Integumentary
10.2 Integumentary Basic Concepts
Skin
Skin is made up of three layers: epidermis, dermis, and hypodermis. See Figure 10.1[1] for an illustration of skin layers. The epidermis is the thin, topmost layer of the skin. It contains sweat gland duct openings and the visible part of hair known as the hair shaft. Underneath the epidermis lies the dermis where many essential components of skin function are located. The dermis contains hair follicles (the roots of hair shafts), sebaceous oil glands, blood vessels, endocrine sweat glands, and nerve endings. The bottommost layer of skin is the hypodermis (also referred to as the subcutaneous layer). It mostly consists of adipose tissue (fat), along with some blood vessels and nerve endings. Beneath the hypodermis layer lies bone, muscle, ligaments, and tendons.
There are several common skin disorders that a nurse may find when assessing a patient’s skin.
Hair
Hair is a filament that grows from a hair follicle in the dermis of the skin. See Figure 10.2[2] for an illustration of a hair follicle. It consists mainly of tightly packed, keratin-filled cells called keratinocytes. The human body is covered with hair follicles except for the mucous membranes, lips, palms of the hands, and soles of the feet. The part of the hair that is located within the follicle is called the hair root, the only living part of the hair. The part of the hair that is visible above the surface of the skin is the hair shaft. The shaft of the hair has no biochemical activity and is considered dead.
Functions of Hair
The functions of head hair are to provide insulation to retain heat and to protect the skin from damage by UV light. The function of hair in other locations on the body is debated. One idea is that body hair helps to keep us warm in cold weather. When the body is cold, the arrector pili muscles contract, causing hairs to stand up and trapping a layer of warm air above the epidermis. However, this action is more effective in mammals that have thick hair than it is in relatively hairless human beings.
Human hair has an important sensory function as well. Sensory receptors in the hair follicles can sense when the hair moves, whether it is because of a breeze or the touch of a physical object. Some hairs, such as the eyelashes, are especially sensitive to the presence of potentially harmful matter. The eyebrows protect the eyes from dirt, sweat, and rain. In addition, the eyebrows play a key role in nonverbal communication by expressing emotions such as sadness, anger, surprise, and excitement.[3]
Nails
Nails are accessory organs of the skin. They are made of sheets of dead keratinocytes and are found on the distal ends of the fingers and toes. The keratin in nails makes them hard but flexible. Nails serve a number of purposes, including protecting the fingers, enhancing sensations, and acting like tools. A nail has three main parts: root, plate, and free margin. Other structures around or under the nail include the nail bed, cuticle, and nail fold. See Figure 10.3 for an illustration of the structure of a nail.[4],[5] The top diagram in this figure shows the external, visible part of the nail and the cuticle. The bottom diagram shows internal structures in a cross-section of the nail and nail bed.
Impaired Skin and Tissue Integrity
Skin integrity is a medical term that refers to skin health. Impaired skin integrity is a NANDA-I nursing diagnosis defined as, “Altered epidermis/or dermis.”[6] However, when deeper layers of the skin or integumentary structures are damaged, it is referred to as impaired tissue integrity. The NANDA-I definition of impaired tissue integrity is, “Damage to the mucous membrane, cornea, integumentary system, muscular fascia, muscle, tendon, bone, cartilage, joint capsule, and/or ligament.”[7]
Risk Factors Affecting Skin Health and Wound Healing
There are several risk factors that place a patient at increased risk for altered skin health and delayed wound healing. Risk factors include impaired circulation and oxygenation, impaired immune function, diabetes, inadequate nutrition, obesity, exposure to moisture, smoking, and age. Each of these risk factors is discussed in more detail in the following subsections.
Impaired Circulation and Oxygenation
Skin, like every other organ in the body, depends on good blood perfusion to keep it healthy and functioning correctly. Cardiovascular circulation delivers important oxygen, nutrients, infection-fighting cells, and clotting factors to tissues. These elements are needed by skin, tissues, and nerves to properly grow, function, and repair damage. Without good cardiovascular circulation, skin becomes damaged. Damage can occur from poor blood perfusion from the arteries, as well as from poor return of blood through the veins to the heart. Common medical conditions that decrease cardiovascular circulation include cardiac disease, diabetes, and peripheral vascular disease (PVD). PVD includes two medical conditions called arterial insufficiency and venous insufficiency.
