Chapter 17 Care of Aging Skin and Mucous Membranes Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 1.

Chapter 17

Care of Aging Skin

and Mucous Membranes

Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 1

Lesson 17.1


Objectives

Discuss changes related to aging that have an effect on skin and mucous membranes.

Identify the older adults who are most at risk for problems related to the skin and mucous membranes.

Describe interventions that assist older adults in maintaining intact skin and mucous membranes.


Nursing Process for Impaired Skin Integrity


Skin Color

Examination of the skin should take place in good, preferably natural, light; one side of the body should be compared with the other, and touch should be used to determine skin temperature or the presence of rashes or irritation

Color changes, including pallor, cyanosis, jaundice, or erythema, can indicate a variety of problems


Dry Skin

One of the most common problems of aging Can result in itching (pruritus), burning, and

cracking of the skin Many older people develop a habit of

scratching or picking at dry or cracked skin, increasing their risk for further tissue damage and infection


Assessing Skin Impairment


Dry, Scaly Skin


Rashes and Irritations

Medications, communicable diseases, and contact with chemical substances are common causes of skin rashes and pruritus

Allergic response to medications can manifest as diffuse rashes over the body

Scabies is a superficial infection caused by a parasitic mite (Sarcoptes scabiei) that burrows under the skin


Scabies Lesions


Pigmentation

Changes in skin pigmentation are common with aging

Common conditions such as acne rosacea can be treated with topical medications

Changes in the size or pigmentation of moles are of greater significance because these changes may indicate the presence of a precancerous or cancerous condition that needs immediate medical attention


Tissue Integrity

Breaks in tissue integrity increase the older person’s risk for infection and often result in the need for costly, time-consuming treatments

Skin tears, abrasions, lacerations, and ulcers most often result from friction, shearing force, moisture, and pressure


Pressure Ulcers

A particular risk to older adults who suffer from compromised circulation, restricted mobility, altered level of consciousness, fecal or urinary incontinence, or nutritional problems

Excessive pressure on tissues, particularly over bony prominences, can quickly lead to skin breakdown


Pressure Ulcers (cont.)

Ulcer development depends on the amount of pressure, length of time pressure is exerted, and underlying status of the tissues involved

Pressure ulcers are categorized or staged based on their appearance and depth of tissue penetration


Risk Factors for Pressure Ulcers

Immobility Inactivity Incontinence Malnutrition Diminished sensation, decreased mental

status Impaired skin integrity


Braden Scale for Predicting Pressure Sore Risk

The Braden Scale takes into consideration the following factors when assessing for pressure ulcer risk Sensory perception Moisture Activity Mobility Nutrition


Bony Prominences and Common Pressure Ulcer Sites


Pressure Ulcers


Audience Response SystemQuestion 1

A common complaint in older adults that may be caused by dryness, irritation, or infection of the skin is:

A.decubitus.

B.bruising.

C.pruritus.

D.alopecia.


Amount, Distribution, Appearance, and Consistency

of Hair The hair of both men and women typically

becomes thinner and has a finer consistency with advanced age

Men tend to lose more hair than do women, although some men retain a full head of hair throughout life

Male pattern baldness typically results in progressive loss of hair at the temples and back of the head


Amount, Distribution, Appearance, and Consistency

of Hair (cont.) Sudden and excessive hair loss (alopecia) or

breakage is likely to indicate a systemic problem

Diminished or absent hair on the lower legs or feet—particularly when combined with excessively dry, scaly, or flaky skin and weak or absent pedal pulses—indicates decreased blood supply to the lower extremities


Tissue of the Feet

Because many aging individuals are unable to bend adequately to view the feet, a family member or friend can perform this inspection for independent older adults

Many older adults neglect their feet simply because they cannot see or reach them

Unless foot inspection is done on a regular schedule, severe problems can occur before anyone is aware of them


Common Foot Problems


Nails

Aging results in hyperkeratosis of the nails, particularly the toenails

Thick, hard nails are difficult to cut using normal foot care equipment

The strength and effort required to cut these nails may exceed an older person’s abilities, resulting in overgrowth

Fungi cause the nails to become thick, brittle, misshapen, and discolored


Other Common Foot Problems

Corns, calluses, blisters, and bunions usually result from years of poorly fitted footwear

Many independent older adults use commercially available foot remedies or attempt to remove corns or calluses This practice is dangerous and significantly

increases the risk for serious foot infections, which may necessitate amputation of a toe, toes, or entire foot


Nursing Interventions for Impaired Skin Integrity

Assess the level of impairment and the contributing factors

Institute measures to reduce the risk for skin and tissue breakdown

Institute measures to promote tissue healing Provide good foot care


Treatment Options

Treatment options for pressure ulcers are dependent on the stage



A superficial infection caused by a parasitic mite that burrows under the skin is:

A.lice.

B.scabies.

C.ringworm.

D.leukoplakia.


