talks about changes in the integumentary and musculoskeletal system with associated diseases and interventions

1. Nursing Interventions for Specific
Problems in Older Person

2. Integumentary System
-primary functions are protection from
environmental stresses, regulation of
temperature, maintenance of fluid and
electrolyte balance, excretion of metabolic
waste and sensory reception.

3. Skin Management: Changes in the Integumentary System
Decreased skin elasticity (sagging of skin) with decreased tensil strength
Men experience hair loss (balding) and both sexes develop gray hair and
wrinkles
Changes in pigmentation with accumulation of discoloration, photoaging is
common
Normal oral temperatures are lower later in the life than in younger years
Skin fold thickness is significantly reduced in the forearm and the back of
the hands
Sensitivity to cold temperature
Dry skin
Loss of subcutaneous tissue
Thinning of dermis
Decrease elastin associated with wrinkling
Vascular lesion
Decreased proliferative potential delays wound healing delays wound
healing and vitamin D production

4. 2 Categories of Aging Changes
Intrinsic factors –related to decrease in
proliferative capacity that leads to cellular
senescence resulting in altered biosynthetic
activity of skin derived cells. (Genetics play role
in this factor)
Extrinsic factor –are environmental with
sunlight being the primary culprit Cumulative
changes related to environmental factors are
referred to as photoaging, which is dependent
on the degree of exposure and skin pigment.

6. mon Skin Disor

8. Pruritus
Nursing Intervention
•Restricting amount/frequency of bathing & soap use
and by applying topical ointments.
• Application of oily emollients & those containing
alpha-hydroxy acids relieve symptoms by improving the
barrier function of the skin.
•Topical lotion that contain menthol and camphor
relieves itching
• Traditional systemic antihistamines may provide
some relief from itching (adverse effect: urinary
retention, impaired psychomotor function and
drowsiness.

9. Xerosis
Nursing Intervention
•Avoid using rough textured bed linens
•Encourage or assist patient to wear loose
fitting clothing
•Apply lubricant to moisten lips and oral
mucosa as needed
•Loosely apply incontinent garments
(if used)
•Refrain from using alkaline soap
in the skin
•Keep bed linens clean, dry and free
from wrinkles

10. Rashes
Nursing Interventions
•Proper hygiene by gently cleansing to
remove the exudates and gentle
drying.
•When rash is related to dry skin,
moisturizing agent is
immediately applied.
•Massage or cool compress
•Antihistaminic drugs
•Topical corticosteroids

11. Inflammato
ry
Conditions

12. Eczema/ Dermatitis
Nursing Interventions
•Avoidance of drying agents such as soap
and water
•Application of moisturizers and topical
immunosuppressant
•Tropical corticosteroids
•Tacrolimus ointment and
Pimecrolimus cream

13. Seborrhic Dermatitis
Nursing Intervention
•Cream or shampoo containing ketoconazole
for initial treatment
• Ciclopirox olamine cream (Tarmed)
•Topical glucocorticosteroids
• In the scalp: Shampoo than contains
yeast suppressants such as ketoconazole,
pyrithione zinc, selenium sulfide, salicylic
acid or tar.

14. Intertrigo
Nursing Intervention
•Keeping affected areas clean and dry and separating
adjacent tissues.
•Folds should be washed with tepid water and dried
thoroughly.
•Soft gauze may be used to separate adjacent surfaces.
•For breast candidiasis, a well fitting cotton brassiere
will help absorb moisture and reduce chafing.
•In perineal candidiasis, an adductor block pillow may
improve circulation to the affected area,
reducing air accumulation.

15. •Appropriate treatment of the rash with antifungal
agents and good hygiene often reduce the
discomfort and anxiety associated with rashes.
•Superficial fungal infections usually are treated first
with topical antifungal.
Topical antifungal agents include:
Polyene antibiotics (nystatin)
Azoles (ketoconazole)
Clotrimazole
Ciclopirox
Olamine
Allylamines

16. Lichen Simplex Chronicus
Nursing Intervention
•Steroid creams and antihistamines
•Bedtime oral antihistamines
•Patients are encouraged to keep their fingernails
short
•Application of a dressing such as DuoDerm may
protect the plaque from scratching.
•Mittens may be needed for confused older adults.

