Skin Conditions/Skin Care

By Heidi Cross, MSN, RN, FNP-BC, CWON Ms. EB, a frail 82-year-old woman admitted to a long-term care facility, had a complex medical history that included diabetes, extensive heart disease, ischemic strokes with left-sided weakness and dysphagia, dementia, kidney disease, anemia, chronic Clostridium difficile infection, and obesity. Her condition was guarded at best on admission, and she had a feeding tube for nutrition secondary to dysphagia. Despite these challenges, she survived two years at the facility.

By Heidi Cross, MSN, RN, FNP-BC, CWON "At all times material hereto, defendant failed to develop an adequate care plan and properly monitor and supervise the care and treatment in order to prevent her from suffering the development and deterioration of bed sores."

by Heidi H. Cross, MSN, RN, FNP-BC, CWON "If a patient is cold, if a patient is feverish, if a patient is faint, if he is sick after taking food, if he has a bed sore, it is generally the fault not of the disease, but of the nursing." —Florence Nightingale Ouch! What an indictment of nursing and, by extension, the facility in which the nurse works. We have a lot to thank Florence Nightingale for—a brilliant woman considered to be the founder of nursing and nursing standards and the first to ever put statistics to health care, among other valuable contributions.

By Susan Cleveland, BSN, RN, WCC, CDP The subject of my previous blog on skin assessment was interview; here in part 2, we will look at the elements of observation. Interviewing clients and significant others can provide the clinician with valuable information related to the client’s knowledge of their situation and a historic review of skin issues or potential events. However, observation is also necessary in a comprehensive skin assessment.

by the WoundSource Editors The skin is the largest organ of our body, covering 18 square feet and weighing approximately 12 pounds. Despite positive characteristics, the skin is always susceptible to and at risk of injury and breakdown. Maintaining skin integrity equals maintaining skin health, and this includes people of any age. Older adults are at a higher risk because of the skin aging process. As skin ages, the junction between the epidermis and dermis thins and flattens, reducing circulation. Moisturizing factors in older adults also reduce, thus causing dry, flaky skin and increased risk of skin breakdown.

By Laurie Swezey RN, BSN, CWOCN, CWS, FACCWS Radiation is used to kill cancer cells. Unfortunately, radiation does not discriminate between cancer cells and healthy cells. Skin cells are particularly vulnerable, and almost everyone who undergoes radiation will experience some skin changes

by the WoundSource Editors Those working with at-risk populations must be aware of how to address the skin care needs of our patients and prevent pressure ulcers and injuries. At-risk populations, such as older adults, persons who are incontinent, pediatric patients, immobile patients, post-operative patients, and those with chronic disease processes and spinal injuries, for example, are most at risk for developing pressure ulcers. Those patients who have comorbidities such as obesity, diabetes, and cardiovascular disease are at additional risk.

Vulnerable skin within the skin microclimate is caused by a multitude of factors that are often aggravated by one another. Urine and feces, for example, have a negative impact on the skin as a result of the microorganisms and enzymes they contain. These factors break down the skin barrier and cause inflammation through the release of cytokines that trigger an immune response leading to symptoms of dermatitis (i.e., moisture-associated skin damage [MASD]). Incontinence-associated dermatitis (IAD) is one type of MASD, and the external factors that contribute to IAD include microclimate (water, temperature, pH), mechanical forces (friction, pressure, shear), and biochemical factors (fungi, irritants, bacteria, enzymes).

by the WoundSource Editors It has long been known in clinical practice that long-term exposure of the skin to moisture is harmful and can lead to extensive skin breakdown. The term moisture-associated skin damage was coined as an umbrella term to describe the spectrum of skin damage that can occur over time and under various circumstances. To have a moisture-associated skin condition, there must be moisture that comes in contact with that skin.

By Margaret Heale, RN, MSc, CWOCN Another day at Rose Cottage is over and I am remembering some events and pondering as I wait for my granddaughter to finish work and drop me off home. I have been volunteering here a while now and am getting used to being in a position of watching, listening and not having to react to everything as I am just an outsider helping out. I was a matron though, and the patterns within my brain are such that I must at least ponder at where we are, where we came from and where we are heading. ‘Ahhh,’ you are thinking she is going to bemoan modern nursing and call for a return to the good old days, well you’d be wrong. I am not sure it was all so good and with new blood, new technologies and modern versions of Flo, we will see our Scutari change and develop into a new and exciting place. Well you will, I will join my fellows here at some point and allow you to care and listen.