Arterial Insufficiency
Arterial insufficiency refers to a lack of adequately oxygenated blood movement in arteries to specific tissues. Arterial insufficiency can be a sudden, acute lack of oxygenated blood, such as when a blood clot in an artery blocks blood flow to a specific area. Arterial insufficiency can also be a chronic condition caused by peripheral vascular disease (PVD). As a person’s arteries become blocked with plaque due to atherosclerosis, there is decreased blood flow to the tissues. Signs of arterial insufficiency are cool skin temperature, pale skin color, pain that increases with exercise, and possible arterial ulcers.
When oxygenated blood flow to tissues becomes inadequate, the tissue dies. This is called necrosis. Tissue death causes the skin and tissue to become necrotic (black). Necrotic tissue does not heal, so surgical debridement or amputation of the extremity becomes necessary for healing. See Figure 10.4[8] for images of an arterial insufficiency ulcer and necrotic toes.
Venous Insufficiency
Venous insufficiency occurs when the cardiovascular system cannot adequately return blood and fluid from the extremities to the heart. Venous insufficiency can cause stasis dermatitis when blood pools in the lower legs and leaks out into the skin and other tissues. Signs of venous insufficiency are edema, a brownish-leathery appearance to skin in the lower extremities, and venous ulcers that weep fluid.[9] See Figure 10.5[10] for an image of stasis dermatitis.
Impaired Immune Function
Skin contributes to the body’s immune function and is also affected by the immune system. Intact skin provides an excellent first line of defense against foreign objects entering the body. This is why it is essential to keep skin intact. If skin does break down, the next line of defense is a strong immune system that attacks harmful invading organisms. However, if the immune system is not working well, the body is much more susceptible to infections. This is why maintaining intact skin, especially in the presence of an impaired immune system, is imperative to decrease the risk of infections.
Stress can cause an impaired immune response that results in delayed wound healing.[11] Being hospitalized or undergoing surgery triggers the stress response in many patients. Medications, such as corticosteroids, also affect a patient’s immune function and can impair wound healing.[12] When assessing a chronic wound that is not healing as expected, it is important to consider the potential effects of stress and medications.
Diabetes
Diabetes can cause wounds to develop, as well as cause delayed wound healing. Nurses provide vital patient education to patients with diabetes to help them effectively manage the disease and prevent complications.
Read more about diabetes in the “Antidiabetics” section of the “Endocrine” chapter in Open RN Nursing Pharmacology.
Inadequate Nutrition
A healthy diet is essential for maintaining healthy skin, as well as maintaining an appropriate weight. Nutrients that are particularly important for skin health include protein; vitamins A, C, D, and E; and minerals such as selenium, copper, and zinc.[13]
Nutritional deficiencies can have a profound impact on wound healing and must be addressed for chronic wounds to heal. Protein is one of the most important nutritional factors affecting wound healing. For example, in patients with pressure injuries, 30 to 35 kcal/kg of calorie intake with 1.25 to 1.5g/kg of protein and micronutrients supplementation are recommended daily.[14] In addition, vitamin C and zinc have many roles in wound healing. It is important to collaborate with a dietician to identify and manage nutritional deficiencies when a patient is experiencing poor wound healing.[15]
Obesity
In the same way a balanced diet is vital for healthy skin, a healthy weight is also imperative. Obese individuals are at increased risk for fungal and yeast infections in skin folds caused by increased moisture and friction. See Figure 10.6[16] for an image of a fungal infection in the groin.[17] Symptoms of yeast and fungal infection include redness and scaliness of the skin associated with itching.
Obese patients also are at higher risk for wound complications due to a decreased supply of oxygenated blood flow to adipose tissue. Potential complications include infection, dehiscence (separation of the edges of a surgical wound), hematoma formation, pressure injuries, and venous ulcers.[18] Evisceration is a rare but severe complication when an abdominal surgical incision separates and the abdominal organs protrude or come out of the incision. Nurses can educate patients about making healthy lifestyle choices to reduce obesity and the risk of dehiscence. See Figure 10.7[19] for an image of a dehiscence in an abdominal surgical wound of an obese patient.
