A head-to-toe skin assessment includes inspection and palpation of the skin. The nurse must perform a thorough skin history, examination, and document findings. It is vital for nurses to know the basic principle of skin disease and care when caring for patients. A detailed skin assessment and documentation can help the health team in generating the plan of care, and in maintaining patient’s skin integrity.
I would document T.M.’s lesion correctly to prevent progression and cure the disease. In this case, I would ask T.M about his bathing routine and the skin products she uses. I would document the soap and facial skin care that she uses. “Lesions are traumatic or pathologic changes in previously normal structures” (Jarvis, 2012, p. 216).
A head-to-toe skin assessment
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The nurse must perform a thorough skin history, examination, and document findings. It is vital for nurses to know the basic principle of skin disease and care when caring for patients. A detailed skin assessment and documentation can help the health team in generating the plan of care, and in maintaining patient’s skin integrity.
I would document T.M.’s lesion correctly to prevent progression and cure the disease. In this case, I would ask T.M about his bathing routine and the skin products she uses. I would document the soap and facial skin care that she uses. “Lesions are traumatic or pathologic changes in previously normal structures” (Jarvis, 2012, p. 216). I would describe and document the size, description, and location of the lesion. I ensure to include the number of lesions, the color and pigmentation, surface features, and distribution of
Barone, Eugene J., Judson C. Jones, and Joann E. Schaefer. "Hidradenitis Suppurativa." Skin Disorders. Philadelphia: Lippincott Williams & Wilkins, 2000. 21-25. Print.
“Ask the client to list the changes, losses, or limitations that have resulted from the medical condition” (Jongsma, A. E., Jr., Peterson, L. M., & Bruce, T. J., 2014, p. 260). For instance, I will identify the limitations that Mary has because of her ovarian cancer.
With noticeable increase in chronic diseases, trauma, and increasing number of aging population, nurses are required to be in the position of providing pressure ulcer care and prevention. Immobility, advanced age, incontinence, prolonged pressure or friction, inadequate nutrition, dehydration, anemia, hypoxemia, multiple comorbidities, sensory deficiency, thin skin, prominent bony prominences, circulatory abnormalities, pain, and smoking are important risk factors. The barriers in the implementation of preventive measures are staff shortage, shortage of pressure relieving devices (e.g., foam or air mattresses), excessive workload, and uncooperative patients. The Centers for Medicare and Medicaid Services has classified the pressure ulcers as a preventable Hospital Acquired Conditions and stopped reimbursing for such hospital acquired conditions. In the United States, the cost of an individual patient care per pressure ulcer includes skin cleanser, moisturizer, dressings, wound debridgement, antibiotics, analgesics, turning sheet and support surfaces, nursing time for risk assessment, monitoring, and repositioning. It is the second most common claim after wrongful death and greater than falls or emotional distress. No matter what causes the pressure ulcers, the presence or absence of pressure ulcers is generally regarded as a performance measure of quality nursing care and overall patient health. Pressure ulcers can be avoided by applying simple interventions like factor assessment scales and regular turning of the patient. Proper hydration, a balanced diet, activity, wound care, and keeping patient’s skin and body dry are treatment, as well as, preventive measures of this problem. A thorough physical assessment, risk assessment (using a risk assessment tool like Barden scale), repositioning, patient and caretaker education, effective communication, and
Utilizing this tool will allow The Restorative Nurse and Wound Nurse to generate a graph based off of the data retrieved from the Center of Medicare and Medicaid Services (CMS) quarterly Quality Measures Report (APPENDIX B). The Wound Nurse and Restorative Nurse will start with the last data reported before the start of the On-Time Project and then graph the data every three months during the On-Time Project for the following areas: falls, weight loss, in- house acquired pressure injuries and nosocomial infection. For that purpose, to monitor the effectiveness of the On- Time Project the Wound Nurse and Restorative Nurse will provide a designated share drive to present to the Director of Nursing and other stakeholders on a quarterly schedule at the quarterly Quality Assurance Improvement Program(QAIP)
The first known use of dermatology was established in 1819 and only in the 1930’s did its practice become more widely accomplished, known and sought after. (“Dermatology” 2014) Since then it has extensively evolved and changed and been able to provide services for women and men around the world. Originally being a part of the medicine field can now be considered a division of the beauty industry due to availability of services and treatments for aesthetic, pampering purposes, rather than just originally founded for medical issues of resolving skin disorders and diseases. Dermatology being defined as ‘a branch of medicine dealing with the skin, its structure, functions and diseases’ (“Dermatology” 2014) now offers many professions one being a dermatologist, whic...
