Frequently Asked Questions
Chapter 36: Skin Integrity and Wound Healing

In what way does the skin of the elderly differ from the skin of younger people?

The skin of the elderly (1) lacks the dermal-epidermal junction, contributing to skin tears; (2) has reduced subcutaneous tissue, making the skin more vulnerable to pressure/shear force injuries; (3) has less-active sebaceous glands, so the skin is dryer and more prone to pruritus (itching); (4) is more at risk of malignancies and infections due to reduced skill layer immunologic activity; and (5) has less blood flow and epidermal regeneration, so the skin heals more slowly.

What are important points to make when teaching older people about skin care?

The important points to make when teaching older people about skin care include taking in a well-balanced diet, keeping the skin clean, avoiding rough scrubbing to prevent tears, using pH-balanced cleansers to avoid excess rinsing and water exposure, using lotions and creams to moisturize, monitoring the skin for abnormal lesions, avoiding exposure to the sun, using a sunscreen regularly, and keeping in touch with a dermatologist to screen for skin malignancies.

What nursing interventions should be used to prevent the development or exacerbation of pressure ulcers?

The nursing interventions to prevent the development or exacerbation of pressure ulcers include assessing for risk of development of ulcers by using a tool such as the Braden or Norton scale; keeping the skin clean and dry; repositioning clients every two hours, turning only to healthy areas; using a 30-degree lateral tilt for clients in the sidelying position to avoid high pressure over the trochanters; and using pillows, towels, and positioning aids to protect body surfaces and bony prominences.

What are the steps in partial-thickness wound repair?

The steps in partial-thickness wound repair are (1) the inflammatory phase, when white blood cells migrate to the injury, engulf bacteria, and break down avascular tissue, resulting in erythema, edema, and the production of a serous exudates; (2) the formation of new epidermis; (3) the restoration of epidermal thickness and function; and (4) the synthesis of new collagen.

What are the steps in full-thickness wound repair?

The steps in full-thickness wound repair are (1) the inflammatory phase, in which any clots formed are dissolved with the help of growth factors (polypeptides that regulate the repair process) and white blood cells break down avascular tissue; (2) the proliferative phase, during which granulation tissue and new epithelium are formed; and (3) the maturation phase, a long-term process in which further tissue repair occurs and scars are formed (excessive scars are known as keloid scars).

What are the rationales for the procedure used to obtain a wound culture?

The major rationales for the procedure used to obtain a wound culture are to prevent contamination of the wound and the specimen, to prevent the transmission of the microorganisms on the wound from spreading elsewhere, to assess the wound and evaluate any treatment used, to be certain the specimen is collected and labeled accurately, and to document the procedure and all findings.

What is the difference in the effects and purposes of heat and cold applications?

Cold therapy promotes vasoconstriction, increases blood viscosity, decreases tissue metabolism, anesthetizes, and decreases muscle tension. The purpose of heat therapy is to reduce inflammation and edema, facilitate clotting, control bleeding, reduce tissue oxygen consumption, and decrease pain. Cold therapy is used immediately after injury to a part.

Heat therapy promotes vasodilation, decreases blood viscosity, increases capillary permeability and tissue metabolism, and reduces muscle tension. The purpose of heat therapy is to improve blood flow; increase the delivery of oxygen, nutrients, leukocytes, and antibodies to the injured area; facilitate removal of wastes; reduce edema; and promote muscle relaxation.

What are precautions to remember when using cold and heat therapy?

When using cold and heat therapy, the nurse should remember that (1) clients with neurosensory impairment or impaired mental status cannot perceive when cold and heat are harmful and are at increased risk for tissue injury, (2) clients with impaired circulation may not be able to dissipate heat through dilation of blood vessels, and (3) clients with open wounds are more sensitive to temperature variations.