigo Skin Tag Athlete’s Foot Skin Cancer Hives  Also known as urticaria  Is a relatively common form of an allergic reaction that causes raised red skin welts (wheals)  Wheals vary in size from a few mm to larger  Can be caused by allergies to many things  Common examples are shellfish and some drugs  Dermatitis  Is an inflammation of the skin caused by a direct contact with an irritating or allergy causing substance  Contact dermatitis can be caused by exposure to a material that the client has become allergic to  Irritant dermatitis can be caused by reaction to materials such as soaps, detergents, or chemicals and usually resembles a burn Eczema  Is an inflammatory condition of the skin  It may look different from person to person  In most cases, it is characterized by dry, red, and extremely itchy patches of skin  In other cases it can involve papular or vesicular lesions Shingles  A viral infection causing a painful rash of raised blisters that can appear anywhere on the body  Caused by herpes varicella zoster virus  Blister outbreak lasts about 2 weeks  Can cause extreme and often debilitating pain, itching, or tingling along the affected nerve  Scabies  A highly contagious skin infection caused by a mite  The mite burrows under the skin to deposit its eggs, and this causes intense itching  Scabies is transmitted by skin-to- skin contact between people  A person may be contagious for at least a month before condition is diagnosed  Treatment includes a topical application Psoriasis  Is a persistent skin disorder that causes red scaly plaques (patches) on the skin that can be found anywhere on the body  These patches are areas of excessive skin accumulation that accumulate and become inflamed  Cause has not been identified  Stress and alcohol can make the rash worse Boil  A boil or furuncle is a skin disorder caused by the infection of a hair follicle, usually by Staphylococcus bacteria  Boils present as red, pus-filled lumps that are painful  The most common sites for boils are the back, underarms, shoulders, thighs, and buttocks  Cannot predict when boil may break so always use Standard Practices when providing care Cyst  An abnormal ,closed sac that can occur anywhere in the body  The sac may contain air, fluids, or semi-solid material and has a distinct membrane enclosing it  Once the cyst has formed, it will remain in the tissue unless it is removed surgically or by medication  Impetigo  A contagious skin disorder that is caused by either Streptococcus or Staphylococcus bacteria  A cut or scratch can become infected, and the bacteria are spread by the client scratching the area and touching another part of the body  Infected area forms a crust that can drain and spread the bacteria  Use Standard Practices when caring for a client with impetigo Skin Tag  A small flap of flesh- coloured skin that looks like a droplet or “tag” of skin  Not painful  Most common on women and older adults Athletes Foot  A highly contagious fungal skin infection that causes the affected foot to peel, burn, itch, and turn red  Easily spread through contact  Treated with over-the-counter (OTC) medications Skin Cancer  A malignant growth on the skin that usually develops in the epidermis and so is easily visible  The two most common types of skin cancer are:  Basal cell carcinoma  Squamous cell carcinoma  The most dangerous type of skin cancer is malignant melanoma, which can be fatal if not treated early HCAP 1210 Part 2  Describe the signs, Describe the causes List clients at risk symptoms, and of skin tears and for skin tears and causes of pressure how to prevent pressure ulcers. ulcers and ways to them. prevent them. Identify the pressure Describe the causes Describe the points in the basic of leg and foot process, types, and bed positions and ulcers and ways to complications of Learning sitting positions. prevent them. wound healing. Objectives Describe what to observe about wounds and wound Explain how to secure dressings. Explain the guidelines for applying dressings. drainage. Apply in your Describe how to practice the meet the basic procedures needs of clients who described in this have wounds. chapter.   The skin is the body’s first line of defense.  It protects the body from microbes that cause infection.  You must prevent skin injury and give good skin care to help prevent skin breakdown.  A wound is a break in the skin or mucous membrane. Wound Care  When injury does occur, infection is a major threat.  