Alterations In Skin Integrity Research Articles

Status and Future Scope of Soft Nanoparticles-Based Hydrogel in Wound Healing.

Wounds are alterations in skin integrity resulting from any type of trauma. The healing process is complex, involving inflammation and reactive oxygen species formation. Therapeutic approaches for the wound healing process are diverse, associating dressings and topical pharmacological agents with antiseptics, anti-inflammatory, and antibacterial actions. Effective treatment must maintain occlusion and moisture in the wound site, suitable capacity for the absorption of exudates, gas exchange, and the release of bioactives, thus stimulating healing. However, conventional treatments have some limitations regarding the technological properties of formulations, such as sensory characteristics, ease of application, residence time, and low active penetration in the skin. Particularly, the available treatments may have low efficacy, unsatisfactory hemostatic performance, prolonged duration, and adverse effects. In this sense, there is significant growth in research focusing on improving the treatment of wounds. Thus, soft nanoparticles-based hydrogels emerge as promising alternatives to accelerate the healing process due to their improved rheological characteristics, increased occlusion and bioadhesiveness, greater skin permeation, controlled drug release, and a more pleasant sensory aspect in comparison to conventional forms. Soft nanoparticles are based on organic material from a natural or synthetic source and include liposomes, micelles, nanoemulsions, and polymeric nanoparticles. This scoping review describes and discusses the main advantages of soft nanoparticle-based hydrogels in the wound healing process. Herein, a state-of-the-art is presented by addressing general aspects of the healing process, current status and limitations of non-encapsulated drug-based hydrogels, and hydrogels formed by different polymers containing soft nanostructures for wound healing. Collectively, the presence of soft nanoparticles improved the performance of natural and synthetic bioactive compounds in hydrogels employed for wound healing, demonstrating the scientific advances obtained so far.

Evaluating the repetitive mucus extraction effects on mucus biomarkers, mucous cells, and the skin-barrier status in a marine fish model

Among all the mucosal barriers, the skin and its surrounding mucus are possibly the main defensive tool against changes in the environment that can be harmful for fish. Due to the extraction of this mucus being less invasive, the study of its production and functions has attracted great interest in recent years. However, there are still many gaps concerning the sampling process as well as the possible alterations in skin integrity and mucus composition. In the current study, the effects of skin mucus extraction were determined by comparing the effects of a single extraction (single extraction group, SEG) with those of three successive extractions separated by 3 days (repetitive extractions group, REG). Intact skin histology without mucus extraction (ØEG) and both plasma and skin mucus biomarkers and antibacterial capacities were also assessed. Regarding the skin histology and skin barrier properties, both the SEG and REG did not show differences in the intact skin. Interestingly, repetitive mucus extractions seemed to activate skin mucus turnover, significantly increasing the number of small-sized mucous cells (cell area< 100 µm2) and reducing the number of large-sized mucous cells (cell area > 150 µm2). Repetitive extractions significantly decreased the amounts of soluble protein and increased cortisol secretion. These metabolites remained unaltered in the plasma, indicating different responses in the plasma and mucus. Despite changes in the mucus biomarkers, antibacterial capacity against pathogenic bacteria (Pseudomonas anguilliseptica and Vibrio anguillarum) was maintained in both the plasma and mucus irrespective of the number of mucus extractions. Overall, the mucus sampling protocol had little effect on skin integrity and mucus antibacterial properties, only modifying the amounts of soluble protein exuded and stimulating mucous cell replacement. This protocol is a feasible and minimally invasive way of studying and monitoring fish health and welfare and can be used as an alternative or a complement to plasma analysis. This methodology can be transferred to farm culture conditions and be very useful for studying threatened species in order to preserve fish welfare.

Evidence-based review and discussion points.

