The hypodermis decreases in size with age.Aging causes a diminished inflammatory response, resulting in slow epithelialization and wound healing (Doughty and Sparks-Defriese, 2012).The attachment between the epidermis and dermis becomes flattened in older adults, allowing the skin to be easily torn in response to mechanical trauma (e.g., tape removal).Concomitant medical conditions and polypharmacy, which are common in the older adult, are factors that interfere with wound healing.Age-related changes such as reduced skin elasticity, decreased collagen, and thinning of underlying muscle and tissues cause the older adult’s skin to be easily torn in response to mechanical trauma, especially shearing forces (Wysocki, 2012).Box 48-1 provides a summary of the changes in aging skin. The normal aging process alters skin characteristics and makes skin more vulnerable to damage. When the skin is injured, the epidermis functions to resurface the wound and restore the barrier against invading organisms while the dermis responds to restore the structural integrity (collagen) and the physical properties of the skin. Intact skin protects the patient from chemical and mechanical injury. Understanding skin structure helps you maintain skin integrity and promote wound healing. Fibroblasts, which are responsible for collagen formation, are the only distinctive cell type within the dermis. Collagen (a tough, fibrous protein), blood vessels, and nerves are found in the dermal layer.
It differs from the epidermis in that it contains mostly connective tissue and few skin cells. The dermis, the inner layer of the skin, provides tensile strength, mechanical support, and protection to the underlying muscles, bones, and organs. (From Applegate E: The anatomy and physiology learning system, ed 3, St Louis, 2006, Saunders.) The stratum corneum allows evaporation of water from the skin and permits absorption of certain topical medications.įIG. The thin stratum corneum protects underlying cells and tissues from dehydration and prevents entrance of certain chemical agents. This constant movement ensures replacement of surface cells sloughed during normal desquamation or shedding. After they reach the stratum corneum, they flatten and die. Cells in the basal layer divide, proliferate, and migrate toward the epidermal surface. The cells originate from the innermost epidermal layer, commonly called the basal layer. It consists of flattened, dead, keratinized cells. The stratum corneum is the thin, outermost layer of the epidermis. The epidermis, or the top layer, has several layers. They are separated by a membrane, often referred to as the dermal-epidermal junction.
The skin has two layers: the epidermis and the dermis ( Fig.
Once a wound occurs, it is critical to know the process of normal wound healing to identify the appropriate nursing interventions. A nurse’s most important responsibilities include assessing and monitoring skin integrity identifying problems and planning, implementing, and evaluating interventions to maintain skin integrity. Injury to the skin poses risks to safety and triggers a complex healing response. It is a protective barrier against disease-causing organisms and a sensory organ for pain, temperature, and touch and it synthesizes vitamin D. Skin, the largest organ in the body, constitutes 15% of the total adult body weight ( Wysocki, 2012).