Exposure to Moisture
Healthy skin needs good moisture balance. If too much moisture (i.e., sweat, urine, or water) is left on the skin for extended periods of time, the skin will become soggy, wrinkly, and turn whiter than usual and is called maceration. A simple example of maceration is when you spend too much time in a bathtub and your fingers and toes turn white and get “pruny.” See Figure 10.8[20] for an image of maceration. If healthy skin is exposed to moisture for an extended period of time, such as when a moist wound dressing is incorrectly applied on healthy skin, the skin will break down. This type of skin breakdown is called excoriation. Excoriation refers to redness and removal of the topmost surface of the skin. See Figure 10.9[21] for an image of excoriation.
The opposite occurs when skin lacks proper moisture. Skin becomes flaky, itchy, and cracked when it becomes too dry. Conditions such as decreased moisture in the air during cold winter months or bathing in hot water can worsen skin dryness. Dry skin, especially when accompanied with cracking, breaks the protective barrier and increases the risk of infection. It is important for nurses to apply emollient cream to patients’ areas of dry skin to maintain the protective skin barrier.
Smoking
Smoking impacts the inflammatory phase of the wound healing process, which can result in poor wound healing and an increased risk of infection.[22] Patients who smoke should be encouraged to stop smoking.
Age
Older adults have thin, less elastic skin that is at increased risk for injury. They also have an altered inflammatory response that can impair wound healing. Nurses can educate older patients about the importance of exercise for skin health and improved wound healing as appropriate.[23]
- “501 Structure of the skin.jpg” by OpenStax is licensed under CC BY 3.0. Access for free at https://openstax.org/books/anatomy-and-physiology/pages/5-1-layers-of-the-skin ↵
- “506 Hair.jpg” by OpenStax is licensed under CC BY 3.0. Access for free at https://openstax.org/books/anatomy-and-physiology/pages/5-2-accessory-structures-of-the-skin. ↵
- This work is a derivative of Human Biology by Wakim and Grewal and is licensed under CC-BY-NC 4.0 ↵
- “Blausen_0406_FingerNailAnatomy.png” by BruceBlaus is licensed under CC BY 3.0 ↵
- This work is a derivative of Human Biology by Wakim and Grewal and is licensed under CC-BY-NC 4.0 ↵
- Herdman, T., & Kamitsuru, S. (2017). NANDA international nursing diagnoses: Definitions & classification 2018-2020 (11th ed.). Thieme Publishers. pp. 404, 406, 407, 412, 413. ↵
- Herdman, T., & Kamitsuru, S. (2017). NANDA international nursing diagnoses: Definitions & classification 2018-2020 (11th ed.). Thieme Publishers. pp. 404, 406, 407, 412, 413. ↵
- "JCCD147F1.gif” and “Infective-necrosis-of-second-toe_fig5_40484391” by unknown are licensed under CC BY 4.0 and CC BY-NC 4.0. Access for free at https://www.sciforschenonline.org/journals/clinical-cosmetic-dermatology/JCCD147.php and https://www.researchgate.net/figure/nfective-necrosis-of-second-toe_fig5_40484391 ↵
- Blackburn, L., Acree, K., Bartley, J., DiGiannantoni, E., Renner, E., & Sinnott, L. T. (2020). Microbial growth on the nails of direct patient care nurses wearing nail polish. Nursing Oncology Forum, 47(2), 155-164. https://doi.org/10.1188/20.onf.155-164 ↵
- ”3056fig1_opt.jpeg” by unknown is licensed under CC BY-NC 4.0. Access for free at https://www.medicaljournals.se/acta/content/html/10.2340/00015555-0692 ↵
- Butcher, H., Bulechek, G., Dochterman, J., & Wagner, C. (2018). Nursing interventions classification (NIC). Elsevier. pp. 348-349, 417-419. ↵
- Butcher, H., Bulechek, G., Dochterman, J., & Wagner, C. (2018). Nursing interventions classification (NIC). Elsevier. pp. 348-349, 417-419. ↵
- Park, K. (2015). Role of micronutrients in skin health and function. Biomolecules & Therapeutics, 23(3), 207–217. https://doi.org/10.4062/biomolther.2015.003 ↵
