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Summary

This on-demand teaching session is specifically tailored for neurodiagnostic technologists, and is designed to provide a comprehensive understanding of skin development, pressure injuries, and risk factors. Through the session, participants will learn about the underlying structures of skin, life cycle of skin cells, nutrition and environmental factors affecting the skin, stages of skin breakdown, functions of different skin cells, and how to develop a skin safety policy for their facility. The content of the session includes fun facts about skin, a study of friction and motion in relation to skin safety, and invaluable insight into the underlying science of skin to reduce pressure injuries.

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Description

The first of a three part collection of webinars is designed to teach learners how to evaluate skin integrity, monitor changes and report skin-related issues for patients undergoing neurodiagnostic procedures such as EEG and LTM. The presentations are meant to educate the neurodiagnostic professional on skin preparation and electrode application techniques as well as other appropriate interventions to avoid skin breakdown. Learners will also be provided with information on how to monitor skin integrity and document findings in the medical record.

Presented by: Petra Davidson, BS, R. EEG/EP T. CLTM, FASET

Learning objectives

Learning Objectives:

  1. Identify the stages of skin maturation and skin breakdown.
  2. Recognize specific skin conditions that contraindicate standard electrode application.
  3. Describe the functions of the three main layers of the skin and the nutrients required for healthy, intact skin.
  4. Explain the effects of a balanced lifestyle on skin health.
  5. Develop a skin safety policy to reduce pressure injuries in their own lab.
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Computer generated transcript

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The following transcript was generated automatically from the content and has not been checked or corrected manually.

