Nursing · Adult clinical nursing
Almost every serious failure in this subject begins with not having looked
In the exams: NMC Test of Competence — OSCE: Clinical skills stations (Remaining stations)
Skin complaints account for a very large share of visits to primary care worldwide and skin disease is among the leading causes of years lived with disability — and almost none of it is seen by a dermatologist. Meanwhile pressure damage, leg ulcers, diabetic foot wounds and surgical wounds are assessed, dressed and monitored by nurses, and whether they heal depends more on nursing decisions than on anybody else's. Most pressure injuries are preventable, and their occurrence is used everywhere as a measure of nursing care. Skin also reveals illness elsewhere — jaundice, pallor, a rash that does not fade under pressure, the first sign of a fatal drug reaction. And unlike most disease it is seen by everybody the person meets, which produces staring, assumed contagion and withdrawal that clinicians consistently underestimate.
Skin complaints account for a very large share of visits to primary care worldwide, and skin disease is one of the leading causes of years lived with disability. Almost none of it is seen by a dermatologist; it is seen by generalists.
Pressure damage, leg ulcers, diabetic foot wounds and surgical wounds are assessed, dressed and monitored by nurses, and whether they heal depends more on nursing decisions than on anybody else's. This is one of the clearest examples of nursing owning an outcome.
Most pressure injuries are avoidable, they cause pain, infection and death, they extend hospital stays enormously, and their occurrence is used everywhere as a measure of nursing care quality. Prevention is repositioning, skin inspection and nutrition.
Jaundice, cyanosis, pallor, bruising, a bleeding rash, the changes of liver and kidney disease, and the first sign of a life-threatening drug reaction all appear in skin. Looking at skin is general assessment rather than a specialty interest.
Unlike most disease, skin disease is seen by everybody the person meets, which produces staring, comment, assumed contagion, avoided touch and social withdrawal. The psychological burden of skin conditions is consistently underestimated by clinicians.
Skin keeps water in and organisms out, and almost every skin disease and every wound is a failure of that barrier. Once it is broken, fluid is lost, infection enters, and temperature control is impaired.
A thin outer layer that is the barrier and is constantly renewed, a tougher layer beneath containing blood vessels, nerves, glands and hair roots, and a fatty layer that insulates and cushions. How deep a wound goes determines how it heals.
Sweating cools the body and oil keeps the surface supple and slightly acidic, which discourages organisms. Ageing, some diseases and repeated washing with harsh products remove that protection, and dry cracked skin is then vulnerable.
Skin reports pressure, heat and pain, and that warning is what makes a person move before damage occurs. Remove the sensation, as diabetes and spinal injury do, and injury becomes silent and therefore severe.
Skin needs blood to heal, so anything reducing flow — pressure, vascular disease, smoking, cold, swelling — slows or prevents it. Almost every chronic wound is, underneath, a blood supply problem.
Skin cannot be assessed through clothing, a dressing, or in dim light, and the commonest failure in this subject is simply not looking. Heels, sacrum, between toes, under breasts, in skin folds and behind ears are where things hide.
Flat or raised, fluid-filled or solid, scaly or smooth, single or many, where on the body, and what shape or pattern. A description in ordinary words that another person can picture is more useful than a guessed diagnosis.
Rashes on sun-exposed areas, in skin creases, on the hands and feet, following a nerve, or where something touched the skin each point in a specific direction. Where it is tells you as much as what it looks like.
Warmth, tenderness, hardness and whether it blanches under pressure are all found by touching. And asking how long, how it started, whether it itches or hurts, and what makes it worse narrows it further than looking alone.
A wound or lesion recorded with a measurement and, where consent allows, a photograph, allows the next person to know whether it is improving. Descriptions alone consistently fail to show change over weeks.
Inflammation and early pressure damage appear as redness in pale skin, but in darker skin they appear as a purple, darker or ashen change that is easily missed under poor light. Depending on redness means missing damage in a large share of patients.
Pressure injuries are detected later and at more advanced stages in people with darker skin, and that disparity is documented. It is a direct consequence of teaching and textbooks built around pale skin.
