NUR 2214 / NUR2214 Nursing Care of the Older Adult Quiz 4 Questions and Answers Already Graded A

Age-related changes in skin structure and function: ● Loss of thickness, elasticity, vascularity, and strength that may delay the healing process and increase the risk of skin tears and bruising ● Increased lentigines (brown-pigmented spots, or age spots) ● Loss of subcutaneous tissue causing wrinkling and sagging of the skin, which may affect self-esteem, temperature control, and drug efficacy ● Loss of hair follicles along with thinning and graying ● Increased hair density in the nose and the ears, particularly in men, which may clog external ear canals and impair hearing ● Thicker nails with longitudinal lines ● Decreased 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 first 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 ultraviolet (UV) rays and other external environmental hazards, and (3) protecting underlying organs from 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 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 barrier 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 decreases 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 diminished thermoregulatory function and inflammatory responses, decreased tactile sensation, reduced pain perception, and development of wrinkles and sagging skin because of loss of underlying tissue. Collagen, a fibrous protein that provides tensile strength within the dermis, stiffens and becomes less soluble. Aging results in a decreased amount of subcutaneous tissue and a redistribution of fat to the abdomen and 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 is greater. The loss of this protective padding increases vulnerability 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 and 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 compromised 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 skin, which places them at a greater risk of infection because of an impaired immune response. Hair 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 pseudoscars. The skin appears nearly translucent. It occurs on sun-exposed areas of the extremities. Individuals with dermatoporosis frequently experience skin lacerations associated with increased bleeding 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 dome-shaped papules.