Wound care involves:  Preventing infection  Preventing further injury to the wound and nearby tissues  Preventing blood loss  Preventing pain  A skin tear is a break or rip in the skin. The epidermis separates from the underlying tissues. The hands, arms, and lower legs are common sites for skin tears. Causes include: Skin Tear Friction and shearing Pulling or pressure on the skin Bumping a hand, arm, or leg on any hard surface Holding the client’s arm or leg too tightly Repositioning, moving or transferring a client Bathing, dressing, and other tasks Pulling buttons or zippers across frail skin  Skin tears are painful.  Skin tears are portals of entry for microbes.  Tell the supervisor at once if you cause or find a skin tear, bruise, bump, or scrape.  Persons at risk for skin tears: Need moderate to complete help in moving Skin Tear   Have poor nutrition or are very thin  Have poor hydration  Have altered mental awareness  Are older  Careful and safe care helps prevent skin tears and further injury.  Follow care plan and Keep client’s nails and safety measures for your nails short or moving, lifting, filed repositioning Guidelines for Do not wear rings Gently transfer or position the client Preventing Skin Tears Prevent friction during Use a turning sheet moving or positioning  Pressure Ulcers  Decubitus ulcers, bed sores, and pressure sores  A pressure ulcer is an injury caused by unrelieved pressure to the skin and or underlying tissue  Usually occurs over a bony prominence, pressure points  Shoulder blades, elbows, hips, sacrum, knees, ankles, heels, and toes are bony prominences and considered pressure points  Pressure points that are moist are especially prone to developing a pressure ulcer  Pressure, shearing, and friction are common causes  Risk factors include:   Breaks in the skin Poor circulation to an area Causes of  Moisture Pressure Ulcers  Dry, flaky skin  Irritation by urine and feces Clients at Risk for a Pressure Ulcer  Clients at risk for pressure ulcers are those who:  Are confined to a bed or chair  Require moderate to complete help in moving  Have loss of bowel or bladder control  Have poor nutrition  Have altered mental awareness  Have problems sensing pain or pressure  Have circulatory problems  Are older  Are obese or very thin Stages of a Pressure Ulcer Prevention & Treatment  Preventing pressure ulcers is much easier than healing them.  Good support care, cleanliness, and skin care are essential.  The health team must develop a plan of care for each person at risk.  The client at risk for pressure ulcers is placed on a surface that reduces or relieves pressure.  The doctor orders wound care products, drugs, treatments, and special equipment to promote healing. Protective Devices  These protective devices are used to prevent and treat pressure ulcers and skin breakdown:  Special beds  Bed cradles  Elbow protectors  Heel elevators  Flotation pads, gel or fluid-filled pads and cushions  Egg crate–like mattress  Pillows  Trochanter rolls  Foot boards Critical Thinking!  Thomas Montoya is a 70-year-old Hispanic male with a history of type 2 diabetes mellitus (DM). He has been admitted to the medical–surgical unit to stabilize his blood sugar. Kristin Lee will be Mr. Montoya’s primary HCA. She completes an admission history and physical exam for Mr. Montoya. Mr. Montoya had a below-the- knee amputation (BKA) of the right leg 2 years ago, after he developed gangrene in his right foot. Mr. Montoya states that for 3 weeks, he has had frequent urination and blurry vision. In addition, he has lost 12 pounds in the past month. Since his surgery, he has been less physically active. He did see a dietitian postoperatively and does self-monitoring of blood glucose “once in a while.” He takes metformin 500 mg twice a day. He drinks 8 ounces of beer with dinner each evening and smokes one-half of a pack of cigarettes per day.  What history and physical examination should be of concern?  What problems do you anticipate when providing care?  What risk factors does Mr. Montoya have for the development of pressure ulcers?  The Braden Scale is used to assess Mr. Montoya’s risk for pressure ulcers. What are the categories that will be addressed? What will be his score?  Three days after admission, Kristin performs morning care on Mr. Montoya. She notes a 0.5-inch blister on Mr. Montoya’s left heel. Kristin promptly notifies Mr. Montoya’s primary care nurse about the finding, who orders that the heel be elevated off the bed and that Mr. Montoya be in the chair for an hour at least three times a day.  What other interventions might Kristin initiate to reduce Mr. Montoya’s risk of skin breakdown?  Despite the interventions, Mr. Montoya’s left heel blister worsens to the extent that the nurses document it as a Stage II pressure ulcer, 1 inch in diameter.  How is a stage II pressure ulcer defined?  What is the difference between a stage 3 and stage 4 pressure ulcer?