17. •For localized lesions, a tape that is impregnated with
topical steroid can be applied for a maximum
of 24 hours.
•Caution patients not to apply occlusive dressings
over corticosteroids because they greatly
increase absorption of the medication.
•Provide cold pack.
•Oatmeal baths, moisturizers, menthol and
ultraviolet B light
•Excoriated areas may require topical antiseptics

18. Lichen Sclerosis
Nursing Intervention
•Topical anti inflammatory steroids such as
betamethasone valerate 0.1%
•Skin examination at least twice each year

19. Pruritus Ani
Nursing Intervention
•Avoidance of irritating medications
•Use of warm compresses or baths
•Application of mild steroid creams
•Administration of anti pruritic medications

20. Drug Eruptions
Nursing Intervention
•Withdrawal of the drug is the primary
treatment.
•Topical corticosteroids
•Anti pruritic lotions
•Antihistamines

21. Cosmetic Skin Change Treatment
Wrinkles Photoprotection, Tretinoin (Retin A), Dermal
Peel, Face-lift, Botox (Botulinum toxin), Laser
Hair loss Minoxidil (Rogaine), Antiandrogens, Hair
transplantation
Gray Hair Hair coloring
Unwanted facial hair Facial bleaches, Shaving, waxing, electrolysis
Skin tags Scissor incision, electrodesiccation and
curettage
Cherry angiomas Electrodesiccation and curettage, cryosurgery,
shave excision
Seborrheic keratoses Cryosurgery, glycolic acid, alpha-hydroxy acid
Sebaceous hyperplasia Photoprotection, cryosurgery, E and C
Solar lentigines Photoprotection, 3% hydroquinone,
cryosurgery
Telangiectasia Photoprotection, Electrodesiccation/ intense
pulsed light

22. Neoplastic Disorders

23. Seborrheic Keratoses
Nursing Intervention
•Can be removed for microscopic study or for
cosmetic reasons.
•Biopsy, shave or excision may be used to
remove completely the lesions or
specimen for examination.

24. Actinic Keratoses
Nursing Intervention
•Decreased exposure to sunlight
•Topical agents such as fluorouracil, diclofenac
sodium and aminolevilinic acid with blue light
photoactivation after 14 to 18 hours.
•During treatment, patients should avoid direct
sun exposure.
Nonmelanoma Skin Cancer
Nursing Intervention
•Avoid or minimize use of tanning bed.

25. Basal Cell Carcinoma
Nursing intervention
•Removal of the lesion by electrodessication and
curettage, cryosurgery, excision ,
micrographic surgery, radiotherapy
•Imiquimod 5% cream for superficial BCCs
Squamous Cell Carcinoma
Nursing Intervention
•Removal by cautery, curettage, deep cryotherapy,
excision, or radiotherapy.
•For regional metastasis, surgery with adjuvant
radiotherapy is needed.

26. Malignant Melanoma
Nursing Intervention
•Modified ultraviolet exposure
•Avoid sun exposure in prolonged time
•Use sun screens with a sun protections factor (SPF)
of 15 or higher

27. Infectious
Disorders

28. Herpes Zoster
Nursing Intervention
•Antiviral therapy such as acyclovir (Zovirax), famciclovir
and Valacyclovir (Valtrex)
•Controlled opioid analgesics
•Compresses of hypertonic solutions such as Burow’s
and gentle washing with antibacterial soaps
•Topical antibiotic such as mupirocin ointment (2-3 times
daily)
•Systemic corticosteroids/ oral corticosteroids
•Topical treatments/ creams such as capsaicin cream and
topical anesthetics
•Acupuncture, nerve blocks, transcutaneous electrical
nerve stimulation, and deep brain stimulation

29. Psoriasis
Nursing Intervention
•Topical medications such as corticosteroids, tazarotene,
anthralin, tars, dithranol, vitamin D derivatives
(calcipotriene)
•Keratolytic agents such salicylic acid with topical
steroids
•Ultraviolet B light exposure enhances absorption of
topical therapy with tar and anthralin
•Photochemotherapy with UVA and systemic agents or
oral methoxsalen for moderate to severe psoriasis
•Systemic drugs include oral retinoids (acitretin),
biological agents (alefacept) and cytotoxic drugs
(methotrexate)

