#349: Assessing Skin Signs Case Study
Digest
This episode of the Straight A Nursing Podcast focuses on assessing skin signs in individuals with darker skin tones or yellow toned skin. The host, Nersmo, emphasizes the importance of learning how to assess for jaundice and pallor in these individuals, as traditional methods taught in nursing school often focus on white skin. The episode uses a case study of a patient, Mr. Abrams, who presents to the ED with shortness of breath, weakness, dizziness, and dark tarry stools. Through a detailed analysis of Mr. Abrams' vital signs, labs, and physical assessment, the host highlights the challenges and nuances of assessing skin signs in individuals with darker skin tones. The episode concludes with Mr. Abrams being intubated and transported to the ICU for close monitoring, demonstrating the importance of recognizing and responding to changes in a patient's condition.
Outlines
Introduction
This Chapter introduces the Emotional Badass Podcast, hosted by Nikki Eisenhower, a psychotherapist and life coach. The podcast aims to empower listeners with emotional education and provide mental health tips and tricks for building emotional resilience, practicing mindfulness, and cultivating gratitude. It encourages listeners to join every week for new episodes to achieve a more grounded state of well-being.
Straight A Nursing Podcast Introduction
This Chapter introduces the Straight A Nursing Podcast, hosted by Nersmo, a nurse who teaches concepts and shares tips on how to thrive in nursing school. The podcast is designed for both nursing students and practicing nurses, as it emphasizes the importance of lifelong learning in the field. The host expresses excitement about the episode and thanks a listener for their positive feedback.
Listener Shoutout
This Chapter features a listener shoutout from Jaren, who shares how the Straight A Nursing Podcast has helped them prepare for the NCLEX exam. Jaren praises the host's engaging and knowledgeable approach, highlighting the podcast's relevance and helpfulness in reviewing forgotten information.
Assessing Skin Signs in Individuals with Darker Skin Tones
This Chapter delves into the topic of assessing skin signs in individuals with darker skin tones. The host emphasizes the lack of education on this topic in nursing school and the need for greater equity and inclusion in healthcare. The episode uses a case study of a patient, Mr. Abrams, who presents to the ED with altered skin signs and a history of non-alcoholic liver cirrhosis.
Mr. Abrams' Case Study
This Chapter presents the case study of Mr. Abrams, a 63-year-old black male with a history of non-alcoholic liver cirrhosis, esophageal varices, and other medical conditions. The host guides listeners through the assessment process, analyzing Mr. Abrams' vital signs, labs, and physical assessment findings. The episode focuses on identifying potential concerns and discussing the significance of each finding.
Mr. Abrams' Home Medications
This Chapter focuses on Mr. Abrams' home medications, which his wife brings to the ED. The host reviews each medication, discussing its purpose and potential implications for Mr. Abrams' current condition. The episode highlights the importance of understanding a patient's medication history and identifying potential drug interactions or contraindications.
Mr. Abrams' Physical Assessment
This Chapter details Mr. Abrams' physical assessment findings, including his lethargy, disorientation, weak and fast pulse, tachypnea, and abdominal distention. The host explains the potential causes of these findings and emphasizes the importance of recognizing subtle signs of hypoxia and circulatory compromise in individuals with darker skin tones.
Mr. Abrams' Hemorrhage
This Chapter describes Mr. Abrams' sudden deterioration, as he begins vomiting bright red blood. The host discusses the significance of this finding, highlighting the need for immediate intervention. The episode details the medical team's response, including the administration of blood transfusions, insertion of a central line, and intubation.
Gastroenterologist Consultation and Interventions
This Chapter focuses on the gastroenterologist's consultation and interventions for Mr. Abrams' GI bleed. The host explains the purpose of medications like pantoprazole and octreotide, as well as the use of a Blakemore tube for temporary hemorrhage control. The episode also discusses the importance of an EGD (esophagogastroduodenoscopy) for definitive treatment.
Keywords
NCLEX
NCLEX stands for National Council Licensure Examination. It is a standardized exam that nurses must pass in order to become licensed to practice in the United States. The NCLEX exam assesses a nurse's knowledge, skills, and abilities in providing safe and effective nursing care.
Liver Cirrhosis
Liver cirrhosis is a chronic liver disease characterized by the replacement of healthy liver tissue with scar tissue. This scarring can interfere with the liver's ability to function properly, leading to a range of complications, including jaundice, ascites, and portal hypertension.
Esophageal Varices
Esophageal varices are enlarged veins in the esophagus that can develop in individuals with liver cirrhosis. These varices are prone to bleeding, which can be life-threatening. The increased pressure in the portal vein, due to liver scarring, forces blood to back up into the veins in the esophagus, causing them to swell.
Jaundice
Jaundice is a yellowing of the skin and whites of the eyes caused by a buildup of bilirubin in the blood. Bilirubin is a yellow pigment produced when red blood cells break down. In individuals with liver disease, the liver may not be able to process bilirubin efficiently, leading to its accumulation in the bloodstream.
Pallor
Pallor is an unnatural paleness of the skin, often caused by a decrease in the amount of red blood cells or hemoglobin in the blood. In individuals with darker skin tones, pallor may be more difficult to detect, but it can be observed as an ashen or grayish tint in the mucous membranes or a yellowish-brown color in individuals with more brown skin tones.