Evidence-Based Review| November 01 2015 Evidence-Based Review and Discussion Points Ronald L. Hickman, RN, PhD, ACNP-BC Ronald L. Hickman, RN, PhD, ACNP-BC Ronald L. Hickman is an assistant professor, Case Western Reserve University, and an acute care nurse practitioner at University Hospitals Case Medical Center, Cleveland, Ohio. Search for other works by this author on: This Site PubMed Google Scholar Am J Crit Care (2015) 24 (6): 512–513. https://doi.org/10.4037/ajcc2015849 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Share Icon Share Twitter LinkedIn Tools Icon Tools Cite Icon Cite Get Permissions Citation Ronald L. Hickman; Evidence-Based Review and Discussion Points. Am J Crit Care 1 November 2015; 24 (6): 512–513. doi: https://doi.org/10.4037/ajcc2015849 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search nav search search input Search input auto suggest search filter All ContentAmerican Journal of Critical Care Search Advanced Search Critically ill patients are at risk for alterations in skin integrity and pressure ulcer formation. The administration of vasopressors, used to increase arterial blood pressure, is a life-sustaining therapy that can influence the incidence of pressure ulcer formation among critically ill patients. Vasopressors are pharmacologic agents (eg, neosynephrine, norepinephrine, and vasopressin) that constrict arterial blood vessels, thus predisposing the critically ill recipient to tissue ischemia and a heightened risk for pressure ulcer development. Despite the emerging research that links vasopressor administration and pressure ulcer development, prior research has not examined the influence that the type of vasopressor agent, its dose, and duration of administration has on the occurrence of pressure ulcer formation among critically ill patients. To examine the association between vasopressor administration (eg, type of agent, dose, and duration) and pressure ulcer development, the authors conducted a retrospective, descriptive study. They identified... ©2015 American Association of Critical-Care Nurses2015 You do not currently have access to this content.

Primary Cutaneous Aspergillosis in Two Pediatric Trauma Patients

To the Editors: A spergillosis is the most common mold infection in immune compromised patients,1 and can be nosocomially acquired. We report 2 cases of primary cutaneous aspergillosis (PCA) in previously healthy pediatric patients with multiple traumatic injuries after motor vehicle accidents. CASE 1 A previously healthy 6-year-old boy with a history of prematurity and mild intermittent asthma was admitted to the pediatric intensive care unit after he suffered pulmonary contusions and a mediastinal hematoma in a motor vehicle accident. He developed acute respiratory distress syndrome requiring venoarterial extracorporeal membranous oxygenation. He received systemic corticosteroids for his lung injury and vancomycin for Staphylococcus aureus bacteremia. He developed erythematous bullous lesions on his left proximal forearm, which underwent necrosis with central ulceration (see Fig. 1). Tissue culture grew Aspergillus fumigatus and he was treated with intravenous voriconazole for 21 days, followed by 10 days of oral therapy.FIGURE 1: Bullous lesion of the left forearm after undergoing necrosis and ulceration.CASE 2 A previously healthy 2-year-old girl suffered pulmonary contusions and thoracic spondylolisthesis in a motor vehicle accident. She developed acute respiratory distress syndrome requiring high-frequency oscillatory ventilation and completed a 2-week course of methylprednisolone. Sputum cultures grew Acinetobacter baumanii and Moraxella catarrhalis for which she was treated with vancomycin and cefotaxime. She developed multiple indurated erythematous papules with central eschar on her extremities. Wound culture grew A. fumigatus. She completed a 6-week course of voriconazole, with resolution of the lesions. DISCUSSION PCA is typically associated with alterations in skin integrity and immune compromise. The morphology of lesions varies. It may first manifest as erythema and induration, but can progress to papules, nodules, macules, plaques, pustules, vesicles, bullae or ulcers.1 Diagnosis is typically made by skin biopsy for histopathology and culture. Amphotericin B has historically been first-line therapy; however, voriconazole has been shown to be superior in adults, has a good safety profile in children and offers oral administration.2 Our patients were previously healthy, without underlying immune suppression, but other factors likely caused transient alteration in their defenses. They suffered multiple traumatic injuries, and may have had unrecognized alterations in skin integrity. Trauma is known to alter cellular and humoral immunity, with an initial proinflammatory response to the injury characterized by activation of nuclear factor-κB with resultant increases in acute phase reactants such as cytokines, specifically interleukin (IL)-1b, IL-6, IL-8 and tumor necrosis factor-α. After this proinflammatory state, a compensatory antiinflammatory response syndrome or immune paralysis can occur. Patients develop impaired monocyte function with decreased expression of human leukocyte antigen DR and decreased production of tumor necrosis factor-α, resulting in predominance of the Th2 lymphocyte pattern.3 Posttraumatic impairment of monocyte activity has been shown to correlate with severity of injury, and is predictive of the development of systemic inflammatory response syndrome.4 Corticosteroids have been associated with PCA, with impairment of glycemic control, phagocytic function and strength of the skin barrier.5 Broad spectrum antibiotics can also increase susceptibility to fungal infections in immune compromised patients. Emily B. Martin, MD Department of Pediatrics Division of Critical Care Ochsner Medical Center Jefferson, LA Paul A. Gastañaduy, MD, MPH Department of Pediatrics Division of Pediatric Infectious Diseases Emory University School of Medicine Andres F. Camacho-Gonzalez, MD Allison C. Ross, MD Department of Pediatrics Division of Pediatric Infectious Diseases Emory University School of Medicine Children’s Healthcare of Atlanta at Egleston Kiran Hebbar, MD Department of Pediatrics Division of Pediatric Care Emory University School of Medicine Children’s Healthcare of Atlanta at Egleston Atlanta, GA