Compare with surrounding and opposite areas, and look for a change in colour, a darker or shinier patch, and for skin that feels warmer, cooler, firmer, boggier or more painful than the skin around it. Touch and comparison do the work redness cannot.
In darker skin, healed inflammation frequently leaves areas darker or lighter than the surrounding skin, which can persist for months and is distressing. It is not scarring and it is worth explaining, because people assume permanent damage.
The person knows what their own skin normally looks like and can point to what is different. That question resolves more uncertainty in assessing darker skin than any description in a textbook.
Persistent itch disturbs sleep, concentration and mood, and severe itch is comparable to severe pain in its effect on life. It is consistently treated as a minor complaint, which is why patients stop mentioning it.
Scratching damages the barrier, which causes more inflammation and more itch, and breaks the skin so that infection enters. Breaking that cycle — short nails, cool compresses, treating at night, covering — is most of the practical management.
Generalised itch without a rash can come from liver disease, kidney failure, thyroid disease, iron deficiency, some cancers and many medicines. Itch with no visible cause is investigated rather than creamed.
Much itch in older people and in hospital is simply dry skin, made worse by hot water, soap, frequent washing and dry air. Regular moisturising is a treatment, and it is the intervention most often left out of a care plan.
Itch intensifies at night when there is nothing to distract from it, which is why it destroys sleep and why timing treatment towards the evening helps. Asking specifically about nights finds severity that a daytime question misses.
Eczema is an inflamed, dry, itchy skin condition in which the barrier is defective, so the skin loses water and reacts to things that would not trouble intact skin. That is why moisturising is the foundation of treatment rather than an adjunct.
In infants on the face and outer limbs, in children in the creases of elbows and knees, in adults frequently on the hands. It runs in families alongside asthma and hay fever, and flares with infection, stress, heat and irritants.
Effective treatment involves applying moisturiser in far larger quantities and far more often than patients expect, and continuing between flares. Under-use is the single commonest reason treatment appears to fail.
Steroid creams are widely and disproportionately feared, so they are under-used, applied too thinly and stopped too early, and the eczema persists. Addressing that fear directly, rather than simply prescribing again, is what changes outcomes.
Weeping, crusting, sudden worsening, pain or small blisters suggests infection complicating eczema, which needs treating in its own right. A flare that is not responding as usual is assessed rather than escalated blindly.
Well-defined raised patches with thick scale, classically on elbows, knees, lower back and scalp, caused by skin cells being produced far too quickly. It is long-term, it fluctuates, and it is not infectious.
Psoriasis is associated with joint disease, and with raised cardiovascular risk, diabetes and depression. Asking about joint pain and attending to general health is part of managing it, which surprises patients who think of it as a skin problem.
Visible scaling on the hands, face or scalp produces assumptions of poor hygiene and contagion, and people avoid swimming, short sleeves and intimacy. The distress is frequently out of all proportion to the area affected.
Scalp psoriasis is hard to treat and embarrassing, and nail involvement is painful, slow to improve and frequently ignored. Both need specific attention rather than being lumped in with the body.
Infection, stress, skin injury, some medicines and stopping oral steroids can all provoke a flare. Knowing this lets somebody anticipate rather than be ambushed.
Acne affects most adolescents to some degree and causes measurable depression, anxiety and social withdrawal, as well as permanent scarring. Dismissing it as something they will grow out of causes lasting harm.
Oil production, blocked follicles, bacteria and inflammation combine, which is why treatment addresses several of those at once. It is not caused by poor hygiene or by chocolate, and saying so removes a great deal of unwarranted blame.
Deep inflamed lesions scar, and effective treatment started earlier prevents scars that cannot later be removed. Delay while waiting for it to settle has a permanent cost.
Improvement takes weeks to months and skin may worsen initially, so people stop after three weeks concluding it does not work. Saying the timeframe in advance is the difference between treatment working and not.
