ltraviolet (UV) rays and other external environmental hazards, and (3)
NUR 2214 Nursing Care of the Older Adult Latest 2023 / 2024
Ch. 17: Integumentary Function
Age-related changes in skin structure and
function:
● L oss of thickness, elasticity, vascularity, and strength that may delay the healing process and increase the risk of skin tears and bruising ● I ncreased lentigines (brown-pigmented spots, or age spots) ● L oss of subcutaneous tissue causing wrinkling and sagging of the skin, which may affect self-esteem, temperature control, and drug efficacy ● L oss of hair follicles along with thinning and graying ● I ncreased hair density in the nose and the ears, particularly in men, which may clog external ear canals and impair hearing ● T hicker nails with longitudinal lines ● D ecreased sebaceous and sweat gland activity, which affects thermoregulation and decreases sweating ● Higher incidence of benign and malignant skin growths
➔ The primary function of the skin is to serve as a barrier against harmful bacteria and other threatening agents, which makes the skin the f irst line of defense for the immune system. Other major functions of the integumentary system include (1) preventing fluid loss or dehydration, (2) protecting the body from u protecting underlying organs f rom injury. In addition, the skin provides thermal regulation of body temperature. Radiation, conduction, convection, and evaporation are facilitated by sensory perceptions that occur in the skin’s nerve endings. The skin also assists in the regulation of blood pressure through “local regulation of 1 / 3
increases vulnerability
cutaneous blood flow and salt and water metabolism” (Johnson, Titze, & Weller, 2016, p. 1). The integumentary system reveals emotions such as anger, fear, or embarrassment through vasodilatation, which reddens the skin tissue. In the presence of the sun’s UV rays, the skin synthesizes vitamin D, which is then used by other parts of the body. Subcutaneous fat, the deepest layer of the integumentary system, provides insulation and acts as a caloric reservoir.
➔ The epidermis is the outermost layer of the skin. The replacement rate of the stratum corneum, the first layer of epidermis, declines by 50% as a person ages. This decline results in slower healing, reduced b arrier protection, and delayed absorption of medications and chemicals placed on the skin. The area of contact between the epidermis and dermis decreases with age, which results in easy separation of these layers. Therefore skin tears occur from harmless activities such as removing a bandage or pulling an older patient up in the bed.
➔ The dermis d ecreases in thickness by approximately 20% with aging. It consists of strong connective tissue that contains the sweat glands, blood vessels, and nerve endings. These changes lead to d iminished thermoregulatory function and inflammatory responses, decreased tactile sensation, reduced p ain perception, and development of wrinkles and sagging skin because of loss of underlying tissue.C ollagen, a fibrous protein that provides tensile strength within the dermis, stiffens and becomes less s oluble.
➔ A ging results in a decreased amount of subcutaneous tissue and a redistribution of fat to the abdomen a nd thighs. Breast tissue also changes and becomes more granular and atrophic.Because of a loss of padding supplied by subcutaneous tissues, the risk for hypothermia, skin shear, and blunt trauma injury i s greater. The loss of this protective padding of pressure points. Topical medication and dermal medication patch absorption may increase because of the changes in the subcutaneous tissue.
➔ With aging, fewer eccrine glands (sweat glands of the palms, feet, and forehead) and apocrine sweat glands (sweat glands of the axilla, scalp, face, and genital areas) exist, resulting in decreased body odor a nd reduced evaporative heat loss because of decreased sweating. The need for antiperspirants and deodorants is reduced. However, older adults are at greater risk of heat stroke because of a c ompromised cooling mechanism. Sebum oils the skin and provides an antimicrobial property.The sebaceous glands and pores become larger with aging. Nevertheless, many older adults experience dry s kin, which places them at a greater risk of infection because of an impaired immune response. 2 / 3
➔ H air thins, and its growth declines. A progressive loss of melanin occurs, resulting in graying of the hair.Heredity influences the onset of the graying process. Changes in the patterns of hair growth and distribution as a person ages are thought to be hormone related. Nails grow more slowly with age and become thicker, brittle, and dull, developing longitudinal striation with ridges.
➔ Nearly 35% of older adults experience chronic skin fragility. This fragile skin is called dermatoporosis.The identifying features of dermatoporosis include atopic changes, actinic purpura, and white p seudoscars. The skin appears nearly translucent. It occurs on sun-exposed areas of the extremities.Individuals with dermatoporosis frequently experience skin lacerations associated with increased b leeding and delayed healing.
In a skin assessment of darkly pigmented skin, prioritize the assessment of:
● Skin temperature ● Edema ● Change in tissue consistency in relation to surrounding tissue
Cherry angiomas are common, bright red, 1- to 5-millimeter (mm) superficial vascular lesions that begin around age 30 and increase in number with age. The cause of these lesions is unknown. They are red or deep purple d ome-shaped papules.
Seborrheic keratoses are benign lesions more commonly seen in the older adult. These are scaly growths that have a “stuck-on,” crumbly appearance that varies in color from tan to brown to black. The lesions may be elevated and range in diameter from 2 to 3 mm. Characterized by slow growth, these lesions begin to appear later in life. The borders may be round and smooth or irregular and notched. If the lesion is “picked off,” it will recur. Patients should be reassured that the growths are benign and are a commonly occurring skin m anifestation.
Skin tags are common stalk-like, benign tumors often found on the neck, axilla, eyelids, and groin, although they m ay occur anywhere on the body. Beginning as early as age 20, these are tiny, f lesh- colored or brown excrescences that develop into a long, narrow stalk (up to 1 centimeter [cm]). As they mature, they can be easily r emoved with scissors, electrocautery, or liquid nitrogen. Skin tags are usually excised only on the request of the patient, usually for cosmetic reasons.
Seborrheic dermatitis is a common, chronic inflammation of the skin. The scalp, ear canals, eyebrows, eyelashes, nasolabial folds, axilla, breasts, chest, and groin are common sites.The usual pattern of distribution begins with
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