Urinary Incontinence Nursing Considerations at the End of Life

Urinary incontinence occurs at the end of life either as a consequence of treatment(s) for a urologic health condition or as the result of disease progression. End-of-life urinary incontinence conditions include bladder abnormalities (urge, emptying, hesitancy), infection, and/or the need for diversional methods. Alterations in skin integrity may be the result of previous treatment(s) to the urinary system and lower abdomen, or from urinary incontinence. Treated urinary incontinence at the end of life provides dignity and will maintain quality of life. This article describes the urinary care needs and options for individuals receiving end-of-life care.

Establishing a Preoperative Skin Assessment Practice

Patients undergoing surgery are typically not screened for alteration in skin integrity until they are in the operating room. These patients have a lengthy perioperative phase which puts them at an increased risk for altered skin integrity. CMS and other Third Party payors will no longer be reimbursing for care for hospital-acquired pressure ulcers. The Institute for Healthcare Improvement and the National Quality Forum recommend performing an admission skin assessment.

The Role of Interventional Patient Hygiene in Improving Clinical and Economic Outcomes

To successfully educate, integrate, and empower nonlicensed personnel in the surgical intensive care unit in the use of a skin care protocol to maintain and improve skin integrity. Observational intervention study. Surgical intensive care unit. Data related to alterations in skin integrity were collected over 4 months, representing approximately 2000 patient-days. A total of 97 specific events representing 121 "areas of concern" were identified by nonlicensed personnel. Nonlicensed staff members' knowledge in 6 key areas related to pressure ulcer (PrU) development was surveyed before and after implementation of an interventional patient hygiene (IPH) program incorporating comprehensive bathing and incontinence protocols. A unique point-of-use skin inspection tool was used by nonlicensed personnel to communicate areas of concern to licensed personnel (registered nurses [RNs]). Reduction in PrUs and improvement in nonlicensed staff knowledge of facility protocols. Incidence of new PrUs decreased from 7.14% at baseline to 0% at the end of the study. Nonlicensed staff knowledge increased to 100% in all 6 knowledge areas. Implementation of an IPH program incorporating comprehensive bathing and incontinence management resulted in enhanced communication between nonlicensed staff and RNs as well as improved patient outcomes.

Skin Integrity in Hospitalized Infants and Children: A Prevalence Survey

The purpose of this paper was to describe the spectrum of alterations in skin integrity and skin care needs of hospitalized infants and children. A 1-day skin prevalence audit was conducted in the spring of 2005 in a tertiary care university-affiliated children's hospital. Patient skin was assessed for any alterations. The Braden Q Scale was used to assess patient risk for pressure ulcer development. Alterations in skin integrity included diaper dermatitis, pressure ulcers, intravenous infiltrations, device-related injuries, and epidermal injuries. Many patients required additional skin care, including wound/incision care, ostomy care, and care related to invasive devices. Alterations in skin integrity represent a serious problem in the pediatric inpatient setting. The data presented identify skin integrity challenges in the hospitalized patient and can help guide staff education and resource allocation, encourage evidenced-based management protocols, and serve as a benchmark for similar pediatric facilities.