Welcome to lesson one skin development. This course is specifically targeted for the neurodiagnostic technologist and will cover basic skin knowledge, pressure injury, facts and prevention of pressure injuries. For the NDT technologist. At the end of the course, the technologist should be able to explain nutritional and environmental factors that affect the skin. The technologist should be able to recognize patients at risk for pressure injuries and the various stages of pressure injuries. The technologist should also be able to develop a skin safety policy for their facility to reduce pressure injuries in their own lab. The patient is the the the of the of the of the than one include. Number one, identifying stages of skin maturation. Two identify the stages of skin breakdown. Three identify specific skin conditions that contraindicate standard electrode application. And four identify patients at risk for skin breakdown t tribology is the study of friction, wear, lubrication and the design of bearings. The science of interacting surfaces and relative motion. You will find out exactly how related this is to this topic. As we go throughout the lecture, all of our electrodes, our skin prep, our mechanical prep and our solutions play a part in reb and skin and pressure ulcers. The science of interacting surfaces and relative motion is trebly recent scientific research published in the journal of Trebly demonstrates a passion for applying this science to reducing pressure injuries. A recent nursing journal publication revealed moisture as a common etiology for skin damage as well as pressure rub has been studying these very factors for years and elevates our understanding of the interaction of surfaces in motion such as electrodes adhered to the skin with a moving surface of paste or other conducive between the two surfaces. In order to understand the interaction, we must first understand the surfaces we'll start with the skin is covering basic skin knowledge. We will talk about the basic skin fundamentals how to identify the stages of maturation of the skin and requirements for healthy intact skin. And as always, we will be careful to provide supporting materials for your future. Curiosity and learning experience is the skin fundamentals will include fun facts about the skin, the structure of the skin life cycle of skin cells and the function of the skin. The skin is the the the the the organ in the body. It varies in thickness like dough according to function and location to nine millimeters. The skull has some of the thickest skin. Professor Parsons from the University of London reports that the thickness of the forehead is typically 4 to 5 millimeters and the skin becomes thicker as we progress to the back of the head where the skin often ranges from 7 to 9 millimeters thick. Thus protecting the back of the head. We most likely to hit it. The the skin, the weighs about as much as the brain, similar, similar to other organs. The skin relies on proper functioning of other organ systems for maintenance growth and healing. Skin is often affected by our environment. There are three basic layers of the skin. Each one comprised of multiple layers in itself. The very top layer, the epidermis consists of five specific types of cells and layers. The top layer being the stratum corneum followed by the stratum lucidum, the stratum granulosa, the stratum spins and the the dermis consists of the reticular dermis or connective tissue and the papillary dermis which contains nerves and capillaries followed at the very bottom by the subcutaneous fat layer. In order to fight skin breakdown, we have to truly understand the surfaces we're dealing with. The skin is comprised of the three basic layers. The epidermis dermis and subcutaneous fat. These layers have layers. Each of these layers has surfaces that interact. Many of these layers are not static but float and move above and below one another. The epidermis consists of five layers on the soles and palms and four layers everywhere else on the body. From the top to the bottom of the scalp, the epidermis is the stratum corneum. The stratum granulosa, the stratum spinosa and the stratum basal the next slide will detail how each of those layers moves to the next layer in progression. A layer of ridges holds the epidermis to the dermis. This is a loose layer. It's not firmly connected. The dermis is only two layers. The papillary dermis and the reticular dermis. The dermis provides sensation vascularization and stabilization to the epidermis. The connective tissue or reticular dermis attaches to the subcutaneous fat layer. The fat layer provides additional structure protection and support for the dermis and epidermis as well as the organs underneath the cells. Life cycle of the epidermis consists of five steps. Each cell begins down at the stratum stratum basil or the very bottom. They move up to the stratum spinosa where they provide immunity, tensile strength and flexibility. They then progress to the orderly process of cell death known as cell apoptosis in the stratum granulosa in only the thickest parts of the skin. So the soles of the feet and the palms of the hands, the cells then move to the stratum lucidum which provide waterproofing all cells end up in the stratum corneum where they're finally sloughed off. This is a, is a, is a this to happen rapidly. If the process happens rapidly, dry skin is visible on the surface and this causes the appearance of dandruff on the scalp or psoriasis on other skin tissue. Typically, the process should take about 28 days with psoriasis or dandruff, the entire process occurs in only 3 to 5 days causing thickened plaques as the body is not able to slough up the skin as quickly as the cells are dying. Each layer of cells has special functions and is able to provide a unique job to maintain repair and grow the skin. Beginning at the subcutaneous fat layer. The connective tissue and fat provide adherence to underlying tissues and bone as well as instillation and thermo regulation. The dermis has many responsibilities and many participants including various glands, blood vessels, hair collagen and elastin gs are very specialized and function for skin health. Eccrine glands are present in all humans at all stages of life and produce non odorous sweat. For thermoregulation. The apocrine glands activate during puberty in specialized regions of the body causing odorous and yellow staining sweat to aid in additional thermoregulation. Sebaceous