Tabloski ch12 lecture

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THIRD EDITION
CHAPTER
12
The Integument
Copyright © 2014, © 2010, © 2006 by Pearson Education, Inc.
All Rights Reserved

Learning Objectives
1. Describe normal skin changes
associated with aging.
2. Identify risk factors related to common
skin problems of older adults.
Gerontological Nursing, Third Edition
Patricia A. Tabloski

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 Cancer
Source: 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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