A Protocol for the Use of Amorphous Hydrogel to Support Wound Healing in Neonatal Patients: An Adjunct to Nursing Skin Care

The care registered nurses offer makes a critical difference in the quality and cost-effectiveness of patient outcomes. The prevention and treatment of alterations in skin integrity remain primary nurse-sensitive quality indicators. Although wound prevention is a primary goal for nurses, iatrogenic wounds do occur. Neonatal patients are at greater risk for alterations in skin integrity because of the fragile nature of their skin. When skin breakdown occurs, nurses must have knowledge of effective treatment alternatives. The purpose of this article is to describe the use of a collaborative practice protocol to introduce and document patient outcomes with the use of amorphous hydrogel as a treatment modality for iatrogenic neonatal wounds. All hospitals collect data on the quality of patient care, and it has been known for some time that registered nurses can make a critical difference in the quality of patient care and the effectiveness of patient outcomes. The American Nurses Association has identified ten specific quality measures that are impacted by nursing care. Referred to as nurse-sensitive quality indicators, these measures include the maintenance of skin integrity.

Neonatal Skin Care: Clinical Outcomes of the AWHONN/NANN Evidence-Based Clinical Practice Guideline

To test the effectiveness of an evidence-based clinical practice guideline for neonatal skin care on selected clinical outcomes for newborns in neonatal intensive-care units (NICU), special-care units (SCU), and well-baby nurseries. Prospective evaluation of the collaborative neonatal skin care research-based practice project of the Association of Women's Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses. NICU and well-baby units in 51 hospitals located throughout the United States. Member site coordinators (N = 51) and the neonates (N= 2,820) observed during both the pre- and postimplementation phases of the project. Site coordinators received specialized education in neonatal skin care and implemented an evidence-based clinical practice guideline addressing 10 aspects of neonatal skin care. Baseline observations of skin condition, care practices, and environment of newly admitted neonates were collected by site coordinators. Postimplementation observations were then completed. Skin condition was assessed with the Neonatal Skin Condition Score (NSCS), which ranges from a score of three (best condition) to a score of nine (worst condition), based on dryness, erythema, and skin breakdown. Changes in frequency of selected skin care practices were used to assess the effectiveness and feasibility of using the practice guideline in everyday clinical practice. Aspects of the care environment with potential effect on skin integrity were monitored to determine risk factors. Fifty-one site coordinators made 11,468 systematic assessments of 2,464 NICU and SCU newborns and 356 well newborns. Baseline skin scores were better in well newborns compared with premature newborns. After implementation of the guideline, skin condition was improved, as reflected by less visible dryness, redness, and skin breakdown in both the NICU/SCU and well newborns. The guideline was integrated into care, as evidenced by increased use of emollients, particularly with premature infants, and decreased frequency of bathing. A relationship was shown between selected aspects of the environment and alterations in skin integrity. Use of the AWHONN/NANN Neonatal Skin Care Research-Based Clinical Practice Guideline was successfully implemented at 51 sites, and effectiveness was demonstrated by changed care practices and improved skin condition in premature and full-term newborns. The results of this project support a wider dissemination of the project's practice guideline for neonatal skin care.

Neonatal Skin Care: Clinical Outcomes of the AWHONN/NANN Evidence-Based Clinical Practice Guideline