Dark or red marks left after a spot fade over months and are not scars, while true scars are textural. Distinguishing them relieves considerable distress, particularly for patients with darker skin where marks are more prominent.
Infection in the skin and the tissue beneath produces an expanding area that is red or darker, warm, swollen and tender, usually with fever. Marking the edge allows the next person to see whether it is advancing.
A crack between toes, a cut, an insect bite, a leg ulcer, an injection site or dry fissured skin. Finding and treating the entry point prevents recurrence, and the space between the toes is the most commonly overlooked.
A chronically swollen leg is prone to repeated infection, and each infection damages the drainage further. Treating the swelling is what breaks that cycle, and it is usually neglected in favour of treating each episode.
A collection of pus does not resolve with antibiotics alone and requires drainage. A fluctuant, exquisitely tender swelling is reported for assessment rather than dressed repeatedly.
Pain wildly out of proportion to appearance, rapid spread over hours, skin discolouration or blistering, a very unwell patient. A deep spreading infection destroying tissue is a surgical emergency, and it kills quickly.
Fungal infection favours skin folds, feet, the groin and under breasts, producing itchy scaly patches, sometimes with a raised advancing edge. It is very common and very commonly treated as eczema, which makes it worse.
Cracking, peeling and itching between the toes is the commonest fungal infection and is a major entry point for bacterial infection of the leg. In anybody with a swollen leg or diabetes, it is looked for specifically.
Fungal nail infection is slow to treat, frequently recurs, and requires months of treatment, which people abandon. Being honest about the timescale determines whether it is completed.
Yeast infection in skin folds, the mouth, or the nappy area is common in infants, in older people, in diabetes, on steroids and on antibiotics. Recognising the setting makes the diagnosis.
Drying skin folds thoroughly, particularly between toes and under breasts, changing damp clothing, and letting air reach the area prevents recurrence more reliably than any cream alone.
Painful blisters in a band on one side of the body, not crossing the midline, from reactivation of the chickenpox virus. Pain frequently precedes the rash by days and is mistaken for something else entirely.
Involvement of the forehead, eyelid or tip of the nose risks the eye and needs urgent assessment, because sight can be lost. That single distribution rule is worth remembering exactly.
Nerve pain persisting for months after shingles is common, particularly in older people, is severe, and responds to specific treatments rather than to ordinary analgesia. Patients are frequently told nothing can be done.
Recurrent blisters around the mouth are usually a nuisance, but in a newborn, in eczema, or in somebody immunosuppressed they can cause serious widespread infection. The context changes the significance completely.
Warts are viral, common, largely harmless and frequently resolve without treatment, though slowly. Treatment is for discomfort or position rather than urgency, and in immunosuppressed people they behave more stubbornly.
Scabies is a mite burrowing in the skin, producing severe itch worse at night, with a rash between the fingers, on the wrists, around the waist and in the groin. The itch is out of proportion to the visible rash.
Household members and close contacts are treated at the same time whether or not they itch, because itching begins weeks after infestation. Treating only the person who complains guarantees it returns.
Itching persists for weeks after successful treatment because it is a reaction rather than continuing infestation, and patients retreat themselves repeatedly. Explaining this prevents unnecessary treatment and real irritation of the skin.
In older, frail or immunosuppressed people scabies can appear as widespread thick crusting with little itch, carrying enormous numbers of mites and spreading readily in care settings. It is regularly diagnosed as eczema or psoriasis for months.
Head lice spread by head-to-head contact regardless of hygiene, and the shame attached to them is entirely unwarranted. Saying so plainly to a parent is part of treating it.
Small red or purple spots that remain when pressed are bleeding into the skin, and with fever and illness they suggest meningococcal infection or another cause of bleeding. This is an emergency and it can appear late.
In suspected meningococcal infection the rash appears late and sometimes not at all, so a very unwell person with fever, headache, neck stiffness or light intolerance is treated on that basis. Waiting for the rash costs lives.
Widespread blistering, skin separating in sheets, and involvement of the mouth, eyes or genitals suggests a severe reaction that behaves like a burn and carries high mortality. It is a transfer-to-specialist-care emergency.
