CARE OF CLIENTS WITH INTEGUMENTARY DISORDERS

ANATOMY AND PHYSIOLOGY OF SKIN

- The skin is the largest sensory organ of the body.
- The functions of the skin are as follows:

 It is the first line of defense against

 It maintains body temperature.
 It is a secretory organ.
 It is a sensory organ.
 It decreases water loss from the body.
 It produces and absorbs vitamin D.
 It is an excretory organ.
- The layers of the skin are:
epidermis, dermis, and hypodermis (subcutaneous fats).
-The epidermal appendages are:
the nails, hair, sebaceous glands and sweat glands.
-The sebaceous glands secrete sebum, an oily substance that lubricates the hair and skin;
lessens the amount of heat and water loss from the skin; and has bactericidal action.
-The sweat is composed of water, sodium, potassium, chloride, glucose, urea, and lactate.

Physiologic Changes
- Loss of pigmented in hair and skin
- Wrinkling of skin
-Thinning of the epidermis and easy bruising and tearing of the skin
- Decreased skin turgor, elasticity and subcutaneous fat
- Increased nail thickness and decrease nail growth
- Decreased perspiration
- Dry, itchy and scaly skin
- Seborrheic dermatitis and keratosis formation
Integrity of Skin
Good nursing care includes protection of the skin and prevention of skin tears. A skin tear is a
potentially preventable, traumatic wound that occurs primarily on the extremities of older
adults because of age and debility. The wound occurs as a result of careless handling, friction
alone or shearing and friction forces that separate the epidermis from the dermis or separate
both structures from the underlying tissue

Risk Factors for Skin Tears in the Elderly

Assess the patient for the following factors:
• Dry skin with dehydration
• Areas of ecchymoses
• Presence of friction, shearing, or pressure from bed or chair
• Impaired sensory perception
• Impaired mobility
• Taking multiple medications
• Prolonged use of corticosteroids
• Presence of renal disease, congestive heart failure, or stroke impairment
• Incorrect removal of adhesive dressings
• Rough handling when being bathed, dressed, transferred, or repositioned.

The Payne-Martin classification system (Ayello & Sibbald, 2008) classifies skin tears:
• Category I: A skin tear without tissue loss
• Category II: A skin tear with partial tissue loss
• Category III: A skin tear with complete tissue loss in which the epidermal flap is missing
Measures to Prevent Skin Tears and Protect Fragile Skin
• Have patients wear long sleeves and long pants to protect the extremities or protect the
fragile skin on extremities with stockinette’s.
• Provide adequate lighting to reduce the risk of bumping into furniture or equipment.
• Maintain the patient’s nutrition and hydration; offer fluids between meals.
• Lubricate the skin with cream or lotion twice a day, paying special attention to the arms and
legs.
• Use an emollient soap for bathing, and do not use soap every day on extremities if no soiling
has occurred.
• Use a lift sheet to move and turn patients.
• Avoid wearing rings or bracelets that could snag the skin.
• Use transfer techniques that prevent friction or shear.
• Pad bed rails, wheelchair arms, leg supports, or other equipment where the patient might
bump an extremity.
• Support dangling arms and legs with pillows or blankets.
• Use nonadherent dressings on fragile skin. Use gauze wraps or stockinettes to secure
dressing. If tape must be used, use a paper or nonallergenic tape and apply it without tension.
• Mark the dressing with an arrow showing the direction it should be removed.
• Remove tape and dressing with extreme caution:
• Use a solvent or saline to loosen the adhesive bond.
• Slowly peel tape away from anchored skin (stabilize skin).
• If a thin hydrocolloid or solid wafer skin barrier is used as a protective barrier between the
skin and the dressing, allow it to fall off naturally.
Prevention
 Hygiene
The ritual of the daily bath is almost an obsession with the average American. The elderly
patient who has dry skin does not need a full bath every day; cleansing of the axillae and
genital-rectal area between bathing days should be sufficient. Elderly patients should use a mild
lotion-based soap or body wash for bathing. After showering or bathing, a lotion or cream that
helps seal in moisture should be applied while the skin is still damp. Moisturizing lotion or
cream should be reapplied at bedtime.
 Environment
Several environmental factors can have a direct effect on the health of the skin. These include
prolonged exposure to chemicals, excessive drying from repeated immersions in water, very
cold temperatures, and prolonged exposure to sunlight. Some of these are occupational
hazards. Overexposure to the ultraviolet rays of the sun can seriously and permanently damage
the superficial and deeper layers of the skin. The damage results in severe wrinkling and
furrowing, as well as loss of elasticity, and the skin assumes a tissue-paper transparency. In
addition to the potential for premature aging and degenerative changes, solar damage also can
result in malignant changes. Ultraviolet rays from the sun have long been known to be
carcinogenic. This is especially true for fair-skinned people who have subjected their skin to
prolonged exposure to sunshine. Although sunburns are particularly harmful, it is the normal
daily exposure of unprotected fair skin to sun that causes long-term damage.
 Diet
Even borderline deficiencies of vitamins and minerals will cause the skin to take on a sallow and
dull appearance. Severe nutritional deficiencies lead to skin breakdown and the development of
sores and ulcers. Dehydration causes loss of skin turgor and predisposes to pressure ulcers.
People can be so concerned about their physical appearance that they refuse to eat properly
for fear of gaining weight; however a well balanced diet will enhance appearance.
 Age
Young people are not the only ones who should be concerned with the care of their skin. As we
grow older, our skin undergoes certain changes that easily lead to irritation and breakdown if
proper care is not given. The oil and sweat glands become less active, and the skin has a
tendency to become dry and scaly. It also loses some of its tone, becoming less elastic and
more fragile. Frequent cleansing of the skin becomes unnecessary as the skin ages, and alcohol
and other drying agents must be used sparingly, if at all. Assist older patients to establish a
regular routine of massaging oil, cream, or oily lotion into the skin.

Treatment
- Anti-aging products ; Sun screen , Serum