As this case study is evaluated we look at who is involved. This case involves a 44 year old patient this is the plaintiff in this case. The issue began when the patient noticed bumps on his wrist; one may think that this
As an ICU nurse I constantly watch how patients develop pressure ulcers, a pressure ulcer is an area of skin that breaks down due to having constant friction and pressure, also from having limited movement and being in the same position over a prolonged period of time. Pressure Ulcers commonly occur in the buttocks, elbows, knees, back, shoulders, hips, heels, back of head, ankles and any other area with bony prominences. According to Cox, J. (2011) “Pressure ulcers are one of the most underrated conditions in critically ill patients. Despite the introduction of clinical practice guidelines and advances in medical technology, the prevalence of pressure ulcers in hospitalized patients continues to escalate” (p. 364). Patients with critical conditions have many factors that affect their mobility and therefore predispose them to developing pressure ulcers. This issue is significant to the nursing practice because nurses are the main care givers of these patients and are the ones responsible for the prevention of pressure ulcers in patients. Nurses should be aware of the tools and resources available and know the different techniques in providing care for the prevention of such. The purpose of this paper is to identify possible research questions that relate to the development of pressure ulcers in ICU patients and in the end generate a research question using the PICO model. “The PICO framework and its variations were developed to answer health related questions” (Davies, K., 2011).
Voegeli D; British Journal of Nursing (BJN), 2010 Jul 8; 19 (13): 810, 812, 814 Care or harm: exploring essential components in skin care regimens.
Assessment of a patient’s health status is the collection of data through nursing assessment techniques,
A visit to the doctor is never an exciting moment for any child. The thought of syringes with sharp needles, the sight of blood being drawn, and unknown machines creates anxiety. As I waited to see my pediatrician all of these thoughts came to mind, terrified of what she could possibly do to me. I was next to see her, with every step my palms drenched in sweat and my heart raced faster. Expecting the worse, I wondered what she would say about the rash on my back or what she would do about it. When she took a look, she quickly made a diagnosis of pityriasis rosea. Unfamiliar with this skin disorder, I began to think the worst; maybe I caught it from someone or that, it might never go away and I worried it was contagious. My doctor assured me
...d and will be published in JSciMed Central, one of the International peer reviewed dermatologic journals.
... in caring for the patient. While bed-bathing my patient I used my interpersonal, listening and communication skills. These helped me when I was talking and giving instructions to my patient. I discovered how important communication is in nursing between the nurse and the patient in order to understand each other fo example asking a patient for consent. Moreover, it is during bed-bathing that the nurse and patient can form a therapeutic relationship leading the patient to trust the nurse. During bed-bathing my patient I also checked to see the skin for example bruises and pressure sores. Since communication and listening skills are vital in nursing, I will, therefore, need to improve my skills so I can be a better nurse in the future. Moreover, next time I should not let my feelings get in the way when approaching a similar or same situation like this in the future.
The theory explains that assessment takes place during interaction. The nurse uses his or her special knowledge and skills while the patient delivers knowledge of him or her self, as well as the perception of problems of concern to the interaction. During this phase, the nurse gathers data about the patient including his or her growth and development, the perception of self, and current health status. Perception is the base for the collection and interpretation of data. Communication is required to verify the accuracy of the perception, as well as for interaction and translation.
Patient’s personal hygiene is a vital part of the nurse’s role. Young (1991) described cleanliness as a basic human right, not a luxury the need for the patient to physically cleansing and which would include skin, hair and nails.
Documentation is a form of communication that provides information about the patient and confirms that care was provided to that patient. Some reasons why nurses document is for communication and continuity of care of the patient and by that it means clear, complete and accurate documentation in a health record ensures that all those involved in a client’s care, including the client, have access to information upon which to plan and evaluate their interventions. Next, quality improvement/assurance and risk management through chart audits and performance reviews documentation is used to evaluate quality of services and appropriateness of care. Additional reason is it establishes professional accountability because documenting that is showing a valuable method of demonstrating that nursing knowledge, judgment and skills have been applied within a nurse-client relationship in accordance with the Standards of Practice for Registered Nurses. Another purpose is for legal reasons the client’s record is a legal document and can be used as evidence in a court of law or in a professional conduct proceeding. Courts may use the health record to reconstruct events, establish time and dates, and refresh one’s memory and to substantiate and/or resolve conflicts in testimony. Although you may never be named as a defendant in legal case, you may be called to testify at a discovery or