glands are found in regions with hair and produce an oil like coating to the hair. The hair ceruminous glands only occur in the ears and produce cerumen like their name suggests to protect the specialized hairs in the ear canal. The skin has many different functions. Each layer of the skin has different cells which each provide a different function in the epidermis or the very top layer of skin. We have four different types of cells. The kerat is tiote which undergo cell division and protect the body from heat chemicals and microorganisms. Melanocytes produce the pigment melanin and give skin its color. Langerhans are responsible for immune responses. And merkel cells produce the of touch. The dermis or the middle layer has glands including the eccrine gland that produces sweat. For thermoregulation. The apocrine gland which produces sweat during puberty, sebaceous glands which produce an oil like substance that coats the hair and only in the ears. The ceruminous glands which produce cerumen or earwax in the dermis. We also find blood vessels, hair collagen and elastin each with their own function to help the skin mature. The subcutaneous or fat layer provides insulation and thermoregulation. It is also contains the connective tissue which helps hold muscle and skin to bone requirements for healthy intact skin are threefold. They include hydration, nutrition and proper environment. In order to maintain healthy intact skin cells depend on balance hydration, nutrition and a healthy environment. While we cannot provide these for our patients prior to neurodiagnostic testing, it is important to know what factors might have negatively impacted their skin prior to their arrival patients is a type of, of, of, of, of, of, of are most at risk for skin breakdown. The over cleaned patient who showers with very hot water for lengthy periods of time with heavily foamy soaps and shampoos and is very picky about what they eat as well as the dirty patient who smells with cigarette smoke, alcohol and has not had a balanced meal in weeks. Similar, similar, similar to many other body systems. The skin is particularly sensitive to a balanced lifestyle and over cleanliness can be as dangerous to a body as under cleanliness, healthy intact skin also requires balanced hydration. The proper amount of beverages, food sources and endogenous hydration. Proper hydration for skin function is reliant on consuming enough water to maintain the perfusion and oxygenation of cells within the layers of skin. Patient is exhibit to the to the to the and the eight by eight requirement is a myth. A healthy individual with a well-balanced diet does not require eight glasses of eight ounces of water per day. This individual only needs to drink to thirst. Our bodies have the ability to utilize water from the foods we consume and the endogenous sources within our own cells known as metabolic water. However, when we fail to follow a balanced diet, our food water is depleted greatly. Consequently, our metabolic or endogenous water is also depleted. In order to make our skin appear hydrated, we resort to various lotions and emollients which can actually cause trans epidermal water loss and then inhibit desmosome metabolism. Proper hydration allows our cells to move macro and micronutrients throughout the body. These nutrients are carried to needed areas. They provide structure, immunity, wound healing, cell growth and mobility of epidermal cells through their life cycle. Nutrition for healthy intact skin includes two major categories. One is macronutrients consisting of proteins, amino acids and carbohydrates. The other is micronutrients, vitamins, ABC de and K iron selenium, calcium, copper and zinc. Individuals with poor nutritional balance. Suffer from poor wound healing, poorer nutritional balance causes lengthy inflammatory phases. Throughout the skin maturation process. It causes decreased fibroblast proliferation can alter collagen synthesis, decreases wound tensile strength and increases the risk of infection. Both macro and micronutrients are required to move the skin through the three major stages of healing, including inflammation, proliferation and remodeling. Our macronutrients such as proteins, amino acids and carbohydrates serve as fuel for the process. They promote cell proliferation and formation of new tissues. The macronutrients, sorry. The micronutrients such as vitamins and minerals, increase cells stimulate the healing process, stimulate the action of enzymes, promote immunity and assist in transportation of nutrients to cell tissues. Is is this is, this is a is not designed to dive into the details of each macro and micronutrient function. This class will provide information in the supplementary section in further detail. If you're curious, it is important to be able to identify the stages of skin maturation as they will affect how you prep your patient's skin. At age 13, you typically have more oils in your skin. It is also typically better hydrated due to our consumption. As we get a little older, our hormone levels change, causing the skin tissue itself to change. And the maturation rate process also changes. The risk of damage to the skin occurs most in infancy and in the elderly as maturation is greatest at these times as the body ages and suffers or enjoys the care provided. The skin alters an appearance and function. The underlying bone fat and muscle alter the cosmetic appearance of the skin. However, there are more serious changes occurring within the skin layers according to rid and fissure, the self renewing capability of the epidermis, that outer layer which provides vital barrier function is diminished with age, vital thermal regulation. Function of eccrine sweat glands is also altered with age. The dermal collagenous extracellular matrix which comprises the bulk of skin and confers strength and resiliency undergoes gradual fragmentation which deleterious impacts skin mechanical properties and dermal cell functions. Aging also affects wound repair, pigmentation, innervation, immunity, vasculature and subcutaneous fat homeostasis. Altogether, age-related alterations of skin lead to age-related skin fragility and diseases. At the end of each section, you will find a link to all documents used in the creation of the educational materials. Please note that none of the authors companies or other individuals involved in the production of the supporting documents support these particular educational materials.