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Skin wounds have a variety of presentations and causes, and their treatment greatly depends on the health of the patient. Frail elders are at an increased risk of many conditions and infections because their immune system is weakened (Strazzieri-Pulido, Peres, Campanili, & de Gouveia Santos, 2017). Moreover, as many geriatric patients have limited mobility, they can also injure themselves easily. The diagnosis of wounds should include a visual assessment as well as tests to exclude or confirm the infectious causes of the problem. Shingles, for example, is prevalent in older adults, since it develops in people with lowered immunity to the virus (Kawai, Gebremeskel, & Acosta, 2014). Shingles may not require treatment, but individuals can benefit from controlling their symptoms. The prevention of this condition includes vaccination because exposure to the virus negatively affects geriatric patients. Shingle is a type of skin wound that is difficult to diagnose early, and prevention should be the focus of treating frail elders.
Diagnosis of Skin Wounds in Frail Elders
The process of diagnosing skin wounds should start with the visual inspection. Clinicians need to assess the overall health of geriatric patients and investigate their skin regularly to detect wounds early. Moreover, this step may prevent the development of infections. Then, if a wound is located, it is necessary to determine its type – some of the skin tears happen as a result of immobility, injury, and falls, while others have viral causes (LeBlanc et al., 2016). To exclude or confirm the presence of bacteria and viruses in one’s wound, blood tests can be performed. The distinction between colonization and infection is essential for preventing complications of the wound. Colonization refers to the period when bacteria exists on the surface or inside of the hosts’ body but does not trigger any responses (Leaper, Assadian, & Edmiston, 2015). Infection, on the other hand, is characterized by the host reacting to the bacteria (Leaper et al., 2015). The latter invades the tissue and triggers the immune system – this leads to the appearance of various symptoms.
Wound Type Description: Shingles
Shingle is a viral condition that is also called herpes zoster. It is a response of the body to the virus of varicella-zoster (VZV) which also causes chickenpox (varicella) (Kawai et al., 2014). Shingles occur in people who already have the virus in their bodies. VZV is highly contagious to people who have not encountered it before – the history of chickenpox plays a crucial role in the infection. Shingles are prevalent in older patients due to the virus’s reactivation in the body with lowered immune system protection (Kawai et al., 2014). Contributing factors are old age, history of chickenpox, suppression of the immune system, and the lack of immunization.
The main symptom of shingles is skin rash which appears on the body and face in linear patterns and develops into blisters filled with fluid. However, other symptoms may appear earlier than the rush – a person may experience pain, tingling, and itching sensations on the skin (Dooling et al., 2018). Other signs can include fever, fatigue, and headache but they are not as frequent as pain and rash. The blisters filled with exudates and blood break open in the following days before crusting over and falling off one’s body (Kawai et al., 2014). The skin either heals completely or has scars as a result of the wound. The period between the onset and the appearance of the rash can last for one or two days, and the formation and healing of blisters also take one to several weeks.
Treatment, Prevention, and Improvement
The treatment of shingles is focused on symptom management since the virus cannot be expelled from the body. Some patients with herpes zoster do not require medical assistance because their symptoms are not severe. Others can use pain relievers such as over-the-counter drugs and topical lotions. Antiviral medications may help individuals with severe and long-lasting conditions. Acyclovir is one of the most common drugs used to shorten the duration of shingles and help people with low immunity (Kawai et al., 2014). If the wound needs to be dressed, it is better to choose materials that will not increase inflammation and pain.
The prevention of shingles is prioritized because the virus cannot be removed from the body. Two main types of immunization practices exist, both being directed at preventing varicella activity. The first one is a vaccine against chickenpox – it reduces the possibility of becoming infected or having complications (Hales, Harpaz, Ortega-Sanchez, & Bialek, 2014). The second option is the herpes zoster vaccine focused on preventing the reactivation of the virus or decreasing the potential for adverse outcomes such as postherpetic neuralgia (Dooling et al., 2018). This complication can severely affect the neurological system and cause persistent pain. Thus, a vaccine is beneficial to all people regardless of their previous medical history with VZV.
Conclusion
Skin wound care for geriatric patients has many nuances which are based on these individuals’ weakened immune systems. Some skin problems occur due to people’s lack of mobility or environmental factors. Shingles, however, develop in older people due to the presence and reactivation of the virus in one’s body. This viral infection is characterized by such symptoms as fever, pain, itchiness, and rash. Shingles cannot be treated, but pain-relieving and antiviral drugs can help people with the condition’s severe form. Vaccination is the primary way of preventing shingles and making their effects less dangerous.
References
Dooling, K. L., Guo, A., Patel, M., Lee, G. M., Moore, K., Belongia, E. A., & Harpaz, R. (2018). Recommendations of the Advisory Committee on Immunization Practices for use of herpes zoster vaccines. MMWR Morbidity and Mortality Weekly Report, 67(3), 103-108.
Hales, C. M., Harpaz, R., Ortega-Sanchez, I., & Bialek, S. R. (2014). Update on recommendations for use of herpes zoster vaccine. MMWR Morbidity and Mortality Weekly Report, 63(33), 729-731.
Kawai, K., Gebremeskel, B. G., & Acosta, C. J. (2014). Systematic review of incidence and complications of herpes zoster: Towards a global perspective. BMJ Open, 4(e004833), 1-18.
Leaper, D., Assadian, O., & Edmiston, C. E. (2015). Approach to chronic wound infections. British Journal of Dermatology, 173(2), 351-358.
LeBlanc, K., Baranoski, S., Christensen, D., Langemo, D., Edwards, K., Holloway, S.,… Woo, K. Y. (2016). The art of dressing selection: A consensus statement on skin tears and best practice. Advances in Skin & Wound Care, 29(1), 32-46.
Strazzieri-Pulido, K. C., Peres, G. R. P., Campanili, T. C. G. F., & de Gouveia Santos, V. L. C. (2017). Incidence of skin tears and risk factors: A systematic literature review. Journal of Wound, Ostomy and Continence Nursing, 44(1), 29-33.
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