Skin Integrity and Wound Care: Study Notes for Personal Health

Skin Integrity and Wound Care

Structures of the Skin

The skin is composed of three main layers, each with distinct functions and characteristics:

• Epidermis: The outermost layer, made of keratin, provides waterproof protection. It lacks blood vessels and regenerates quickly.

• Dermis: Located beneath the epidermis, this layer contains elastic tissue (mainly collagen), nerves, hair follicles, glands, immune cells, and blood vessels.

• Subcutaneous Layer: Anchors the skin to underlying tissues and provides insulation and cushioning.

Functions of the Skin

The skin serves multiple essential functions for overall health:

• Protection: Acts as a barrier against pathogens and physical injury.

• Body Temperature Regulation: Blood vessels dilate to dissipate heat and constrict to retain heat.

• Psychosocial: Contributes to self-image and social interactions.

• Sensation: Contains nerve endings for touch, pain, and temperature.

• Vitamin D Production: Synthesizes vitamin D when exposed to sunlight.

• Immunologic: Provides immune defense mechanisms.

• Absorption: Absorbs certain substances through the skin.

• Elimination: Excretes waste products via sweat.

Factors Affecting Skin Integrity

Several factors influence the health and resilience of the skin:

• Unbroken and healthy skin defends against harmful agents.

• Resistance to injury is affected by age, tissue amount, and illness.

• Nourishment and hydration of cells increase resistance to injury.

• Adequate circulation is necessary for cell life and healing.

Developmental Considerations

• Children under 2 years have thinner, weaker skin, making them more susceptible to injury and infection.

• Skin structure changes with age; older adults have impaired circulation and collagen formation, leading to decreased elasticity and increased risk for tissue damage.

Causes of Skin Alterations

• Very thin or obese individuals are more prone to skin injury.

• Fluid loss during illness causes dehydration and skin breakdown.

• Jaundice results in yellowish, itchy skin.

• Skin diseases (e.g., eczema, psoriasis) may cause lesions requiring special care.

Types of Wounds

Wounds are classified based on their cause, characteristics, and severity:

• Intentional: Surgical wounds.

• Unintentional: Traumatic wounds.

• Neuropathic or vascular: Related to nerve or blood vessel issues.

• Pressure-related: Caused by prolonged pressure.

• Open or closed: Skin is broken or intact.

• Acute or chronic: Duration and healing time.

• Partial thickness, full thickness, complex: Depth and involvement of skin layers.

Wound Terminology

• Incision: Clean cut by a sharp instrument.

• Contusion: Injury by blunt force; skin intact, bruising present.

• Abrasion: Scraping of epidermal layers.

• Laceration: Tearing of skin and tissue.

• Puncture: Deep wound by a pointed object.

• Penetrating: Object remains embedded.

• Avulsion: Tearing away of tissue.

• Chemical, thermal, irradiation: Caused by exposure to chemicals, heat, or radiation.

• Pressure ulcers, venous ulcers, arterial ulcers, diabetic ulcers: Specific types based on etiology.

Principles of Wound Healing

Effective wound healing depends on several principles:

• Intact skin is the first line of defense against microorganisms.

• Hand hygiene is critical in wound care.

• The body responds systematically to trauma.

• Adequate blood supply is essential for healing.

• Wounds should be free of foreign material.

• Extent of damage and health status affect healing.

• Proper nutrition supports healing.

Phases of Wound Healing

Wound healing occurs in four overlapping phases:

• Hemostasis: Immediate response; blood vessels constrict, clotting begins, exudate forms.

• Inflammatory: Lasts 2-3 days; white blood cells (leukocytes, macrophages) migrate to wound, debris is removed, growth factors released.

• Proliferation: Lasts several weeks; fibroblasts build new tissue, capillaries grow, epithelial cells cover wound, granulation tissue forms.

• Maturation: Begins ~3 weeks post-injury; collagen remodeled, scar forms (avascular, does not sweat, grow hair, or tan).

Factors Affecting Wound Healing

Local Factors

• Pressure

• Desiccation (dehydration)

• Maceration (overhydration)

• Trauma

• Edema

• Infection

• Excessive bleeding

• Necrosis (dead tissue)

• Biofilm (microorganism grouping)

Systemic Factors

• Age: children and healthy adults heal faster

• Circulation and oxygenation: adequate blood flow is essential

• Nutritional status: healing requires proper nutrition

• Wound etiology: specific wound conditions affect healing

• Health status: corticosteroids and radiation delay healing

• Immunosuppression

• Medication use

• Adherence to treatment plan

Wound Complications

• Infection: Microbial invasion delays healing.

• Hemorrhage: Excessive bleeding.

• Dehiscence: Separation of wound edges.

