Tabloski ch12 lecture

Gerontological NursingGerontological Nursing

CHAPTER

THIRD EDITION

Copyright © 2014, © 2010, © 2006 by Pearson Education, Inc.All Rights Reserved

The Integument

12

Gerontological Nursing, Third EditionPatricia A. Tabloski

Learning Objectives

1. Describe normal skin changes associated with aging.

2. Identify risk factors related to common skin problems of older adults.


Learning Objectives

3. Delineate skin changes associated with benign and malignant skin changes.

4. List nursing diagnoses related to common skin problems.


Learning Objectives

5. Discuss the nursing responsibilities related to pharmacological and nonpharmacological treatment of common skin problems.

6. Explain the nursing management principles related to the care of pressure ulcers.


Introduction

• The overall health of a person often is reflected by assessment of skin color, texture, warmth, general appearance, and overall grooming.

• An important part of the nurse’s role is to educate the older adult about normal skin changes, maintaining a lifestyle that promotes healthy skin, and minimizing exposure to environmental hazards.


Usual Structure and Function of Skin Layers

• The skin can be divided into three major layers: –Epidermis–Dermis–Subcutaneous layer


Dermal Accessory Structures

• Accessory structures of the skin include the hair, nails, and glands; each accessory structure has a unique purpose and function.


Usual Functions of the Skin

• Skin is a “highly active biological factory.”

• It contributes to the immune function, regulates temperature, and provides the vehicle for vitamin synthesis and sensory reception for the central nervous system.


Normal Changes of Aging

• Age-related changes in the skin of older adults:–Decrease in the thickness–Decreased elasticity


Hair

• The hair of the older adult appears gray or white due to a decrease in the number of functioning melanocytes.

• The texture and thickness of the hair also changes.


Nails

• The nails of the older adult become dull and yellow or gray in color.

• Nail growth slows, which results in thicker nails that are more likely to split.


Glands

• With aging, there is a decrease in the size, number, and function of both eccrine and apocrine glands.

• As the ability to sweat decreases, the older adult may be unable to control body temperature by the normal sweating mechanism, and therefore is at a high risk for heat exhaustion.


Sun Damage

• The cumulative effect of sun exposure throughout a lifetime leads to premature aging and increases the risk for skin cancer.

• UVR-related skin damage is thought to be distinct from the normal aging process.


Common Skin Conditions in Older Adults

• Skin changes leave the older person increasingly susceptible to skin injuries such as pressure ulcers and skin tears with a steadily decreasing ability to effect skin repair.

• Common skin conditions of the older adult include skin cancer, skin tears, pressure ulcers, delayed skin healing, cellulitis, and fingernail and toenail problems.


Pressure Ulcers in the Older Adult

• The Centers for Medicare and Medicaid Services (CMS) announced that hospitals will no longer be reimbursed for treatment of pressure ulcers that develop during the hospital stays of Medicare patients. This announcement changed the payment process for pressure ulcers.



• This mandate put a new focus, albeit a financial one, on the importance of prevention and documentation of pressure ulcers for nurses and all caregivers in health care facilities.



• A pressure ulcer is defined as “localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear or friction.”



• The three types of pressure ulcers are:–A necrosis of the epidermis or dermis,

which may or may not progress to a deep lesion.

–A deep or malignant pressure ulcer where necrosis is observed initially in the subcutaneous tissue and tracks outward.

–Full-thickness wounds of dry black eschar.


Fingernail and Toenail Conditions

• Changes in the nail plate occur with aging, and are also caused by trauma, systemic diseases such as diabetes and circulatory disorders, as well as dermatological conditions.


Pharmacological Treatment of Skin Problems in the Older Adult

• Pharmacological treatment of skin problems may include topical or systemic administration of medications.


Nonpharmacological Treatment of Skin Problems in the Older Adult

• Prevention and early treatment of skin problems in older people may also include nonpharmacological interventions and patient education.

• Identification and correction of factors that may contribute to pathological skin changes is a key nursing responsibility.


Box 12-1 ABCDEs of Skin CancerSource: American Cancer Society (2011); Skin Cancer

Foundation (2011c).


Pressure Ulcers

• Pressure ulcers have been associated with quality of care. Nurses and others are responsible for preventing or healing them, and failure to do so could lead to litigation.

• Mobility and activity are important considerations in preventing and modifying risk factors as well as allowing healing to occur.


Treatment of Pressure Ulcers

• Many agencies have established protocols that offer specific nursing care guidelines for each stage of the ulcer.


Nursing Management Principles

• Nursing care and documentation of the older adult with a skin problem should focus on careful assessment of the risk factors, provision of nursing interventions to minimize the risk of skin breakdown, documentation of care, and evaluation of the older patient’s status.

Tabloski ch12 lecture

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