HLT51607 – Diploma of Nursing

1. HLT51607 – Diploma of Nursing • Care of the skin

2. Skin Tabbner’s, 2005, p. 603

3. Functions of the skin • Protection • First line defence • Regulation of body temperature • Evaporation • Sweat gland activity • Sensation • Touch, pressure, temperature, pain • Absorption • Some medications • Production • Vitamin D • Excretion • NaCl, urea, aromatic substances (garlic)

4. Dermatitis be Inflammatory condition of the skin characterised by erythema, pain or pruritus. Various Cutaneous eruptions occur & may be unique to a particular antigen, disease or infection Condition may chronic or acute Skin conditions/diseases

5. Superficial dermatitis of unknown cause. Initially may be pruritic, erythematous, papulovesicular, oedematous & weeping. Later may become crusted, scaly, thickened & lichenified (patch of papules) Eczema

6. Common, chronic, inheritable skin condition. Characterised by red patches covered by thick, dry, silvery adherent scales that are the result of excessive development of epithelial cells. Lesions may be anywhere on the body, but are more common on extensor surfaces, bony prominences, scalp, ears, genitalia and the perianal area. May be accompanied by arthritis Treatment – corticosteroids, ultraviolet light, creams, shampoos Psoriasis

7. A pruritic skin eruption characterised by transient wheals of varying shapes and sizes with well defined erythematous margins and pale centres Cause: Drugs, food, insect bites, inhalants, emotional stress, exposure to heat or cold, and exercise Urticaria

8. Acne Vulgaris – inflammatory condition of sebaceous glands, characterised by papules, pustules and blackheads Boils (furuncle) – a localised skin infection originating in a gland or hair follicle, characterised by pain, redness and swelling Skin infectionsbacterial

9. Carbuncle – a large infection in deep subcutaneous layer, the pus drains through skin openings. Usually found on the back of the neck and the buttocks Folliculitis – inflammation of one or more hair follicles.

10. Cellulitis – Diffuse, spreading infection of the skin characterised by heat, redness, and swelling. Paronychia – acute infection of the soft tissue around the nail

11. Warts – benign skin lesion with a rough surface Viral infections

12. Characterised by painful vesicular skin eruptions that follow the underlying route of the nerve affected. Usually occurs on one side of the body Extremely painful May cause scarring (HSV)– group of small itchy vesicles, reddened at the base. Extremely contagious Lesions usually occur on the lips and face (HVS1), or the genitals and mucous membranes (HSV2). Once acquired the HSV remains dormant in the skin or tissues of the nervous system. It is reactivated by exposure to stress, febrile illnesses, sunlight, drugs, and certain foods, contact with someone who has the virus. Herpes Simplex Virus

13. Acute infection Affects the cranial and spinal nerves. Usually affect adults Herpes Zoster Virus (HZV

14. Infestations Scabies – • Caused by a mite that burrows under the horny layers of the skin • Accompanied by severe itching • The burrows are seen as raised lines with tiny individual vesicles, commonly seen on the hands, trunk and genitals.

15. The louse must feed within 24hrs of hatching. The nit (egg) is firmly attached to the hair shaft. (Capitis, corporis, pubis) Pediculosis/ Lice

16. Fungal infections • Transmission is by direct and indirect contact. • Warm weather and tight clothing encourage fungus growth. Tinea can occur on the head (capitis), beard, body (corpus), groin, nails, feet (pedis)

17. Candida Albicans/ Thrush • Under stress it may cause superficial infections of the mouth or genital area. • White exudate, peeling, bleeding and a characteristic smell. • Diabetes Mellitus • Antibiotic Therapy

18. Malignant epithelial cell tumour Slow growing, pearly or pinkish tumour • Usually found on exposed areas of the body • Easily treated when small • Recurrence is unusual • Primary cause is excessive exposure to the sun or to x-rays

19. Malignant Melanoma • Rapidly spreading lesions • Vary from flesh to black in colour • May have an irregular boarder • May be raised or flatMay ulcerate or bleed • Prompt treatment is necessary as it spreads very quickly

20. Malignant epithelial cell tumour. Slow growing. Pearly or pinkish tumour usually found on exposed areas of skin. Easily treated when small, recurrence unusual. Primary cause is excessive exposure to the sun or X rays Basal cell carcinoma

21. Squamous cell carcinoma (SCC) A malignant tumour Firm, red, conical hardened nodules. • Size ranges from less than 1cm to several cm • Often the result of overexposure to sun Prompt treatment necessary

22. Skin Assessment and Care • Assessment • Assessment tools • Regular observation

23. Excessive washing causes • Stripping of protective oils. • Removal of resident bacteria. • Reduces the thickness and number of cell layers in the stratum corneum. • Disturbs the Acid Mantle. • Alters hydration of the skin.

