Tissue Integrity (SHORTENED)

Tissue Integrity

• The skin is the largest organ system, comprising about 15% of total body weight.

  • Functions of the Skin:

    • Acts as a barrier against:

      • Injury

      • Infection

      • Ultraviolet radiation (UV)

      • Temperature fluctuations

    • Facilitates perception of touch, pain, pressure, and vibration.

    • Eliminates waste and supports underlying structures.

    • Synthesizes vitamin D.

Skin Anatomy and Function

• The skin is comprised of three layers:

  • Epidermis

    • Outermost layer of skin containing keratinocytes.

    • Keratinocytes:

      • Protect against water loss, pathogens, and injury.

      • Migrate from the basal layer to the surface, dying and shedding over time.

    • Other Cells in the Epidermis:

      • Melanocytes:

        • Produce melanin, which determines skin/hair color and protects from UV rays.

      • Merkel Cells:

        • Detect light touch, especially in palms and soles.

      • Langerhans Cells:

        • Ingest and present foreign antigens for immune response.

  • Dermis

    • Thicker layer beneath the epidermis, composed of connective tissue, blood and lymph vessels.

    • Divided into:

      • Papillary Region:

        • Contains fibroblasts that help with wound healing.

      • Reticular Region:

        • Provides strength and elasticity due to collagen and elastin fibers.

    • Loss of collagen and elastin increases risk of tissue integrity issues.

  • Subcutaneous Layer

    • Composed mostly of adipose tissue.

    • Functions include:

      • Insulation

      • Shock absorption

      • Protection of internal organs.

    • Contains blood vessels and nerves aiding in thermoregulation and sensation.

Skin Changes and Contributing Factors

• Clients may experience various skin conditions based on age and health status.

Neonates and Children

• Skin Characteristics: Immature skin

• Common Problems:

  • Diaper rash

  • Skin tears

Adults

• Risk Factors for Impaired Tissue Integrity:

  • Vulnerability in skin at early age and later in life.

  • Risks during Infancy and Early Childhood:

    • Maceration

    • Dermatitis

  • Risks in Older Adults:

    • Thinning skin

    • Decreased elasticity

• Conditions contributing to issues include:

  • Impaired Mobility:

    • e.g., spina bifida, cerebral palsy.

  • Chronic Diseases:

    • Liver failure, kidney disease, cancer.

• Skin Problems Associated with Skin Frailty:

  • Skin tears

  • Pressure injuries

  • Infections (e.g., cellulitis)

Common Skin Issues

• Older Adults:

  • Thinning skin, skin infections,

  • Diabetes:

    • Diabetic ulcers.

• Clients with Reduced Mobility or Paralysis:

  • Increased risk for pressure injuries, skin infections, impaired circulation.

• Obesity:

  • Dry skin, increased risk for pressure injuries and skin infections.

Specific Risks for Certain Clients

• Cancer Patients:

  • Risks include:

    • Skin inflammation

    • Damage from radiation

    • Delayed wound healing

    • Pressure injuries.

    • Infection risks including celluIitis.

Additional Conditions Impacting Skin Integrity

• Chronic illnesses (e.g., hepatic diseases, kidney diseases, malnutrition).

• Associated skin changes include skin tears and pressure injuries.