Any rash accompanied by high fever, low blood pressure, confusion or rapid deterioration is treated as a sign of serious systemic illness rather than as a skin problem. The rash is a symptom of something else.
Swelling of the lips, tongue or throat with or without a widespread raised itchy rash may be an allergic reaction threatening the airway. This is recognised immediately and treated as an emergency.
Drug reactions are among the commonest causes of a new rash in hospital, and the responsible medicine was frequently started one to three weeks earlier rather than yesterday. A careful timeline of every new medicine is the diagnostic step.
Fever, facial swelling, blistering, involvement of the mouth or eyes, extensive skin peeling, enlarged lymph nodes, or a patient who is systemically unwell. Any of these turns a rash into an emergency.
The most important action is identifying and stopping the responsible medicine, and continuing it while treating the rash allows a severe reaction to progress. Everything else is supportive.
A drug allergy recorded with the name of the medicine and what actually happened prevents a future re-exposure that could be fatal. Recorded vaguely, or not at all, it is the beginning of the next reaction.
Some reactions are predictable effects rather than allergy, and labelling somebody allergic to a whole class of essential medicines unnecessarily restricts their future care. Describing what happened matters more than applying the word.
Skin cancer is the most common cancer in many countries, and the great majority is caused by ultraviolet exposure accumulated over a lifetime. It is also the most visible, and therefore the most findable, cancer there is.
The commonest types grow slowly, rarely spread, and appear as a pearly nodule or a sore that does not heal, typically on the face, ears or scalp. They are curable, and they destroy tissue locally if left for years.
Melanoma can spread early and is the cause of most skin cancer deaths. It presents as a new or changing pigmented lesion, and it is found by noticing change rather than by recognising an appearance.
A mole that has grown, changed shape or colour, become uneven, itched, bled or crusted, or that simply looks different from the person's others. Change over weeks to months is the signal.
Skin cancer in people with darker skin is less common but is diagnosed later and has worse outcomes, and it occurs at sites people do not check — palms, soles, under nails and in the mouth. Those sites are looked at specifically.
Ultraviolet damage builds over a lifetime and sunburn in childhood raises risk substantially, which is why prevention aimed at children matters most. It is also why protecting a child is about the adult's behaviour.
Avoiding the strongest midday sun, covering with clothing and a hat, and using sunscreen on what remains exposed, in that order of effectiveness. Sunscreen alone, applied thinly and once, is the weakest of the three.
People working outdoors accumulate enormous exposure and are rarely given any advice about it, while the discussion focuses on holidays. Asking what somebody does all day is the relevant question.
More pigment gives real but incomplete protection, and both sunburn and skin cancer occur. Messaging that implies immunity means people never check their skin and never protect it.
Loss of pigment in patches, and darkening of areas after inflammation, cause significant distress, particularly where skin colour carries social weight. Dismissing them as cosmetic underestimates what they cost somebody.
Bleeding stops, the wound is cleaned by inflammation, new tissue is built, and the scar is remodelled over months. Knowing the stage a wound is in tells you what it needs and what is normal to see.
A new wound is expected to be a little red, warm, swollen and tender, and that is healing rather than infection. Confusing the two produces unnecessary antibiotics, and missing genuine infection produces harm.
Wounds heal faster in a moist environment and are damaged by drying out and by sitting in excessive fluid. That single principle explains most of what dressings are designed to do.
A clean wound with edges brought together heals quickly with a fine scar, while an open wound must fill in from the base, which takes far longer and leaves more scar. Which one you are dealing with sets the timeframe.
A wound that looks healed at two weeks has only a fraction of its final strength and continues remodelling for a year. That is why lifting restrictions after surgery extend beyond the point the skin looks fine.
Without adequate blood flow a wound cannot heal regardless of what is put on it, which is why arterial assessment in a leg ulcer comes before any dressing decision. Treating the dressing when the problem is the artery wastes months.