- Cox, J. (2019). Wound care 101. Nursing, 49(10), 32-39. https://doi.org/10.1097/01.nurse.0000580632.58318.08 ↵
- Guo, S., & Dipietro, L. A. (2010). Factors affecting wound healing. Journal of Dental Research, 89(3), 219–229. https://doi.org/10.1177/0022034509359125 ↵
- “Tinea cruris.jpg” by Robertgascoin is licensed under CC BY-SA 3.0 ↵
- Rosen, T. (2011). Inframammary candida intertrigo. UpToDate. https://somepomed.org/articulos/contents/mobipreview.htm?0/29/474 ↵
- Guo, S., & Dipietro, L. A. (2010). Factors affecting wound healing. Journal of Dental Research, 89(3), 219–229. https://doi.org/10.1177/0022034509359125 ↵
- “Bogota bag.png” by Suarez-Grau, J. M., Guadalajara Jurado, J. F., Gómez Menchero, J., & Bellido Luque, J. A. is licensed under CC BY 4.0 ↵
- “Trench_foot.jpg” by Mehmet Karatay is licensed under CC BY-SA 3.0 ↵
- “Dermatomyositis15.jpg” by Elizabeth M. Dugan, Adam M. Huber, Frederick W. Miller, and Lisa G. Rider is licensed under CC BY-SA 3.0 ↵
- Guo, S., & Dipietro, L. A. (2010). Factors affecting wound healing. Journal of Dental Research, 89(3), 219–229. https://doi.org/10.1177/0022034509359125 ↵
- Guo, S., & Dipietro, L. A. (2010). Factors affecting wound healing. Journal of Dental Research, 89(3), 219–229. https://doi.org/10.1177/0022034509359125 ↵
Learning Objectives
- Consider all aspects of diversity, including age
- Differentiate between normal and abnormal findings for older adults
- Detail specific adaptations in patient care to accommodate the needs of older adults
The needs of the older adult population will continue to influence health care through this century. The aging “baby boomer” population, along with an increased average life span of Americans, has led to an increased number of older adults and is only expected to grow. The U.S. Census Bureau projects that 1 in 5 Americans will be over the age of 65 by 2030, and by 2034, the number of older individuals will outnumber children for the first time in U.S. history.[1]
Each individual ages in their own way, and the physical, psychosocial, and cognitive health of older individuals varies widely. Because of this broad scope of health and illness in the aging population, providing nursing care that meets the needs of each older adult can be challenging. Additionally, although there are common physiological changes that occur with aging, many individuals ignore symptoms by erroneously attributing them to the aging process. For example, many older adults mistakenly believe that pain from arthritis is a normal part of growing older and do not seek treatment, resulting in decreased physical activity that puts them at increased risk for developing chronic disease. Providing individualized nursing care and patient education to older adults can promote effective preventative health care and self-management that maintains and enhances their quality of life.[2] Let’s begin by reviewing basic concepts related to the aging process.
Ageism
Gerontology is the study of the social, cultural, psychological, cognitive, and biological aspects of aging. There are many stereotypes and negative attitudes about aging adults that persist in the US and around the world. This bias can be linked to a general lack of knowledge about the aging process and misunderstandings about older adults. Because of these influences, many individuals have anxiety about aging that can lead to negative stereotypes of older individuals called ageism.[3]
Ageism among nurses and other health care professionals puts older people at risk. Research has demonstrated that ageism in health care negatively impacts older adults’ overall health, well-being, and quality of care received. Ageism results in increased risks of mortality, poor functional health, and slower recovery times from illness. Negative perceptions about aging can also lead to poor mental health and depression.[4] As you read this chapter, think about your own attitudes about aging and how these beliefs may impact the care you provide.
