Skin Integrity and Wound Healing Lecture Notes

Skin Anatomy and Function

• Skin Layers: Epidermis (outer layer), Dermis (middle layer).

• Function: Barrier and protector.

• Compromised skin allows bacteria to enter the body.

Age-Related Skin Differences

• Infants: Thin, immature skin, difficulty regulating temperature.

• Use of hats, gloves, and socks to maintain warmth because heat leaves through the skull, hands, and feet.

• Menopause example: Heat can be seen radiating from the head due to hormonal regulation.

• Adolescents: Thicker, tougher skin.

• Older Adults: Frail skin, less hair, increased sensitivity to cold, easier to tear.

• Avoiding high bed angles (above 30 degrees) for elderly patients to prevent shearing and friction.

Skin Functions

• Absorption: Vitamin D from the sun.

• Vitamin D and B: Many people are deficient.

• Sunscreen: Balance between protection and potential risks.

• Generation and tanning: Tanning beds common.

• Ex-husband's generation tanning practices of using baby oil and iodine.

• Secretion: Sweat cools the body and releases electrolytes (e.g., sodium).

• Sweating leads to dehydration.

• Relationship between salt and water in the body.

Wound Healing Intentions

• Primary Intention: Surgical wounds with clean edges that are stitched together.

• Secondary Intention: Uneven wounds that heal on their own (e.g., kitchen knife cuts).

• Tertiary Intention: Open wounds packed to heal from the inside out (e.g., pressure wounds).

• Open wound care example and the process of packing the wound

Wound Care Considerations

• Home wound care nursing: Addressing hygiene and self-care issues.

• Maggots in wounds: Indicates neglect and non-compliance with health care.

• Treating maggots: Flushing and manual removal.

Phases of Wound Healing

• Inflammatory Phase: Lasts 3-5 days; body attempts to achieve homeostasis.

• Granulation Phase: Lasts 5-21 days; new blood vessels form, providing oxygen for tissue regeneration.

• Maturation Phase: Tissue grows, collagen rebuilds, forming scars.

• Scarred tissue is inelastic and lacks elasticity.

Impaired Tissue Integrity

• Impacts thermal regulation, fluid balance, protection, comfort, and pain.

• Promoting protein intake for healing.

• Skin issues and malnutrition.

• Eating disorders: Anorexia nervosa (thin skin, dehydration, lanugo) and bulimia (rotting teeth from vomiting acid).

• Edema: Extreme cases can cause skin to split, leading to open wounds.

Risk Factors for Skin Breakdown

• Impaired mobility:

• Increased risk of pressure sores due to lack of circulation.

• Pressure sores can result from bedridden patients.

• Pressure from medical devices.

• Genetics and skin cancer risk.

Skin Assessment

• Color, cap refill, hygiene.

• Elderly patients: Less frequent showering needed.

• Family history, allergies, and medications.

• Steroids can hinder skin healing.

• Location, size, appearance, and discharge color.

• Temperature, pinch for turgor.

• Common sites of pressure ulcers: Bony prominences (elbows, back of ears, hip joints, heels, knees).

• Pillows for turning prevents pressure when turning patients.

• Avoid patient angles of 30 degrees or higher to prevent shearing and friction.

• Patch Test/Allergy Test: Scratch tests on the back or arm to identify allergens, followed by blood tests.

• Wound cultures: Sterile swabs to identify infections.

• Tissue biopsy: Removal of tissue for testing.

• Wood's lamp: Blue fluorescent light to detect pigment disorders and infections.

Prevention

• Good skin hygiene.

• Nutrition.

• Limited sun exposure.

• Avoid burns.

Secondary Prevention: ABCDEs of Melanoma Screening

• Asymmetry: Moles should be symmetrical.

• Border: Edges should be even.

• Color: One consistent color is ideal.

• Diameter: Smaller is better.

• Evolution: Watch for changes.

• Early detection improves survival from skin cancer. John Cena and Khloe Kardashian examples mentioned.

Interventions

• Antibiotics, steroids, chemotherapy.

• Wound cleansing with sterile saline and dressing changes (sterile technique).

• Phototherapy: UV light for acne; red light therapy for collagen.

• Surgical debridement: Removal of necrotic tissue to stage wounds properly.

• The slides will cover skin cancer and what to do.