Skin: Physiologic Changes To The Skin

However, only 10% of nurses actually complete accurate inspections of the skin during their initial physical assessments of the patients (Lahmann et al., 2010). As a result, patients who are at risk of developing pressure ulcers are often overlooked by nursing staff.

Fortunately, according to Chan et al., (2008), 95% of pressure ulcers can be prevented and nursing care is believed to be a primary method of preventing pressure ulcer development. Research was conducted on accredited search databases such as CINAHL, Nursing Resource Center and OvidSP on prevention measures for pressure ulcers. A number of credible evidence based research was found that supported the nursing intervention of

Pressure ulcers are one of the most common problems health care facilities often face which causes pain and discomfort for the patient, cost effective to manage and impacts negatively on the hospital (Pieper, Langemo, & Cuddigan, 2009; Padula et al., 2011). The development of pressure ulcers occur when there is injury to the skin or tissue usually over bony prominences such as the coccyx, sacrum or heels from the increase of pressure and shear. This injury will compromise blood flow and result in ischemia due to lack of oxygen being delivered (Gyawali et al., 2011). Patients such as those who are critically ill or bed bounded are at high risk of developing pressure ulcers (O'Brien et

Pressure ulcers are a problem and can lead to poor patient outcomes as well as hospital fines. Evidence based studies have shown that “the average cost of care in an acute care hospital for a patient with a stage III or stage IV pressure ulcer reported by the Centers for Medicare & Medicaid Services (CMS) is $43,180” (Jackson, 2008). Pressure ulcers and other skin breakdowns are among the most significant adverse events causing distress for patients and their care givers and compromising patients’ recovery from illness or injury (Gardiner, 2008). It is the tasks of nurses to ensure prevention of these complications is part of the daily care regimen.

The Integumentary system is defined as “an organ system consisting in the skin, hair, nails, and exocrine glands” (Integumentary System, 1999). This systems main purpose is to protect the body from the environment around it. The skin covers and protects tissues, nerves, veins, and muscles of the body. The hair and nails give extra strength in reinforcing the skin while keeping the body warm and protecting the skin from harmful UV rays. The exocrine glands of the skin include the sudoriferous glands, sebaceous glands, and the ceruminous glands. Each exocrine gland has a different function as well as location in the skin. The following text will explain the effects of melanoma on the integumentary system.

While nurses encounter patients with pressure ulcers in home care and acute care settings, they are mainly a problem with elderly adults in long term care facilities. This is because of decreased sensory perception, decreased activity and mobility, skin moisture from incontinence, poor nutritional intake, and friction and shear (Stotts and Gunningberg, 2007).

Data should be collected on pressure ulcers, this is easily provided by conducting audits and creating a Skin Champion position, as is the case in my hospital, that is filled by a nurse that creates educational documents, conducts audits on the use of Braden scale and following up with Wound Care staff. Changes in healthcare, as in any business, usually starts when there is a direct impact on financial reimbursement, and the formation of new pressure ulcers on inpatient care places the cost on the facility and not Medicare or Medicaid (Medscape, 2015). The audits should provide management with enough data to track ulcer formation, this will drive education, change in nursing attitude towards use of restraints, improve patient satisfaction and improve reimbursements to the facility.

The three layers that make up healthy skin: Epidermis, Dermis and Hypodermis. Epidermis is composed of keratinized, stratified squamous epithelium. This layer provides a thick, water proof protective covering over the underlying skins. The dermis layer is composed of primarily of dense, irregular, fibrous connective tissue that is rich in collagen and elastin. The dermis contains blood vessels, nerve ending, and epidermally derived cutaneous oranges such as sweat glands, sebaceous glands and hair follicles. The last layer is Hypodermis this layer is composed primarily of loose dead skin. The fat layer provides cushioning and insulation for

According to the Agency for Healthcare Research and Quality (AHRQ), 2.5 million patients are affected by pressure ulcers and incur costs anywhere from $9.1 billion to $11.6 billion per year in the United States (AHRQ, 2014). As of October 1, 2008, the Centers for Medicare and Medicaid Services (CMS) will not reimburse hospitals for cases in which the pressure ulcer was acquired after admission (CMS, 2008). Because of this high cost, the number of patients affected each year, and insurances no longer reimbursing hospital acquired pressure ulcers (HAPU), an accurate skin assessment upon admission is critical to reduce costs, ease pain in patients, and lower incidences of pressure ulcers. This paper will address what leadership and management skills and functions are required of a wound care nurse who identifies a problem with the accuracy of skin assessments on newly admitted patients.

Pressure ulcer is an adverse outcome in the clinical care setting that also linked to poor quality of nursing care. Though pressure should never happen in a professional care setting, it is still prevalent throughout the world’s medical settings. This article looks at many other previous studies from 1992 to present to compare and find the underlying issues that may contribute to pressure ulcer. A closer look at the nurse’s knowledge versus actual decision will be observe, because it is the key factor in pressure ulcer prevention.

Skin and its derivatives make up the integumentary system which acts as a barrier between the body and the outside world. Skin has physical, mechanical, chemical, and immunologic components which allow for body temperature regulation, protection against pathogens, cutaneous sensation, and metabolic functions. When the structural integrity of skin is compromised, its functions are impaired leading to major disability or even death.

Sweat glands and fatty layers in the process of regulating body temperature in mammals. When the external temperature is high, sweat glands release bodily fluids combined with sodium to keep the body temperature from accelerating and exceeding the normal temperature. When the outside temperature is low, fatty layers on the skin act as insulation, trapping heat and keeping it from leaving the body. The dermis is the layer of skin under the epidermis, and it's made up mostly of soft tissue such as collagen, elastin and fibrillin these are tissues that make your skin elastic and flexible yet strong and structurally stable. The dermis controls body temperature through the production of sweat and the control of evaporation the process known as insensible

contribute to skin homeostasis. Last but not least, the article mentions how anxiety or the feeling

Under the Dermis, there is a layer of adipose tissue which is called the Subcutaneous layer.This layer helps to maintain the human body temperature stable. This layer of fat acts like a pathway for nerves and blood vessels that go from the Dermis to the muscles. Also, it helps protect and prevents muscle and bones from

The skin also known as the Integumentary system is the largest organ in the human system; it covers about 20 square feet. The skin has many functions, most of it is having to act as a protection agent. The skin is an important organ because it stops unwanted things from entering the body through the pores. It protects us from microorganisms; it cushions and insult the tissue laying underneath it; it protects the skin from involuntary damages like cuts and bumps; It protects us from chemical damages like acids, alkalis and many more, protects us from thermal damages like heat. The skin acts as a first wall of defense for things on the outside by disallowing them to enter and for things on the inside by disallowing them to leak out or exposed. For example, the skin stops fluid leakage from the body and it helps keeps and maintain the basic body temperature. The skin not only protects and cushions, it also acts as an excretory system. It helps excrete some toxic substances the body doesn’t need just like the urinary system does. It does this by releasing salts, water, and urea in form of sweat through the pores of the skin.