Healing requires protein, calories, vitamin C and zinc, and a malnourished patient does not heal. Nutritional assessment and actually getting food into somebody is wound care, not something separate from it.
Bacteria and dead tissue in a wound consume resources and prevent new tissue forming, which is why wounds are cleaned and dead tissue removed. A wound that has stalled is examined for both.
Continued pressure on a wound prevents healing entirely, repeated movement disrupts new tissue, and surrounding skin macerated by fluid breaks down further. Offloading is frequently the intervention that matters most.
Diabetes, smoking, steroids, chemotherapy, anaemia, kidney disease, age and immobility all slow healing. A wound that is not healing is a reason to look at the person rather than to change the dressing again.
Length, width and depth, recorded consistently, is what shows whether a wound is improving. Without measurement, four different nurses across four weeks cannot tell a wound that is healing from one that is not.
Pink and moist means new tissue; yellow and stringy means dead tissue; black means dead and dry; red and bleeding easily may mean overgrowth. What the base looks like determines what the wound needs.
Edges that are rolled, undermined or not advancing, and surrounding skin that is macerated, hard, inflamed or broken. The skin around a wound frequently reveals more about the cause than the wound itself.
How much fluid, what colour, whether it smells, and whether pain is changing. Increasing pain and a new smell in a previously stable wound are the two most useful warnings of infection.
A photograph taken with permission, in consistent light, with a measure visible, is worth pages of description for showing change. It also protects the patient, because deterioration cannot be argued about.
Most chronic wounds are cleaned with clean warm water or saline, and antiseptics used routinely can damage healing tissue. The purpose is removing debris and excess bacteria, not sterilising something that cannot be sterile.
A wet wound needs something absorbent, a dry wound needs moisture added, a cavity needs filling, and fragile surrounding skin needs a gentle adhesive. There is no single best dressing, only a best match.
Every dressing change cools the wound, disturbs new tissue and hurts, so dressings are left as long as they are working rather than changed by routine. Frequent unnecessary changes measurably delay healing.
Dressing changes are among the most painful things done to patients, and analgesia timed in advance, gentle removal, soaking adherent dressings and letting the patient pause are what make them bearable. Rushing is not kindness.
Most wound care happens at home, done by the patient or a relative, so what they were shown, whether they were watched doing it, and whether they have the supplies decides the outcome.
Increasing pain, more fluid, new smell, fragile bleeding tissue, breakdown of healing tissue, and a wound that was improving and has stopped. In chronic wounds these matter more than redness and warmth.
All chronic wounds contain bacteria, and swabbing every wound and treating every result produces resistance without benefit. Wounds are swabbed when there is clinical reason, and the patient is treated rather than the swab.
Redness extending beyond the wound, fever, feeling unwell, or rapidly increasing pain means infection has spread into the surrounding tissue and needs systemic treatment promptly. That distinction changes the urgency completely.
A deep wound, particularly on a foot, that probes to bone or has persisted for months may involve bone infection, which needs prolonged treatment and imaging. It is regularly treated as a skin wound for a year.
Chronic wounds are where a great deal of unnecessary antibiotic prescribing happens, and every unnecessary course makes the next infection harder to treat. Declining to swab without reason is good practice rather than laziness.
Sustained pressure between a bone and a surface squeezes vessels shut, and tissue deprived of blood dies. It happens over hours, it happens deep before it shows on the surface, and it happens to anybody who cannot move.
Dragging a patient up a bed shears tissue layers against each other, and skin that is damp from sweat, urine or wound fluid breaks down at much lower pressures. Handling technique and continence care are therefore prevention.
Anybody immobile, with reduced sensation, poorly nourished, incontinent, very thin or very unwell, or with a device pressing on them. Most inpatients have at least one risk factor and the assessment exists to find them.
Heels and the sacrum account for most pressure injuries, and heels are particularly vulnerable because there is almost no tissue over the bone. Offloading heels completely is more effective than any dressing.
Oxygen tubing behind ears, masks on the bridge of the nose, catheters, plaster casts, splints and monitoring probes all cause pressure damage in places nobody inspects. Looking under every device is part of the round.