24. Soaps are Alkaline Contain lyre which emulsifies the lipid coat of the skin Contain strong perfumes = skin is irritated. Each time the skin is washed the pH can rise up to 9.0-10.0. It usually takes 45 minutes for the skin to revert back to it’s normal pH level. Prolonged exposure means the skin can take up to 19 hrs , to revert back to normal ph. Recovery period of the skin depends on the age of the person and condition of the skin. Effects of soap and water on the skin

25. A managed skin care program To minimise the harmful effects of incontinence the skin must be cleansed after each episode of changing an incontinence device or episode of faecal incontinence. The aim of cleansing is to • Keep the skin dry • Avoid too dry or too moist skin • Keep the skin odour free.

26. Maintenance of To keep skin intact know skin irritants which upset the normal balance of the skin are to be avoided. • Cleanse • Moisture • Protect the skin using safe and appropriate skin care products.

27. Effective skin care program Includes • Skin cleanser • Moisturiser • Protective cream • Skin sealant • Adhesive remover

28. Ideal • Maintain skin ph • Maintain skins normal flora • Maintain hydration of the skin

29. Skin care products Cleaners Should be neutral or at physiologic pH level Superior to soaps – contain surfactants which lift dirt/ debris with no/minimal scrubbing. Contain humectants that condition the skin Film former binds the stratum corneum and provides a barrier effect Example of a skin cleanser: Smith and Nephew triple care cleanser.

30. Adhesive removers To assist in the non-traumatic removal of all adhesive wound care products.

31. Skin Sealants Designed to provide a waterproof layer between skin and substances that can cause deterioration Eg. Skin prep Smith & Nephew.

32. Skin moisturising products Used after cleansing to soothe irritated skin. Preserves moisture content of skin by adding and trapping moisture in the skin. • Lotion – high water content • Cream – high solid content • Zinc oxide should be a main ingredient, aides in healing. • Eg. Triple care cream by Smith & Nephew.

33. Assessment tools Braden scale • Sensory perception – • completely limited, very limited, slightly limited and no impairment • Moisture – • constantly moist, moist, occasionally moist, rarely moist • Activity – • bedfast, chair fast, walks occasionally, walks frequently

34. Assessment tools Braden scale Mobility – • completely immobile, very limited, slightly limited, no limitations Nutrition – • very poor, probably inadequate, adequate, excellent Friction and shear – • problem, potential problem, no apparent problem

35. When a patient is identified as “at risk” Maintain and improve tissue tolerance to pressure Skin assessment – fundamental to early identification of skin damage, assists with planning • Daily skin inspection for signs of impaired skin integrity • Skin checks with each turn

36. When a patient is identified as “at risk” Skin hygiene – care to maintain the skin’s natural acid mantle (pH 4-6.8) • Avoid irritating substances • Treat dry, flaky skin with topical moisturisers Skin moisture maintenance – excessive moisture causes maceration and decreased tolerance to pressure • Avoid sustained contact with body fluids • Actively promote continence

37. When a patient is identified as “at risk” Maintenance of stable skin temperature (higher temperatures increase the skin’s metabolic requirements, also there is the increase in perspiration). Local temperature increases with the length of time that the patient is in one position • Avoid skin contact with plastic surfaces • Remove warming blankets once hypothermia is corrected • At least 2 hourly turning schedules on a basic hospital mattress

38. When a patient is identified as “at risk” Optimise nutritional status – maintaining ideal weight, adequate fluids, ensuring vitamin and mineral intake adequate

39. Protect the individual against the external forces of pressure, friction and shear Instigate an appropriate turning schedule • According to skin’s tolerance to pressure • Avoid direct contact between bony prominences (use foam, pillows etc) • Avoid uninterrupted sitting in a chair • Proper turning/transferring techniques (to prevent shearing and friction)

40. Protect the individual against the external forces of pressure, friction and shear Eliminate shear and friction • Protect exposed skin (protective dressings, padding/sheepskin) • Elevate foot of bed 20 degrees • Lower head of bed to less than 30 degrees (reduces incidence of shearing) • Proper turning/transferring techniques

41. Protect the individual against the external forces of pressure, friction and shear Reduce heel pressure • Elevate heels (foam, pillows) so they don't touch the mattress • Consider heel protectors Promote activity and mobilisation • Mobilise where appropriate • Refer to physiotherapist and/or occupational therapist Use an appropriate support surface • Constant low pressure device (overlays) • Alternating pressure (alternating air mattresses) • Sheepskins

43. Common Pressure Points