CHAPTER: WOUNDS Everyone, somebody, anybody, and nobody
Who? Normal structure Epidermidis
vitamin D, psychosocial, absorption, and elimination Outer layer, average turn over time 20 days, prevent dehydration, barrier to chemicals, allows evaporation, allows absorption of medications, and melanocytes -- pigment Dermis Inner layer of skin, tensile strength, mechanical support, protect underlying muscle, bones and organs. Connective tissue: elastin > mobility of skin Collagen: fibrous protein -> strength Fibroblasts: collagen synthesis Macrophages: immunologically active cells Subcutaneous Comprised: ADIPOSE tissue and connective tissue layer Provide "padding" and even weight distribution over bony prominences, store fat for (Hypodermis) energy, heat insulator Fascia/ muscle A thin layer of connective tissue covering the muscle layer Composed of contractile fibers that control position and movement Muscle layer is the most metabolically active layer of the skin and soft tissue Most vulnerable to ischemia damage Pathogens Most common: bacterial infections (Staph or strep), E.coli, Mycobacterium tuberculosis Fungal infection (mold and yeast): candida albicans, aspergillus -> zobarax to treat herpes Viral infections (organisms use host's genetics to reproduce): Herpes simplex, Herpes zoster Prions (protein particles): Creutzfeldt -- Jakob disease Parasites (organisms that live on the host and often cause harm): Protozoa (malaria, toxoplasmosis), Helminths (worms, flatworms, roundworms), Flukes (schistosomes), arthropods (lice, mites, ticks) HERPES SIMPLEX: painful vesicles... Clusters around the mouth or in the genital region SHINGLES: Extend along the path of a single... Pressure injury (1) DEFICIT REDUCTION ACT (DRA): payment for pressure ulcers, highly preventable formation & conditions would not be covered if they developed during a hospital stay (... - staging acquired condition) Centers for Medicare and Medicaid Services stated that the physician or licensed provider must complete a skin assessment of admission Must assess/determine the risk of developing pressure ulcers Assessment per facility's protocols
"A pressure ulcer is localized injury to the skin and/or underlying tissue usually over a body prominence, as a result of pressure or pressure in combination with shear and/or friction" V A pressure is an area of skin and tissue loss caused by prolonged or excessive soft tissue pressure usually over a bony prominence Friction and/or shear Results in skin breakdown Tissue ischemia V Tissue damage Tissue infarction
Pressure ulcer formation
Factors Impaired sensory input, impaired cognitive functioning, impaired motor function (skin influencing the friction and/or shearing), orthopedic devices, decreased circulation, anemia, elderly, development incontinence, chronic diseases, obesity, edema, nutrition and hydration of pressure ulcers Shear, tunneling, undermining, friction, maceration INJURY STAGES The stagging system: Suspected deep tissue injury Stage 1, 2, 3, 4 Unstageable Medical device-related pressure injury Mucosal membrane pressure injury Stage 1: Pressure injury Non -- branch able erythema of INTACT skin typically over a bony prominence Does... Go away when pressure is removed Skin temperature feels warmer or cooler than adjacent tissue Skin may feel firm, swollen look red tissue, sensation (pain/itching), SKIN IS STILL INTACTTTTTTTT!!!!!!! Color changes of PURPLE or MAROON indicate deep tissue pressure injury Stage 2: Partial-thickness skin loss, superficial, exposed dermis Wounded bed viable, pink or red, moist, could present as