Changing position regularly, at intervals matched to the individual's risk, is what prevents the majority of pressure damage. It is also the intervention most often recorded as done when it was not.
Skin over bony points looked at, not asked about, every time the patient is repositioned or washed. Damage found at the stage of a colour change is reversible; damage found as an open wound is not.
Specialist mattresses and cushions reduce risk and do not remove the need to reposition, and a patient on an expensive mattress who is not turned still develops pressure damage. The equipment is an addition.
A malnourished, dehydrated patient develops pressure damage more readily and heals it more slowly, so getting food and fluid into them is prevention. The dietitian referral is a pressure care intervention.
Sitting concentrates pressure on a small area and is frequently overlooked because it is not lying in bed. Long periods in a chair, particularly slumped, cause serious damage and need their own repositioning plan.
Most leg ulcers result from veins failing to return blood adequately, producing swelling, skin changes and ulceration typically around the ankle. It is a circulation problem that presents as a wound.
Properly applied compression heals most venous ulcers and is what prevents recurrence, and dressings alone largely do not. Patients find compression uncomfortable and stop, so explaining why it is the treatment matters.
Compression applied to a leg with poor arterial supply can cause tissue death, which is why arterial assessment comes before compression, always. This is the single most important safety rule in the chapter.
Ulcers from poor arterial supply are typically painful, on the foot or toes, with a pale or dark base, in a cool leg with weak pulses, and pain is worse when the leg is raised. That reversal of the pain pattern is the clue.
A healed venous ulcer recurs in a large proportion of people unless compression is continued indefinitely, and that is frequently not explained. Follow-up and hosiery are the difference between healing once and staying healed.
Nerve damage removes the warning of injury and vascular disease prevents healing, so a minor wound becomes an ulcer and an ulcer can lead to amputation. Both problems are usually present together.
In a person with diabetes, a foot ulcer is urgent rather than routine, because infection spreads fast in poorly supplied tissue and bone involvement follows. Delay of weeks is measured in toes.
A person who cannot feel the wound keeps weight on it, which is why offloading — special footwear, a cast, crutches, bed rest — is central and why advice to rest is insufficient on its own.
Between the toes, the heel, the sole, under calluses and around the nails, at every contact. This is one of the highest-value examinations in the whole of nursing, and it takes under a minute.
Daily inspection, well-fitting shoes, never walking barefoot, checking inside shoes, prompt attention to any break, and professional nail care. Teaching this properly prevents more amputations than any treatment cures.
A closed surgical wound is usually dressed briefly and then left alone, and interfering with it more than necessary introduces infection. Knowing what normal looks like prevents unnecessary intervention.
Increasing pain after the first days, spreading redness, discharge, fever, or a wound that opens. Pain that is improving and then worsens is the most useful single warning.
A surgical wound separating, particularly an abdominal one, is a serious complication. A sudden discharge of pink fluid from an abdominal wound frequently precedes it and is reported immediately rather than dressed.
Knowing what a drain is for, how much it should produce, and when sutures or clips are due out prevents both premature and forgotten removal. Sutures left in too long cause infection and scarring.
When to shower, what normal looks like, what to report, when sutures come out, and who to contact. Given verbally at a busy discharge, none of it is retained, which is why it is written.
Cooling a burn with running water for a substantial period immediately after injury reduces its depth and improves the outcome, and it is effective even somewhat delayed. Ice is not used, because it causes further damage.
Toothpaste, oil, butter, ash and traditional applications cause infection and make assessment impossible. Saying clearly what not to apply is as important as saying what to do, and it must be said without shaming anybody.
Superficial burns are painful, red and heal quickly; deeper ones blister; the deepest are white or charred and paradoxically painless because nerves are destroyed. A painless burn is a deep one, which is counterintuitive and important.
Extensive burns lose enormous volumes of fluid and require calculated replacement, and under-resuscitation kills. Estimating the area affected is therefore an urgent early assessment rather than a documentation exercise.
