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Module 3 - Skin Integrity, Wound Management and Surgical Asepsis.docx

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Kileen Tucker Scott

MODULE 3 SKIN INTEGRITY, WOUND MANAGEMENT AND SURGICAL ASEPSIS Part A: Skin Integrity and Wound Management 1. Review the structure and functions of the skin. The skin guards the body from environmental stresses such as trauma, dirt and pathogens. The skin provides protection from injury from physical, chemical, thermal and light wave sources. It prevents penetration, perception, temperature regulation, identification, communication, wound repair, absorption and excretion and production of vitamin D. The skin has two layers. The outer layer is the epidermis and the inner supportive layer is dermis. Beneath these layers is the subcutaneous. The inner stratum germinativum forms new skin cells and its major ingredient is the tough and fibrous protein keratin. The dermis is the inner supportive layer consisting the most connective tissue. It enables the skin to resist tearing and allow the skin to stretch. The subcutaneous layer is adipose tissue, which is made up of lobules of fat cells. The subcutaneous stores fat for energy, provides insulation for temperature and aids in protection by its soft cushioning effect. Structure of the Skin Layers: Epidermis, Dermis and Hypodermis Epidermis top layer o Thin, but tough o Forms a rugged protective barrier o Is avascular; it is nourished by blood vessels in the dermis below o Melanin: provides the brown tones to the skin and hair People have the same amount of melanocytes but the amount of melanin they produce varies with genetic, hormonal, and environmental influences o Consists of 4-5 layers depending on the region of skin Stratum corneum thin, outermost layer, composed of flattened, dead, keratinized cells; these cells are constantly being shed Stratum lucidum only present in thick skin, helps reduce friction between corneum and granulosum Stratum granulosum layer where keratin proteins and water-proofing lipids are being produced and organized Stratum spinosum where keratinisation begins Stratum basale innermost layer, where cells divide, proliferate and migrate toward the epidermal surface Dermis inner layer o Provides tensile strength, mechanical support and protection to the underlying muscles, bones and organs o Consists of collagen, blood vessels and nerves o Only cell type is the fibroblasts, which are responsible for collagen formation Hypodermis subcutaneous layer o Stores fat for energy o Contains loose connective tissue, adipose tissue and some blood vessels o Acts as insulation for temperature control o Anchors skin to deeper tissues o Aids in protection by its soft cushioning effect Functions of the Skin Minimizes injury from physical, chemical, thermal and light wave sources Prevents penetration; barrier that stops invasion of microorganisms and loss of water and electrolytes from within the body Perception; vast sensory surface holding the neurosensory end organs from touch, pain, temperature and pressure Temperature regulation; skin allows heat dissipation through sweat glands and heat storage through subcutaneous insulation Identification; people identify one another by unique combinations of facial characteristics, hair, skin colour, and even fingerprints. Self-image is often enhanced or deterred by the way societys standards of beauty measure up to each persons perceived characteristics Communication; emotions are expressed in the sign language of the face and in the body posture. Vascular mechanisms such as blushing or blanching also signal emotional states. Wound repair; allows cells replacement of surface wounds Absorption and excretion; allows limited excretion of some metabolic wastes, by-products of cellular decomposition such as minerals, sugars, amino acids, cholesterol, uric acid and urea Production of Vitamin D; ultraviolet light converts cholesterol into Vitamin D 2. Identify the normal changes in aging skin. Reduced skin elasticity o Folds and sags o Appears thin, lax, dry and wrinkled The sweat glands and sebaceous glands decrease in number and function o Dry skin o Patient is more susceptible for heat stroke Decreased collagen increases the risk for shearing, tearing injuries Thinning of underlying muscles and tissues The attachment between the epidermis and dermis becomes flattened Diminished inflammatory response, which results in slow epithelialisation and wound healing More prone to skin breakdown due to the hypodermis decreasing in size Reduced nutritional intake, increases risk of pressure ulcer development and impaired wound healing Factors that place the aging person at risk for skin disease and breakdown: the thinning of the skin, the decrease in vascularity and nutrients, the loss of protective cushioning of the subcutaneous layer, a lifetime of environmental trauma to skin, the social changes of aging, the increasingly sedentary lifestyle, and the chance of immobility 3. Identify the risk factors for: a. Impaired skin integrity The risk factors for impaired skin integrity may result in injury, minimize thermal regulation and the wound may take a longer time to heal. When a pressure ulcer develops it may cause pain and patients may not want to get up from bed. If the ulcer is not treated properly it may cause inflammation and infection. Preventative measures must be taken to delay or prevent pressure ulcer from developing. Nurses should make sure that the bed is fitted without and creases and turn bed-rest clients every 1-2 hour. Massaging and applying lotion to keep the skin moisturized. b. Pressure ulcer development Impaired Sensory Perception: Clients who have an altered sensory perception of pain and pressure are at more risk, as they are unable to feel when a portion of their body senses increased, prolonged pressure or pain Impaired Mobility: Clients who are unable to change positions independently are at more risk, i.e. they lay on bony prominences too long, creating pressure ulcers Alteration in Level of Awareness: Clients who are confused, disoriented or have changes in level of consciousness are unable to protect themselves because they may not understand how to relieve or communicate their discomfort. Clients in a coma cannot perceive pressure and cannot move to relieve it. Nutrition status: malnutrition is a serious risk factor for developing pressure ulcers. Poorly nourished skin is prone to injury. Inadequate intake of protein, calories, fluids, and nutrients is associated with greater risk of pressure ulcers and wound healing. Advanced Age: changes to the skin that naturally occur with aging make older adults more prone to developing pressure ulcers. Age can alter skin characteristics and make skin more vulnerable to damage. c. Common sites for pressure ulcer formation The common sites of pressure ulcer formation are on bony prominences (pressure points), because they bear the weight of the body in certain positions and thus are at greatest risk for forming pressure ulcers, such as: Scapula Elbow Shoulder Heel Sacrum Lower leg Occipital bone Hips Ankle bones Sacrum 4. Identify the forces of pressure, shear, and friction and their role in impairment of skin integrity. Pressure occurs when the tissue is compressed between a bone and an external surface, usually the surface of a bed or chair. Therefore, pressure ulcers occur over a bony prominence. These prominences are called pressure points because they beat the weight of the body in certain positions and thus are at greater risk for forming pressures ulcers. Shearing is the force that moves the layers of muscles and bones in a direction opposite to the skin. The underlying tissue capillaries are stretched and angulated by the shear force. As a result, necrosis occurs deep within the tissue layers. The tissue damage occurs deep in the tissues, causing undermining at the point of pressure. Shearing most often occurs when a client slides down or is dragged up in a be
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