30. Dermal Ulcers

31. Leg Ulcers and Stasis Dermatitis
Nursing Intervention
•Determine the cause of the ulcer
•Peripheral pulses and sensation should be assessed to
rule out arterial disease and neuropathy
•Application of compression to a limb with arterial
insufficiency
•Compression bandages or hosiery when venous
disease is confirmed
•Four layer compression dressing or compression
pump
•Superficial occlusive dressings, topical ointments,
corticosteroids therapy and antibiotics

32. Pressure Ulcers (Decubitus Ulcers)
Nursing Intervention
•Assessment
•Debridement to remove necrotic tissues
•Gentle cleansing with tepid normal saline, povidone
iodine and hypochlorite
•Dressing
>Occlusive dressing
>Semi permeable transparent films sucha as Opsite
>Absorptive gels such as karaya powder
>Noncontact normothermic wound therapy that
involved warming the dressing

33. Over all Nursing Managements for Skin Conditions:
Goal: Preservation or restoration of skin integrity without
complications, relief of discomfort and implementation
of measures to reduce the risk of ulcers.
• Stress good personal grooming and cleanliness
• Avoid friction, irritation or mechanical injury when bathing,
dressing, moving or turning an older patient.
• Baths are not necessary everyday for elder people. The bath
water temperature should not exceed 105F. Avoid soap
and rubbing alcohol because they tend to dry the skin.
• Do not put oily lubricants in the bathtub because they make
the tub surface slippery; instead put lubricants directly
into the skin.
• Include hair and nail care in personal hygiene. Soak the feet to
loosen debris under the nails and makes it easier to cut

34. • Encourage diet high in vitamins and nutrients to help
maintain healthy skin in older adult. Vitamins A
and C and protein
• Teach patient about foods high in nutrients and help
ensure that they are included in the diet.
• Environmental modification also can be made to
promote healthy skin.
• Advise older adult to stay out of the sun and avoid
exposure to wind and cold.
• Provide soft, unwrinkled clothing next to the skin to
minimize skin irritation and pruritus.
• Encourage ambulatory patients to wear supportive
shoes that protects feet from trauma

35. Nursing Care of
Patients with
Musculoskeletal
Alterations

36. Changes in Musculoskeletal of elder
patients
• Decrease bone mass
• Bone shrinkage due to a loss of cartilage and thinning of
vertebrae, causing long bones to appear
disproportionately long
• Decrease tough receptors with corresponding slowing of
reflexes, and pain sensation
• Decreased proliferative potential delays wound healing and
vitamin D production
• Diminished muscle mass
• Decreased height
• Muscle mass is lost
• Muscle mass can decline rapidly without exercise
• Slight hip/knee flexion
• Kyphosis and backward head tilt

37. Nursing Intervention
*When a patient is bedridden, instruct to:
1. Turn from side to side in bed
2. Flex the knees bilaterally and raise the hips
(bridging)
3. Move from supine to a sitting position, with legs
dangling over the side of the bed
4. Assume prone position in bed

38. * To assess mobility, nurse should:
1. Have the patients walk with shoes on. For older
patients with shuffling gait, sway, hold the
arms out for balance, keep the feet wider
apart and watch his or her feet.
2. If safe, ask the patient to walk down stairs
3. Ask the patient to pick up an object from the floor.
The older person may bend the waist rather
than the knees and hold onto furniture for
support. Have the patient rise from a sitting
position to a standing position.
4. If appropriate, ask the patient to rise from a
reclining position to a sitting position.

39. Nursing Goals: Preservation, restoration or
improvement of joint mobility, muscle
strength and skeletal health; maintenance,
restoration or improvement in mobility and
self-care; relief of discomfort related to
musculoskeletal disorders or injuries;
prevention of complications associated with
immobility or musculoskeletal disorders.

40. Other interventions:
•Exercise (active and passive), proper nutrition and
patient education.
•Proper sitting of patients in the wheelchair
•Prevent falls
Types of exercises:
*ROM exercises
*Resistive exercise
*Isometric exercise
*Isotonic exercise
*Isokinetic exercise
*Balance exercise
*Aerobic exercise