Burns to the face, hands, feet, genitals or across joints, burns encircling a limb, inhalation injury, electrical and chemical burns, and burns in children or older people. Recognising these and transferring early changes outcomes.
A scar crossing a joint or the neck contracts as it matures and can restrict movement permanently, which is why positioning, stretching and pressure therapy during healing are treatment rather than cosmetic care.
Some scars grow beyond the original wound, becoming raised, itchy and painful, and this occurs more commonly in darker skin. It is not a complication of poor care and patients frequently believe it is.
Scarred skin has altered sensation, does not sweat, burns easily and feels foreign to the person. Explaining that these are permanent features rather than problems to be fixed is more useful than reassurance.
A visible scar carries the story of a burn, an operation, self-harm or violence, and being asked about it repeatedly is exhausting. Not asking, unless it is clinically relevant, is a form of care.
People with significant scarring are discharged with itch, tightness, sun sensitivity and distress unaddressed, because the wound has healed. The wound healing is not the end of the injury.
Most stoma difficulty is skin breakdown around it from leakage, and once the skin is broken the appliance sticks less, which causes more leakage. Breaking that cycle early is the whole of the management.
An opening cut too large exposes skin to output and one cut too small constricts the stoma, and the size changes over the weeks after surgery. Re-measuring rather than reusing the same template prevents most problems.
Volume, consistency and colour indicate hydration, obstruction and how much of the bowel is working. A high-output stoma causes dehydration and salt loss that is regularly missed.
Skin around feeding tubes, drains, catheters, tracheostomies and cannulae breaks down, gets infected and is rarely inspected because attention is on the device. Looking at the skin, not just the device, is the discipline.
Removing dressings and appliances roughly strips skin, particularly in older people and children, and repeated stripping creates the wound you were trying to prevent. Gentle removal and skin protection are genuine techniques.
A malodorous wound causes people to stop visiting, to eat less, and to withdraw entirely, and patients apologise for it constantly. Managing odour is not cosmetic; it determines whether somebody still has a social life.
People with visible skin disease are stared at, questioned, avoided and assumed to be contagious, including by healthcare staff. Touching a patient's skin without hesitation communicates something that no reassurance does.
Skin conditions are widely assumed to result from poor hygiene, and patients arrive already ashamed. Saying explicitly that this is not caused by anything they did is frequently the most useful sentence in the consultation.
Examining skin requires exposing the body, sometimes repeatedly, to different people. Privacy, explanation, exposing only what is needed and covering promptly are not courtesies but the conditions on which somebody consents.
Not how itchy it is out of ten, but whether they still swim, wear short sleeves, sleep, work or see people. That question reveals the actual severity of a skin condition, and it is almost never asked.
Pressure damage prevention and staging, the non-blanching rash, compression only after arterial assessment, the diabetic foot, burn first aid, and recognising a severe drug reaction. Pressure care appears in every paper.
Relying on redness to detect early pressure damage in darker skin; applying compression without arterial assessment; treating a chronic wound with antibiotics on the basis of a swab; waiting for the rash in suspected meningococcal illness; treating a fungal infection as eczema; applying ice or butter to a burn.
Look at the skin, in good light, undressed. Reposition and inspect. Assess arteries before compressing. A foot ulcer in diabetes is urgent. Cool a burn with running water. Stop the suspected medicine.
Look under every device. Look between the toes. Measure the wound. Mark the edge of spreading redness. Time the analgesia before the dressing change. Ask what the condition stops them doing.
In this subject almost every serious failure begins with not having looked. Nothing in these chapters substitutes for uncovering the skin, in good light, and comparing it with what was there yesterday.
Written in plain sentences on purpose. Nursing is studied in a second language by a large share of the students who will read this, and a sentence that has to be decoded twice is a sentence that teaches less.
These are the twelve questions written with this SUNYRA nursing manual, to check what it teaches. They are not past papers and were not written to any one examination's pattern; an examination tag means only that the examination's published blueprint covers this subject. Difficulty was not graded in the source, so every question is marked medium.
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