Integrity Versus Despair
Aging individuals must continually adjust to changes in health and physical strength, lifestyle changes as a result of retirement, the loss of significant others, and changing roles and relationships with family members and friends. As a result, older individuals may find it difficult to accept the changes associated with aging. Nurses can support older adults in maintaining a positive self-image and outlook by considering Erikson’s theory of development. Erikson’s theory of development describes the stage of older adulthood as “Integrity versus Despair.” This stage begins at approximately age 65 and ends at death. During this stage, older adults reflect on their accomplishments and the person they have become. If they feel they have led a successful life, they often feel satisfied and develop a sense of integrity. Conversely, individuals who feel unsuccessful or do not feel they achieved their life goals often feel unsatisfied and may experience hopelessness and despair that can lead to depression. Nurses can assist older adults in developing a sense of integrity by encouraging the patient to reminiscence about previous positive life events and relationships and cultivate a positive mindset of guiding the next generation.[5]
Many older adults, especially those with declining health due to chronic disease, acknowledge that changes in their health status and mobility threaten the autonomy and independence they previously experienced throughout adulthood. As a result, many older adults strive to be autonomous so they are not overly reliant on others for their daily care. They often engage in self-management activities in response to changes in their health and physical strength, ranging from simple daily tasks, such as medication management, to more complex tasks, such as relocating to new residences that are better suited to their changes in physical and mental health. Research has found that when older adults are faced with declines in their physical health and/or cognitive abilities, they often draw upon experiences and skills acquired in earlier adulthood for the purpose of self-managing their new conditions. They reflect on their resilience used to overcome significant challenges faced in earlier adulthood and then apply skills and knowledge gained through previously productive activities to managing their new health changes. However, not all older adults have sufficient personal and external resources to devote towards successful self-management of their health conditions. Nurses can assist older adults by personalizing health self-management strategies that emphasize their existing skill sets and knowledge.[6]
Other Considerations
Retirement
In addition to the physiological changes that occur with aging, older adults vary in their level of activity. For example, many older adults continue working into their seventies and beyond. Individuals may choose to continue to work because of their sense of purpose or because of a need for income. Some older individuals experience a loss of identity when they retire because their work role was an important aspect of their life. Retirement can bring a sense of freedom and adventure, as well as a need to find new identity and purpose.
Social Isolation
Retirement and the loss of daily interaction with coworkers, as well as death of family members and friends, can lead to social isolation in the aging population. Social support impacts a person’s health and quality of life and should be included as part of the assessment. It is helpful for nurses to be familiar with community resources that provide socialization opportunities and provide referrals for patients in need of additional services.
Modified Living Environment
Although many aging adults live in assisted living facilities or skilled nursing centers, many older adults prefer to live at home. Modifications may be needed to the home environment to promote safety and independence. For example, grab bars, elevated toilet seats, and other modifications may be needed in the bathroom, along with good lighting, minimization of clutter, and removal of rugs throughout the home. Assessment of the home environment for safety and ease of mobility is an important aspect of home care nursing.
If an older adult requires more care than family members are able to provide at home, nurses provide valuable information about available care options and make referrals to social workers and case managers. There are a wide variety community-based resources to enhance care for older adults. Local aging and disability resource centers (ADRCs) can help facilitate referrals based on specific needs of the older adult. Examples of other resources include adult day centers, home health agencies that provide personal care and nursing assistance, community-based residential facilities (CBRFs), and residential care apartment complexes (RCACs). If an older adult requires 24-hour nursing care, placement in a nursing home (also referred to as a skilled nursing facility) may be required. Use the following hyperlink to read more information about nursing home resources provided by the Centers for Medicare and Medicaid (CMS).
Learn more about nursing home resources by reviewing the Nursing Home Resource Center provided by the Centers for Medicare and Medicaid (CMS).
Ageism
Gerontology is the study of the social, cultural, psychological, cognitive, and biological aspects of aging. There are many stereotypes and negative attitudes about aging adults that persist in the US and around the world. This bias can be linked to a general lack of knowledge about the aging process and misunderstandings about older adults. Because of these influences, many individuals have anxiety about aging that can lead to negative stereotypes of older individuals called ageism.[7]
Ageism among nurses and other health care professionals puts older people at risk. Research has demonstrated that ageism in health care negatively impacts older adults’ overall health, well-being, and quality of care received. Ageism results in increased risks of mortality, poor functional health, and slower recovery times from illness. Negative perceptions about aging can also lead to poor mental health and depression.[8] As you read this chapter, think about your own attitudes about aging and how these beliefs may impact the care you provide.