<h3>Objective</h3> To test the effectiveness of an evidence-based clinical practice guideline for neonatal skin care on selected clinical outcomes for newborns in neonatal intensive-care units (NICU), special-care units (SCU), and well-baby nurseries. <h3>Design</h3> Prospective evaluation of the collaborative neonatal skin care research-based practice project of the Association of Women's Health, Obstetric and Neonatal Nurses and the National Association of Neonatal Nurses. <h3>Setting</h3> NICU and well-baby units in 51 hospitals located throughout the United States. <h3>Participants</h3> Member site coordinators (N=51) and the neonates (N=2,820) observed during both the pre-and post implementation phases of the project. <h3>Method</h3> Site coordinators received specialized education in neonatal skin care and implemented an evidence-based clinical practice guideline addressing 10 aspects of neonatal skin care. Baseline observations of skin condition, care practices, and environment of newly admitted neonates were collected by site coordinators. Postimplementation observations were then completed. <h3>Main Outcome Measures</h3> Skin condition was assessed with the Neonatal Skin Condition Score (NSCS), which ranges from a score of three (best condition) to a score of nine (worst condition), based on dryness, erythema, and skin breakdown. Changes in frequency of selected skin care practices were used to assess the effectiveness and feasibility of using the practice guideline in everyday clinical practice. Aspects of the care environment with potential effect on skin integrity were monitored to determine risk factors. <h3>Results</h3> Fifty-one site coordinators made 11,468 systematic assessments of 2,464 NICU and SCU newborns and 356 well newborns. Baseline skin scores were better in well newborns compared with premature newborns. After implementation of the guideline, skin condition was improved, as reflected by less visible dryness, redness, and skin breakdown in both the NICU/SCU and well newborns. The guideline was integrated into care, as evidenced by increased use of emollients, particularly with premature infants, and decreased frequency of bathing. A relationship was shown between selected aspects of the environment and alterations in skin integrity. <h3>Conclusions</h3> Use of the AWHONN/NANN Neonatal Skin Care Research-Based Clinical Practice Guideline was successfully implemented at 51 sites, and effectiveness was demonstrated by changed care practices and improved skin condition in premature and full-term newborns. The results of this project support a wider dissemination of the project's practice guideline for neonatal skin care.

Skin integrity in the pediatric population: preventing and managing pressure ulcers.

To summarize clinical and empirical knowledge about pressure ulcers in infants and children and to describe an approach developed at Children's Hospital, Boston, to prevent and manage pressure ulcers. Acutely ill children with potential or actual alteration in skin integrity due to pressure ulcers. The three-pronged approach for pressure ulcer prevention and management developed by the Skin Care Task Force at the Children's Hospital, Boston, decreases unnecessary variation in practice surrounding the prevention and care of pressure ulcers in acutely ill children. The Skin Care Task Force recommends use of Braden Q for pediatric risk assessment, a skin care algorithm for prevention of pressure ulcers, and a pressure ulcer algorithm for staging and managing pressure ulcers.

A Head-Injured Patient: Caloric Needs, Clinical Progress And Nursing Care Priorities

This case study explored literature on nursing care of the head-injured patient and identified outcomes of a head-injured patient in regard to nutritional status, skin breakdown and infection. Literature review revealed head-injured patients experience a hypermetabolism requiring increased nutritional support. Patient outcomes included mild skin breakdown, infection and a 12% loss in body weight. Inadequate nutrition was the patient's most significant outcome. The patient maintained an average daily intake of 915 calories and averaged a total energy expenditure of 2337 calories, thus, demonstrating an average daily deficit of 1422 calories. Top nursing care priorities noted in the patient's chart were: alteration in cerebral tissue perfusion, potential for injury and alteration in skin integrity. Results indicated more accurate assessment of the patient's needs and inclusion of more applicable nursing diagnoses were required to ensure greater continuity in care.

Clinical indicators of elder neglect

An exploratory factor analysis was conducted to test the construct validity of items to an elder mistreatment assessment instrument that specifically related to neglect. The researchers hypothesized that certain commonly accepted neglect indicators would emerge in a meaningful pattern that could then assist clinicians in their assessment of neglect. Interrelationships among the items suggested that three constructs were measured by the neglect items: (a) nutritional deficits; (b) alterations in skin integrity; and (c) alterations in elimination.

Standards of care. Alteration in skin integrity: the pressure ulcer.

The Journal of Wound, Ostomy and Continence Nursing (JWOCN) is the premier publication for wound, ostomy and continence practice and research. The Journal’s mission is to publish current best evidence and original research to guide the delivery of expert health care. The WOCN Society is a professional nursing society which supports its members by promoting educational, clinical and research opportunities to advance the practice and guide the delivery of expert health care to individuals with wounds, ostomies and continence care needs.