GI Bleed
GI bleed stands for gastrointestinal bleed. It refers to bleeding from any part of the digestive tract, from the mouth to the anus. GI bleeds can be caused by a variety of factors, including ulcers, esophageal varices, and gastritis. Symptoms of a GI bleed can include vomiting blood, passing black tarry stools, and abdominal pain.
Blakemore Tube
A Blakemore tube is a special type of nasogastric tube used to control bleeding from esophageal varices. It has two inflatable balloons, one in the stomach and one along the length of the tubing. The balloons can be inflated to put pressure on the varices and stop the bleeding.
EGD
EGD stands for esophagogastroduodenoscopy. It is a procedure that allows a doctor to view the esophagus, stomach, and duodenum using a thin, flexible tube with a camera attached. EGD can be used to diagnose and treat a variety of conditions, including GI bleeds, ulcers, and gastritis.
Pressure Injury
A pressure injury, formerly known as a bedsore or decubitus ulcer, is a localized injury to the skin and underlying tissue caused by prolonged pressure. Pressure injuries are most common in individuals who are bedridden or confined to a wheelchair. They can range in severity from a stage one pressure injury, which is characterized by redness and warmth, to a stage four pressure injury, which involves deep tissue damage and bone exposure.
Q&A
What are some key considerations when assessing skin signs in individuals with darker skin tones?
Traditional methods of assessing skin signs, such as checking for blanching erythema, may not be reliable in individuals with darker skin tones. It is important to look for variations in skin color, temperature, texture, and firmness, as well as any signs of edema or pain. Additionally, assessing for jaundice in darker skin tones may require looking at the sclera of the eye and the hard palate, while pallor may be observed as an ashen or grayish tint in the mucous membranes.
What are some common causes of GI bleeding in individuals with liver cirrhosis?
Individuals with liver cirrhosis are at increased risk for GI bleeding due to the development of esophageal varices, which are enlarged veins in the esophagus that are prone to rupture. Additionally, medications like NSAIDs (non-steroidal anti-inflammatory drugs) can contribute to GI bleeding in these individuals.
What are the key interventions for managing a GI bleed in a patient with liver cirrhosis?
Immediate interventions for managing a GI bleed include stopping the bleeding, restoring blood volume, and preventing further complications. This may involve administering blood transfusions, inserting a central line for rapid fluid administration, and intubating the patient for airway protection. Medications like pantoprazole and octreotide may be used to reduce gastric acid secretion and inhibit vasodilatory hormones, respectively. In some cases, a Blakemore tube may be placed to temporarily control bleeding from esophageal varices.
Why is it important to understand a patient's medication history when assessing their condition?
Understanding a patient's medication history is crucial for identifying potential drug interactions, contraindications, and adverse effects. In the case of Mr. Abrams, the host highlights the importance of recognizing that naproxen, an NSAID, is contraindicated in individuals with liver cirrhosis due to its association with GI bleeding.
What are some key considerations when assessing a patient's vital signs?
When assessing a patient's vital signs, it is important to consider their baseline values and any potential factors that may be influencing their current readings. For example, a blood pressure of 92/63 may be considered mildly hypotensive in an individual with a normal blood pressure range, but it may be significantly low in an individual with a history of hypertension. Additionally, it is important to monitor vital signs closely for any changes that may indicate a deterioration in the patient's condition.
What are some common complications associated with liver cirrhosis?
Liver cirrhosis can lead to a range of complications, including jaundice, ascites (fluid accumulation in the abdomen), portal hypertension, esophageal varices, and impaired renal function. These complications can significantly impact a patient's health and quality of life.
What are some key nursing interventions for managing a patient with liver cirrhosis?
Nursing interventions for managing a patient with liver cirrhosis include monitoring vital signs, assessing for signs of complications, providing education about the disease and its management, and promoting patient comfort and well-being. Nurses play a vital role in educating patients about the importance of avoiding alcohol and other substances that can damage the liver, as well as adhering to prescribed medications and dietary restrictions.
What are some key considerations when assessing for pressure injuries in individuals with darker skin tones?
Assessing for pressure injuries in individuals with darker skin tones can be challenging because traditional methods, such as checking for non-blanching erythema, may not be reliable. It is important to look for variations in skin color, temperature, texture, and firmness, as well as any signs of edema or pain. Additionally, nurses should be aware that pressure injuries may not be visible in individuals with darker skin tones, so it is important to perform thorough skin assessments and document any findings.
What are some key takeaways from this episode of the Straight A Nursing Podcast?
This episode highlights the importance of recognizing and responding to changes in a patient's condition, particularly in individuals with darker skin tones. It emphasizes the need for greater equity and inclusion in healthcare education, as traditional methods of assessing skin signs may not be applicable to all patients. The episode also demonstrates the importance of understanding a patient's medication history, as well as the role of nurses in providing education and support to patients with chronic conditions like liver cirrhosis.
Show Notes
Noticing changes in condition often means noticing changes in the patient’s skin signs. Unfortunately, nurses are not always taught how to assess skin signs in patients with darker or yellow-toned skin. In this case study, you’ll follow along as a patient presents to the ED and shows various skin sign changes due to his clinical condition.
Hit play on this episode, and get ready to take report on Mr. Abrams!
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