Integrity Versus Despair
Aging individuals must continually adjust to changes in health and physical strength, lifestyle changes as a result of retirement, the loss of significant others, and changing roles and relationships with family members and friends. As a result, older individuals may find it difficult to accept the changes associated with aging. Nurses can support older adults in maintaining a positive self-image and outlook by considering Erikson’s theory of development. Erikson’s theory of development describes the stage of older adulthood as “Integrity versus Despair.” This stage begins at approximately age 65 and ends at death. During this stage, older adults reflect on their accomplishments and the person they have become. If they feel they have led a successful life, they often feel satisfied and develop a sense of integrity. Conversely, individuals who feel unsuccessful or do not feel they achieved their life goals often feel unsatisfied and may experience hopelessness and despair that can lead to depression. Nurses can assist older adults in developing a sense of integrity by encouraging the patient to reminiscence about previous positive life events and relationships and cultivate a positive mindset of guiding the next generation.[9]
Many older adults, especially those with declining health due to chronic disease, acknowledge that changes in their health status and mobility threaten the autonomy and independence they previously experienced throughout adulthood. As a result, many older adults strive to be autonomous so they are not overly reliant on others for their daily care. They often engage in self-management activities in response to changes in their health and physical strength, ranging from simple daily tasks, such as medication management, to more complex tasks, such as relocating to new residences that are better suited to their changes in physical and mental health. Research has found that when older adults are faced with declines in their physical health and/or cognitive abilities, they often draw upon experiences and skills acquired in earlier adulthood for the purpose of self-managing their new conditions. They reflect on their resilience used to overcome significant challenges faced in earlier adulthood and then apply skills and knowledge gained through previously productive activities to managing their new health changes. However, not all older adults have sufficient personal and external resources to devote towards successful self-management of their health conditions. Nurses can assist older adults by personalizing health self-management strategies that emphasize their existing skill sets and knowledge.[10]
Other Considerations
Retirement
In addition to the physiological changes that occur with aging, older adults vary in their level of activity. For example, many older adults continue working into their seventies and beyond. Individuals may choose to continue to work because of their sense of purpose or because of a need for income. Some older individuals experience a loss of identity when they retire because their work role was an important aspect of their life. Retirement can bring a sense of freedom and adventure, as well as a need to find new identity and purpose.
Social Isolation
Retirement and the loss of daily interaction with coworkers, as well as death of family members and friends, can lead to social isolation in the aging population. Social support impacts a person’s health and quality of life and should be included as part of the assessment. It is helpful for nurses to be familiar with community resources that provide socialization opportunities and provide referrals for patients in need of additional services.
Modified Living Environment
Although many aging adults live in assisted living facilities or skilled nursing centers, many older adults prefer to live at home. Modifications may be needed to the home environment to promote safety and independence. For example, grab bars, elevated toilet seats, and other modifications may be needed in the bathroom, along with good lighting, minimization of clutter, and removal of rugs throughout the home. Assessment of the home environment for safety and ease of mobility is an important aspect of home care nursing.
If an older adult requires more care than family members are able to provide at home, nurses provide valuable information about available care options and make referrals to social workers and case managers. There are a wide variety community-based resources to enhance care for older adults. Local aging and disability resource centers (ADRCs) can help facilitate referrals based on specific needs of the older adult. Examples of other resources include adult day centers, home health agencies that provide personal care and nursing assistance, community-based residential facilities (CBRFs), and residential care apartment complexes (RCACs). If an older adult requires 24-hour nursing care, placement in a nursing home (also referred to as a skilled nursing facility) may be required. Use the following hyperlink to read more information about nursing home resources provided by the Centers for Medicare and Medicaid (CMS).
Learn more about nursing home resources by reviewing the Nursing Home Resource Center provided by the Centers for Medicare and Medicaid (CMS).
Answer Key to Chapter 2 Learning Activities
2. It is important to take action to limit the distractions within the environment when communicating with Mr. Curtis. Upon entry into the room and initial discussion, it would be helpful to identify a few key family members who might contribute to the admission history and excuse the others for a short period of time. Additionally, it is important prior to beginning an interaction that Mr. Curtis consent to discuss admission details in front of the family members who are present. Other factors to consider include limitation to noise distraction within the environment. For example, closing the door to the hallway and turning off the television may be helpful. If Mr. Curtis uses any assistive devices, such as hearing aids or eye glasses, these should also be encouraged. Finally, it is important that the nurse consider strategies to enhance communication. Sitting across from Mr. Curtis, making eye contact, and creating an open, approachable, nonhurried demeanor can help to facilitate the information exchange.
Answers to interactive elements are given within the interactive element.