Lesson 17.2


Objectives

Identify the older adults who are most at risk for problems related to the skin and mucous membranes

Describe interventions that assist older adults in maintaining intact skin and mucous membranes


Nursing Process for Impaired Oral Mucous Membranes


Dental Caries

Tooth decay, loose teeth, and lost teeth are ongoing problems in the older adult population

Poor nutrition and decreased appetite in older adults can often be attributed to dental problems

Decay, or caries, is caused by the action of bacteria that penetrate through the enamel shield of the tooth and cause destruction


Periodontal Disease

A less obvious but potentially more serious complication of poor oral care

Food debris and plaque build up in the mouth and on the teeth when oral hygiene is inadequate

Activity of bacteria on this debris causes bad breath, or halitosis, which is often disturbing to the older person and to anyone in close contact


Periodontal Disease (cont.)

Gingivitis causes gum swelling, tenderness, and bleeding and eventually leads to recession of the gum tissue away from the tooth


Pain

Dental caries and periodontal disease are the most common reasons for oral pain, but oral lesions such as stomatitis or altered sensations in the mouth are also reported

Pain may be limited to the oral cavity or may affect the face and jaw

Oral pain can cause loss of appetite, decreased food intake, a negative effect on the overall quality of an older person’s life


Dentures

Partial plates tend to catch particles of food and may weaken healthy teeth

Complete dentures are expensive and difficult to fit

Dentures may not fit properly if a significant amount of weight is gained or lost

Dentures can cause irritation, inflammation, and ulceration of gums and oral mucous membranes


Dry Mouth

Xerostomia, or dry mouth, is commonly observed with aging

Dryness may result from the normal age-related reduction in saliva secretion, inadequate hydration, or disease conditions such as diabetes

Makes chewing and swallowing more difficult, promotes tooth decay, and alters the sense of taste


Leukoplakia

White patches in the mouth Often are precancerous and require prompt

medical attention Lesions on the posterior third or sides of the

tongue often are abnormal and should be brought to the attention of the physician


Leukoplakia (cont.)



A disease that is suspected to play a role in thromboembolic disorders, bacterial endocarditis, and myocardial infarction is:

A.dental caries.

B.halitosis.

C.gingivitis.

D.periodontal disease.


Cancer

Oral or pharyngeal cancer have poor prognosis

Early recognition and treatment before the cancer has metastasized to other tissues offer the best hope

Symptoms of oral cancer include leukoplakia or erythroleukoplakia, sores in the mouth that do not heal, oral bleeding, pain or difficulty swallowing, difficulty wearing dentures, swollen lymph nodes in the neck, earache


Disorders Caused by Vitamin Deficiencies

Certain deficiencies of riboflavin, niacin, and vitamin C can affect oral mucous membranes

A smooth purplish sore tongue may be related to riboflavin deficiency

Complaint of a burning sensation or soreness of the mouth may indicate niacin deficiency


Superinfections

Superinfections of the mouth are relatively common in older individuals who receive broad-spectrum antibiotic therapy for some other infection

Antibiotics destroy the normal mouth flora and allow opportunist bacteria or yeast colonies to become established and grow


Superinfections (cont.)

A hairy tongue is the result of enlargement of the papillae on the tongue; this often follows antibiotic therapy

Black or brown discoloration on the tongue may be caused by tobacco use or by a chromogenic (color-producing) bacterium


Alcohol- and Tobacco-Related Problems

Alcohol and tobacco, even in small amounts, can harm the mucous membranes

Alcohol is chemically irritating and drying to the mucous membranes

Tobacco, whether smoked, chewed, or taken as snuff, increases the risk for oral cancer


Problems Caused by Neurologic Conditions

Neurologic conditions such as stroke, multiple sclerosis, or Parkinson’s disease decrease coordination and strength, making it difficult for the person to manipulate the equipment needed for oral hygiene


Problems Caused by Neurologic Conditions (cont.)

Individuals with severe arthritis may find the equipment difficult to manipulate and that it is difficult to open the mouth adequately for good, thorough cleaning

Older persons who take medication for epilepsy or other seizure disorders need to use special precautions, because these medications often cause hyperplasia of the gingiva


Nursing Interventions for Impaired Oral Mucous Membranes

Complete a thorough assessment of the oral mucous membranes

Initiate referral to a dentist or dental hygienist Provide oral hygiene


Nursing Interventions for Impaired Oral Mucous Membranes (cont.)

Promote adequate intake of nutrients and fluids

Provide lozenges or topical analgesics as prescribed

Communicate suspected oral side effects of medication therapy to the physician and dentist



A hairy tongue is the result of enlargement of the papillae on the tongue; this often follows:

A.antibiotic therapy.

B.candidiasis.

C.fungal infection.

D.vitamin deficiency.


Chapter 17 Care of Aging Skin and Mucous Membranes Copyright © 2012, 2008 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. 1.

Documents

affiliate of elsevier

skin pigmentation

intact skin

cracked skin

skin colorexamination

skin temperature

skin impairmentcopyright

common causes of skin