Promoting healthy skin and feet

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Promoting healthy skin and feet
2015-06-14 00:20:45

skin and feet
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  1. Skin and feet
    • these two are overlooked bc of focus on disease and illness
    • integrity of skin and functional ability of feet are essential for well being
  2. age related changes
    • dryness
    • loss of dermis thickness
    • decrease elasticity
    • decreased collagen synthesis
    • changes in melanocytes
    • nails: thick hard brittle
    • decrease blood supply to feet
  3. Physical assessment
    • comprehensive and detailed
    • review past lecture
  4. skin of the older adult
    • exposure to heat, cold, water, trauma, friction and pressure affects the integrity of the skin.
    • skin problems of older adults include:
    • xerosis
    • pruritis
    • seborrheic keratosis
    • herpes zoster
    • cancer
    • those who are immobile or medically fragile are at risk for fungal infections or pressure ulcers
  5. xerosis
    • extremely dry skin, cracked itchy skin
    • is primarily seen on extremities but can affect the face and truck
    • cause: age related changes
    • - worsened by inadequate fluid intake, exposure to environmental elements, smoking and nutritional defciencies
  6. xerosis prevention
    • natural oils, creams, lotions
    • tepid bath water
    • avoid alcohol base products
    • fluid hydration
  7. pruritis
    • itchy skin
    • - syndrome not disease
    • accompanies disorders such as chronic renal failure, bilary of hepatic disease and iron deficiency
    • can damage the intergrity of the skin: scratching
    • - inflammation and infection
    • aggrevated by:
    • - perfumed detergents, fabric softeners, heath and sudden temperature changes, pressure, sweating, restrictive clothing, fatigue, exercise, and anxiety
  8. Pruritis helpful measures
    • rehydration
    • cool compresses
    • oatmeal or epsom salt
  9. Scabies
    • skin condition that causes itching especially at night but the burrowing mite called sarcoptes scabiei
    • contagious
    • diagnosis is made by close observation or scraping
  10. Scabies treatment
    • treatment is for entire family, care givers, close contact
    • eliminate infestation with prescribed lotions and creams
    • - elimite, lindane
    • oral agents: stromectol
    • wash: hot, soapy, and high heat
  11. Purpura
    • extravasation of blood into the surrounding tissue caused by fragility of capillaries, thinning of dermis
    • usually observed on the dorsal surface of the forearm and hands
  12. Purpura treatment prevention
    • care givers need to be gentle with older adults
    • wearing long sleeves shirts for protection reduces shear and friction
    • to reduce the risk of skin tears, nonadherent dressings are secured with tubular retention bandages
  13. keratoses
    • two types: seborrheic and actinic
    • seborr
    • - benign growth on truck, face, neck and scalp
    • in single or multiple lesions
    • usually appears in 65 over
    • is more common in men
    • tag like appearance in people with darker skin
    • Actinic
    • pre cancerous
  14. Keratosis
    • stuck on appearacen waxy raised lesion
    • treatment removed by dermalogist
  15. Actinic keratosis
    • is precancerous lesion
    • can become squamous cell carcinoma
    • directly related to UV light exposure
    • usually found- face, lips, hands and arms
  16. Keratosis prevention
    • sun block and reduce sun exposure
    • follow up by dermatologist
    • early identification and treatment are essential
  17. Herpes Zoster
    • Viral infection: shingles
    • occurs mostly in adults who are fifty yrs and older with compromised immuned systems and/on immunosuppresive therapy
    • cause: reactivation of varicella zoster virus (VZV) within sensory nerves of dorsal root ganglion, decades after initial VZV infection
    • - occurs along nerve pathway, decades after initial VZV infection
    • - occurs along nerve pathway (dermatone)
    • - usually thoracic region
    • - affects eye medical emergency**
  18. Herpes zoster how it starts and what it looks like
    • onset begins with itching, tingling, or pain affected dematone (pathway), several days before rash appears
    • rash: clusters of papulovesicles along dermatone
    • can be painful and pruritic
    • lesions rupture and crust and resolve
    • scarring can occur
  19. Herpes zoster treatment
    • early identification and treatment
    • oral agents: antiviral agents
    • pain and pruritic management
    • vaccine all over age of 60 yrs
    • complications: infection, postherpetic neuralgia (pain), eye involvement emergency can go blind
  20. Photo damage of the skin
    • is damage of the skin, prolonged exposure to sun light
    • - enviroment and tanning beds
    • overexposure to the sun is themost common cause of skin damage and skin cancer
    • - approx 90% age related cosmetic problems
    • most incidents of sun damage is preventable
    • - start early
  21. Skin Cancers
    • skin cancers are the most common of all cancers