Answer Key to Chapter 2 Learning Activities
2. It is important to take action to limit the distractions within the environment when communicating with Mr. Curtis. Upon entry into the room and initial discussion, it would be helpful to identify a few key family members who might contribute to the admission history and excuse the others for a short period of time. Additionally, it is important prior to beginning an interaction that Mr. Curtis consent to discuss admission details in front of the family members who are present. Other factors to consider include limitation to noise distraction within the environment. For example, closing the door to the hallway and turning off the television may be helpful. If Mr. Curtis uses any assistive devices, such as hearing aids or eye glasses, these should also be encouraged. Finally, it is important that the nurse consider strategies to enhance communication. Sitting across from Mr. Curtis, making eye contact, and creating an open, approachable, nonhurried demeanor can help to facilitate the information exchange.
Answers to interactive elements are given within the interactive element.
Learning Activities
(Answers to “Learning Activities” can be found in the “Answer Key” at the end of the book. Answers to interactive activity elements will be provided within the element as immediate feedback.)
1. Mr. Yang is an 87-year-old patient admitted to the medical surgical floor due to a recent fall at home. His wife reports that the patient has become increasingly frail and unsteady. Utilizing the SPICES tool, develop a list of assessment questions for Mr. Yang to determine potential problems and subsequent interventions.
Ageism: Negative stereotypes of older individuals.
Gerontology: The study of the social, cultural, psychological, cognitive, and biological aspects of aging.
SPICES tool: Focuses on areas of common problems for aging individuals and can lead to early intervention and treatment.
Ageism: Negative stereotypes of older individuals.
Gerontology: The study of the social, cultural, psychological, cognitive, and biological aspects of aging.
SPICES tool: Focuses on areas of common problems for aging individuals and can lead to early intervention and treatment.
Answer Key to Chapter 1 Learning Activities
- When given instruction to titrate medications independently, the nursing student should recognize that this is outside of their scope of practice and training. The nursing student should inform the nurse that within the student role, they are not able to complete this action because it is outside of their practice scope. The nursing student should also report this instruction promptly to their instructor so that appropriate follow-up can be taken regarding re-education and review of the principles of safe delegation.
- It is important to acknowledge that the conversation that is occurring in the breakroom is a violation of HIPAA. If a staff member is not involved in patient care, disclosure of patient care information is a violation of patient privacy and confidential health information. It is important to voice one's concern regarding the disclosure of private health information and remind all staff of the importance of adherence to HIPAA requirements within a health care setting.
Answers to interactive elements are given within the interactive element.
Answer Key to Chapter 3 Learning Activities
2. It is important to demonstrate professional respect for a patient's cultural beliefs, background, and practices when providing care. You can ensure appropriate actions are taken by introducing yourself with name and role, asking preference on how the individual would like to be addressed, attending to personal space of the patient, following patient and family lead for eye contact behaviors, using inclusive language, etc. It is important to note the patient's language of preference and enact interpreter services if a communication barrier is noted. Additionally, it is important to be honest regarding individual level of understanding about one's cultural beliefs. Ask polite questions and seek clarification to avoid misunderstanding.
Answers to interactive elements are given within the interactive element.
Answer Key to Chapter 1 Learning Activities
- When given instruction to titrate medications independently, the nursing student should recognize that this is outside of their scope of practice and training. The nursing student should inform the nurse that within the student role, they are not able to complete this action because it is outside of their practice scope. The nursing student should also report this instruction promptly to their instructor so that appropriate follow-up can be taken regarding re-education and review of the principles of safe delegation.
- It is important to acknowledge that the conversation that is occurring in the breakroom is a violation of HIPAA. If a staff member is not involved in patient care, disclosure of patient care information is a violation of patient privacy and confidential health information. It is important to voice one's concern regarding the disclosure of private health information and remind all staff of the importance of adherence to HIPAA requirements within a health care setting.
Answers to interactive elements are given within the interactive element.
Answer Key to Chapter 3 Learning Activities
2. It is important to demonstrate professional respect for a patient's cultural beliefs, background, and practices when providing care. You can ensure appropriate actions are taken by introducing yourself with name and role, asking preference on how the individual would like to be addressed, attending to personal space of the patient, following patient and family lead for eye contact behaviors, using inclusive language, etc. It is important to note the patient's language of preference and enact interpreter services if a communication barrier is noted. Additionally, it is important to be honest regarding individual level of understanding about one's cultural beliefs. Ask polite questions and seek clarification to avoid misunderstanding.
Answers to interactive elements are given within the interactive element.