• Evisceration: Protrusion of internal organs.

• Fistula formation: Abnormal passage between organs or tissues.

Pressure Injuries

Factors Affecting Pressure Injury Development

• Aging skin

• Chronic illnesses

• Immobility

• Malnutrition

• Fecal and urinary incontinence

• Altered consciousness

• Spinal cord and brain injuries

• Neuromuscular disorders

Mechanisms

• External pressure compresses blood vessels

• Friction/shearing forces injure blood vessels

• Microclimate: skin temperature and moisture

Risks

• Nutrition and hydration

• Immobility

• Mental status

• Age

Stages of Pressure Injuries

• Stage 1: Nonblanchable erythema of intact skin

• Stage 2: Partial-thickness skin loss with exposed dermis

• Stage 3: Full-thickness skin loss; not involving underlying fascia

• Stage 4: Full-thickness skin and tissue loss

• Unstageable: Obscured full-thickness skin and tissue loss

• Deep tissue pressure injury: Persistent nonblanchable deep red, maroon, or purple discoloration

Psychological Effects of Wounds

• Pain

• Anxiety

• Fear

• Impact on daily activities

• Change in body image

Assessment and Prevention

Health History

• Recent changes in skin

• Activity and mobility

• Nutrition

• Pain

• Elimination

Skin Assessment

• Inspection and palpation, head to toe

• Include bony prominences

• Frequency: acute care (every shift), long-term (weekly then quarterly), home health (each visit)

Wound Assessment

• Appearance

• Size and depth

• Presence of undermining, tunneling, sinus tract

• Drainage types: serous, sanguineous, serosanguineous, purulent

Preventing Pressure Injuries

• Assess at-risk patients daily

• Cleanse skin routinely

• Maintain humidity and use moisturizers

• Protect skin from moisture

• Minimize friction/shearing

• Proper positioning, turning, transferring

• Use appropriate support surfaces

• Nutritional supplements

• Improve mobility and activity

Wound Dressings and Management

Purposes of Wound Dressings

• Provide comfort

• Prevent/control infection

• Absorb drainage

• Maintain moisture balance

• Protect wound and surrounding skin

• Debride necrotic tissue

• Stimulate healing

• Ease of use and cost-effectiveness

Types of Wound Dressings

• Maintain moisture

• Absorb moisture

• Add moisture

Changing the Dressing

• Prepare patient

• Use aseptic technique

• Hand hygiene before and after

• Remove old dressing

• Cleanse wound

• Apply and secure new dressing

Cleaning a Pressure Injury/Wound

• Clean with each dressing change

• Use new gauze for each wipe; clean from top to bottom or center outward

• Use 0.9% normal saline solution

• Dry area with gauze

• Report drainage or necrotic tissue

Bandages, Binders, and Drainage Systems

Types of Bandages

• Roller bandages: circular, spiral, figure-of-eight turns

Types of Binders

• Slings

• Abdominal binders

• Chest binders

• T-binders

Type of Drainage Systems

• Open systems: Penrose drain

• Closed systems: Jackson-Pratt drain, Hemovac drain

Color Classification of Open Wounds

Color	Action
Red	Protect
Yellow	Cleanse
Black	Débride
Mixed	Contains components of RY&B wounds

Home Health Care Teaching Topics

• Supplies

• Infection prevention

• Wound healing

• Appearance of skin/recent changes

• Activity/mobility

• Nutrition

• Pain

• Elimination

Hot and Cold Treatments

Factors Affecting Response

• Method and duration of application

• Degree of heat/cold applied

• Patient’s age and physical condition

• Amount of body surface covered

Effects of Applying Heat

• Dilates peripheral blood vessels

• Increases tissue metabolism

• Reduces blood viscosity and increases capillary permeability

• Reduces muscle tension

• Helps relieve pain

Effects of Applying Cold

• Constriction of peripheral blood vessels

• Reduces muscle spasms

• Promotes comfort

Devices to Apply Heat

• Hot water bags

• Electric heating pads

• Aquathermia pads

• Hot packs

• Warm, moist compresses

• Sitz baths

• Warm soaks

Devices to Apply Cold

• Ice bags

• Cold packs

• Hypothermia blankets

• Cold compresses

Examples and Applications

• Example: A contusion is caused by a blunt instrument, resulting in bruising but with the skin intact.

• Example: Maceration occurs due to overhydration, often related to urinary or fecal incontinence.

• Example: Stage 3 pressure injuries require débridement via wet-to-dry dressings, surgical intervention, or proteolytic enzymes.

Additional info: Proper wound care and skin integrity are essential for preventing infection, promoting healing, and maintaining overall health. These principles are especially relevant for personal health, as skin is the body's largest organ and a critical barrier to disease.