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The largest human

The skin is the largest human organ as a result its functions are numerous and critical. The basic functions of the skin include: 1. The skin functions as the initial barrier from external infections preventing dangerous disease causing micro-organisms from getting into the body. The skin contains specialized cells called Langerhans that engulf foreign invaders. Consequently, keratin layer and sebum provide waterproof ability. Melanocytes protect the skin from ultraviolet light 2. The skin functions as a sense organ; with receptors that send signals on the environment regarding changes in: heat, cold, pain and other sensations.

3. The skin regulates body temperature when surrounding conditions get to the extreme e. g. increased temperature during exercise sweat is produced which evaporates to reduce body temperature. 4. The skin functions as an excretory organ excreting water and excess salt in the process of sweating. 5. Vitamin D required in bone development is synthesized in the skin in the presence of sunlight required for the absorption of calcium phosphate. 6. The skin synthesizes pigments in the process called pigmentogenesis for example the synthesis of sebum.

1(b) CHANGES IN SKIN AT OLD-AGE As old age approaches the skin functions decrease by 50-60% due to structural changes. Notable are reduced: vascular network, keratinocytes, fibroblasts, barrier function, vitamin D synthesis and density of Langerhans. The thicknesses of the skin layers comprising the skin also tend to reduce giving the skin pale and translucent appearance. This is also contributed with the reduction in the number of pigment containing cells termed as malanocytes; this increases the risk to injury and ability to maintain body temperature is reduced.

In sun-exposed areas the skin elasticity and strength diminishes, this condition is termed elastosis which is caused changes in the connective tissue in the skin. Increase in fragility of blood vessels of the dermis leads to bruising and bleeding under the skin. There reduction of secretions of oil from the subcutaneous gland especially in females who experience an early onset age stating menopause. Skin dryness increases leading to itchiness due to lack of skin moisture. The ability to keep cool is lowered as the sweat glands ability to produce sweat is reduced; this exposes one to the risk of being overheated or developing heatstroke.

2(a) CLASSIFICATION OF SKIN TEARS Category I Includes skin tears which don’t involve loss of tissue this category of skin tears is further classified into: a. Linear type; where the epidermis and the dermis of the skin are pulled in one layer away from the supporting structures of the skin. b. Type where epidermis and the dermis of the skin are separated, however, the dermis is covered by the epidermal flap within a 1mm wound margin Category II This category is sub-divided into two: a. Characterized by wounds with little loss of tissue and up 25% of tissue can be lost

b. The second type is characterized by wounds with moderate to large loss of tissue (more than 25%) of the tissue flap is lost during trauma Category III This skin tear involves complete loss of tissue. The major causes of these conditions include initial trauma and necrotisation of the skin flap. (b) Mrs. Iris White is already aged 83, therefore one of the obvious factors that put her at risk of getting skin tears is the reduction of the thicknesses of the layers comprising the skin this make her prone to even minor bruises on the skin. i.

Since she is unable to cope at her home she might have been exposed to excessive sunshine leading to breakdown of collagen and elastic fibers located on the depth of the skin making her skin fragile. ii. Mrs. White is prone to frequent falls as she moves from one place to another in her living place, puts her great risk of obtaining tears associated with falling. iii. Care activities including bathing, positioning, and transferring her from inside to outside pose a danger of contracting a tear because her already fragile skin is stressed during these processes.

3(a). PREVENTION STRATEGIES To protect thin skin and consequently protect tears and cuts various preventive strategies can be undertaken. Baranosky S (2000). Skin tears, outlines the following strategies: 1. Routine position changes; the principle of this strategy is to prevent mounting pressure on the skin which is less elastic due to reduction in the production of collagen a condition that can make her contact a tear. 2. Wear long-sleeved shirts and long pants; this will reduce direct exposure to radiation from direct sunlight.

Since her skin is already deficient of important pigments e. g. collagen, keratinocytes and fibroblasts minimizing exposure to radiation would reduce the danger of skin tears Mrs. White should take a balanced diet; the biochemical principal is, at her age she has vitamin B9 deficiency that promotes a healthy skin. Therefore foods e. g. liver, asparagus, leafy green vegetables which are rich in foliate and foods rich in omega oils such as fish promote a health skin are encouraged. 3.

Regular skin care, that is, take a warm bath, and gently dry clean her skin, use quality moisturizing cream such as cetapil to keep her skin moisturized. This will reduce friction when her skin comes into contact with an object. However, she not to use bath oils which can cause her to slip and fall. In addition the moisturizing creams should not be heavily perfumed. 4. Skin cracks can be caused by indoor heating thus she should avoid as much as she can. A possible solution is to take warm weather vacations. 3 (b).

Barbara Brillhart, , in the journal preventive skin care for older adults analyses the causes of skin tears among the old in the industrialized countries like Canada, Australia, and the united states where the life expectancy is approximately 80 years. The journal outlines skin changes that occur during progression to adult age and primary prevention strategies to prevent skin tears. In the study, it is estimated that healthcare costs on skin tears hit five billion dollar for an estimated 1. 5 billion patients. The trends are similar in other counties including Canada and the United Kingdom.

The study illustrates the widespread risk of skin related tears among the old and the need for increased home care. Further it’s outlined that skin tears can occur allover the body. However, tears that occur at the hand and arm account 80% of all the tears that occur during old age. Causes of skin tears include bumping with object, especially with the sight impaired; whish is the highest cause with other causes for example falls constituting minimal chance. Management strategies include taking a balanced diet, regular skin care, limiting of alcohol with regard to alcoholics and stress management exercises.

The various changes to skin, causes of skin tears, and prevention strategies fit in the conditions surrounding Mrs. White. This journal has outlined the strategies applicable to her situation hence helped with regarding answering these questions. REFERENCES 1. Baranosky S. (2000). Skin tears: The enemy of frail skin advances in skin and wound care, 13, 123-126. 2. Brent Hodgkinson, Rhonda Nay BA, MLitt, (2007). A systematic review of topical skin care in aged care facilities. Journal of Clinical Nursing 16 (1), 129–136.

La Trobe University Bundoora 3. Marth D Mezzy. (2001), Encyclopedia on Elder Care. Springer publishing, Newyork. 4. McGough-Csarny J. , Kopac CA, (1998), Ostomy Wound Management. Health Management Publications. Washington. 5. Davies A. , Clein D. (1999). Skin Complications in the Intensive Care Unit. Elsevier. Ontario 6. Baranoski, S. (2003). How to prevent and manage skin tears. Skin Wound Care; 16:268-70. Ontario. 7. Resnick B. (2003). Health promotion practices of older adults: model testing. 20:2-12. Health Management Publications. Washington.

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