    • basal cell, squamous cell and melanoma
    • prevention, early identification and treatment are essential
    • - primary
    • secondary
    • - tertiary
  22. Basal cell carcinoma
    • most common MAGLINANT skin cancer
    • occurs in older adult but becoming more frequent in younger adults
    • triggered by extensive sun exposure, chronic irritation or ulceration
    • begins as pearly like papule with blood vessels or scar like tissue in an area with no previous trauma, can ulcerate
    • diagnosed by biopsy
    • early detection and treatment are necessary
  23. Squamous cell carcinoma
    • second most common skin cancer
    • aggressive and high incidence of metastasis
    • incidence: fair complexion, older men, chronic exposure to the sun
    • is found on the head, neck and hands
  24. Squamous cell carcinoma description
    • lesions are firm, irregular, fleshy, pink colored nodules that become reddened and scaly
    • maybe wart like with gray top and horny texture and/or ulcerated with raised defined borders
    • because of a different appearance they tend to be overlooked
  25. melanoma
    • less than 5% of skin cancers are this type- incre in the last 30 yrs
    • currently it occurs more often in young fair skinned women and older men
    • occurs in those with a history of blistering sunburns, who are faired skin with freckles and have red or blond hair
    • appears on the legs and backs of women and on the back of men
    • metastasizes quickly, high mortality rate
  26. melanoma ABCD
    • ABCD rules for melanoma
    • early identification and treatment are essential
    • asymmtry, border, color, diameter (no bigger than an eraser)
  27. Candidiasis
    • fungal infection
    • risk: obesity, malnutrition, antibiotics or steriouds therapy hx of dm
    • grows in warm, moist, dark areas- skin folds, axillae, groin, under breast folds, and corner of mouth and vagina (yeast infection)
    • tx prevention
    • - dry areas, incontinence care
    • topical anitfungal agents- nystatin
  28. Candida infection
    • thrush
    • risk: compromise immune system, long term steriod use,
    • irregular white flat raised patches on a reddened base
    • painful
    • tx nystatin swish
  29. Pressure ulcers
    • injury to the skin usually as a result of pressure over boney prominence
    • older adults account for more than 70% of presssure ulcers
    • risk factors for elders are co morbid illness, nutritional status, cognitive decifits and reduce mobility
    • prevention is consider the key to care- frequent position change to minimize pressure
    • medicare and medicaid reimbursement is not given if pressure ulcers are acquired during hospital care
    • is costly to treat and requires extensive rehabiltation at times
  30. braden scale
    • assesses the risk in a numerical scoring system based on sensory perception, moisuture, activity, mobility, nutrition, and friction or shearing
    • thorough hx of risk factors, age, medication, and co morbids is taken
  31. Implication to geron nurising and healthy aging skin
    • treatment and prevention of pressure uclers is complex
    • assessment should be performed upon admission with a risk for development and healing assessed
    • nutritional health should be maintained
    • education should be provided to clients and families
    • review notes from fundies
  32. Feet
    • influence physical, psychological, and social well being
    • feet support weight, hold the body erect and coordinates and maintains balance in walking and are adaptable to conform to different walking surfaces
  33. assessment of feet
    • observation of mobility
    • - gait, use of assistive devices, foot wear
    • past medical hx
    • - musculoskeletal, neuro, vascular, sensory hc of falls
    • bilateral assessment
    • -color, CSM, edema, rash structural or functional deformities and conditions of toenails
    • - assess irritation, abrasions and lesions
  34. Common foot problems
    • older feet have trouble adapting bc of inflammatory changes in bone and soft tissue
    • common foot problems
    • - bunions
    • - hammer toes
    • - fungal infection
  35. Fungal infections
    • incidence increase with age
    • affect skin of foot and or nails
    • fungal (skin)
    • - tinea pedis
    • - risk: warm, moist area,
    • - prevention:dry completely, assess risk
    • - treatment: antifungal topical agent
  36. Fungal infections nails
    • Nails (onychomycosis)
    • fungus forms under the center of the nail, seperate layers
    • degeneration of nail plate with color changes
    • opague thicken and brittle of nails
    • dx- culture
    • tx- oral therapy, long term management up to a yr, hepatic and heart side effects. also photodynamic therapy
  37. care of toenails
    • poor close vision, difficulty bending, obesity and incre thickness of the nails makes self care difficult to the older adult
    • slip on shoes are helpful for those unable to bend
    • low heeled shoes and rubber soles are recommended to avoid injuries
    • prevention- nail care, foot wear- not too tight