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UNIT 4 Supporting Physiological Function
are colonized from the surrounding skin and local skin organisms, the external environment, and inter- nal sources, usually from the mucous membranes of the gastrointestinal system. ■ Critical colonization occurs when the bacteria begin to overwhelm the body’s defenses. You may be able to detect this event by noticing an increase in drainage, a new foul odor, a change in color of the wound bed, new tunneling of the wound, or absent or friable gran- ulation tissue. ■ Infection implies that the microorganisms are causing harm by releasing toxins, invading body tissues, and increasing the metabolic demands of the tissue. Infec- tion of the skin makes it more vulnerable to break- down and impedes the healing of open wounds. If not stopped, bacteria can gain access to the systemic circulation. Lifestyle ■ Sun exposure helps the body to produce vitamin D, a necessary nutrient for health. However, too much exposure to the sun can injure the skin and retina of the eyes. It also increases the risk of skin cancer. The damaging ultraviolet (UV) rays cause drying and pho- toaging (premature aging of the skin). ■ Skin cleansing that is either excessive or insufficient may impair skin integrity. Frequent bathing and use of soap remove skin oils and may lead to drying, which compromises the skin’s barrier function. Infrequent cleansing of the skin contributes to excessive oiliness, clogged sebaceous glands, and inadequate removal of microbes on the skin, which can then infect a wound or lesion. ■ Regular physical activity improves circulation, which is necessary for skin integrity and wound healing. ■ A nutritious diet provides the nutrients needed to maintain skin integrity, as already discussed. ■ Tobacco use compromises the oxygen supply to the tissues, making skin more prone to breakdown and delaying wound healing. It also interferes with vita- min C absorption, which is needed for collagen formation. ■ Body piercings and tattoos present a risk for infection and scarring. The most common complications of tat- tooing are local inflammation (irritation at the site), allergic reaction to the ink, and skin infection (celluli- tis). Unsterile conditions can lead to a systemic infec- tion, such as hepatitis C. Bacterial infections at or near the site of body piercings are most commonly Staphylococcus and Pseudomonas strains . Endocarditis can occur in new piercings (Armstrong et al., 2008). A pierced nipple is more likely to get infected and form an abscess than other types of piercings. Healing time is longer when piercing occurs in the nipple tissue. Nipple piercing can interfere with breastfeeding because scar tissue or nipple jewelry can block the release of milk. Infant
latch-on may be a problem. There is also a risk of swal- lowing or choking on a loose nipple ring. Oral piercings can result in gingivitis, damage to teeth and gums, choking, difficulty eating, and changes in speech. Prolonged bleeding can result with piercing of the tongue if a blood vessel is punctured (Meltzer, 2005). Advise patients to become informed about the procedure and about aftercare and to find reputable piercers. Knowledge Check 32-2 ■ Identify the factors that affect skin integrity. ■ What nutritional components are essential to maintain skin integrity? Think Like a Nurse 32-1: Clinical Judgment in Action ■ Review the case of William Harmon (Meet Your Patient).What risks, if any, does Mr. Harmon have for skin breakdown or delayed healing? ■ What additional information do you need to know to fully evaluate his risk? ■ What risks do you have for impaired skin integrity? What actions can you take to protect your skin? WOUNDS Wounds are a disruption in the normal integrity of the skin. Wounds may be intentional, such as a surgical wound, or unintentional, such as a cut or a pressure injury. Types of Wounds Wounds are classified according to the length of time the wound has existed, as well as the condition of the wound (e.g., contamination, severity). Skin Integrity The simplest wound classification system is based on the integrity of the skin. ■ A closed wound exists when there are no breaks in the skin. Contusions (bruises) or tissue swelling from fractures are common closed wounds. ■ An open wound occurs when there is a break in the skin or mucous membranes. Open wounds include abrasions, lacerations, puncture wounds, and sur- gical incisions. A compound fracture may also lead to an open wound caused by the projection of bone through the skin. Several open and closed wounds are described in Table 32-1. Length of Time for Healing The length of time for wound healing varies according to the skin integrity and the factors affecting it, discussed in the previous section. ■ Acute wounds are expected to be of short duration. In a healthy person, these wounds heal spontaneously with- out complications through the three phases of wound healing (inflammation, proliferation, and maturation).
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