Study sheet: Acute and Chronic Skin Conditions

📋 Course Outline

1. Skin Integrity and Clinical Context
2. Acute Versus Chronic Conditions
3. Focused Skin Assessment
4. Red Flags and Escalation
5. Evidence-Based Skin Care
6. Pressure Injury Management
7. Documentation and Person-Centred Care

📖 1. Skin Integrity and Clinical Context

★ Must-know

• Skin is the body’s first line of defence, and impaired skin integrity can cause infection, pain and reduced mobility, delayed healing, and psychological distress.

Further detail

• Skin conditions are common in aged care, acute medical and surgical wards, and chronic disease management.

• Maggie is an 82-year-old aged-care resident with insulin-dependent type 2 diabetes, hypertension, osteoarthritis, chronic urinary incontinence, limited mobility, and frailty, placing her at high risk for pressure injuries.

💡 Memory Hook

Loss of skin integrity → infection, pain, delayed healing and psychological distress

📖 2. Acute Versus Chronic Conditions

★ Must-know

📌 Acute skin conditions have a sudden onset, often involve inflammation or infection, last a short time, and may resolve with treatment, whereas chronic skin conditions are long-term or recurrent, persist for more than 6 weeks, and require ongoing management.

📌 Inflammatory conditions such as contact dermatitis or eczema must be distinguished from infectious conditions such as cellulitis because they require different clinical responses.

Further detail

• Examples of acute skin conditions include:
  • cellulitis
  • contact dermatitis
  • acute allergic reactions
  • burns and skin trauma
  • surgical wounds

💡 Memory Hook

Acute conditions change quickly; chronic conditions persist and require ongoing management

📖 3. Focused Skin Assessment

★ Must-know

• A focused skin assessment examines:

  • colour
  • temperature
  • moisture
  • integrity
  • sensation
  • pain or itch
  • location and size
  • exudate or odour

• Maggie’s wound assessment identified full-thickness skin loss, visible subcutaneous fat, 30–40% slough, moderate purulent foul-smelling yellow-green exudate, undermining at 3 o’clock, erythema extending 3 cm from the wound edges, increased warmth, significant tenderness, and an adhered dressing.

Further detail

• Key features of acute skin conditions include:
  • redness
  • heat
  • swelling
  • pain
  • rapid changes

💡 Memory Hook

CTMISPLE: colour, temperature, moisture, integrity, sensation, pain/itch, location/size, exudate/odour

📖 4. Red Flags and Escalation

📝 Essential Points

• Red flags requiring immediate escalation include:
  • rapidly spreading redness
  • increasing pain or swelling
  • fever or systemic symptoms
  • purulent discharge
  • blackened or necrotic tissue
  • sudden changes in wound appearance
  • signs of sepsis

📌 Uncertainty or concern should be escalated to the registered nurse, ongoing deterioration to the registered nurse or nurse unit manager, a need for medical review to the resident medical officer or medical officer, and acute deterioration through a MET call.

💡 Memory Hook

Recognise deterioration → notify the appropriate clinician → seek urgent medical review or MET support

📖 5. Evidence-Based Skin Care

★ Must-know

• Evidence-based skin and wound care includes cleansing according to policy or protocol, applying appropriate dressings, following infection-control principles, and preventing pressure injuries.

Further detail

• Symptom relief may include:

  • pain management
  • itch reduction
  • emollients
  • barrier creams

• Prevention measures include:

  • repositioning
  • skin hydration
  • nutrition and hydration support

• Burn injuries can cause hypovolaemia through fluid loss from damaged skin, reducing circulating blood volume and renal perfusion and impairing the kidneys’ ability to filter blood effectively.

📖 6. Pressure Injury Management

★ Must-know

• 🔄 Immediate management includes:
  1. complete a wound and PQRST pain assessment
  2. assess vascularity and skin colour
  3. apply pressure-relieving support surfaces
  4. cleanse according to protocol
  5. obtain a wound swab for culture
  6. apply an appropriate antimicrobial dressing
  7. offload pressure

📌 Pressure should be offloaded by repositioning the patient every 2 hours, using pillows and wedges, and avoiding direct sacral pressure.

Further detail

• An air mattress is an example of a pressure-relieving support surface.

💡 Memory Hook

Assess → cleanse → dress → offload → reposition → monitor

📖 7. Documentation and Person-Centred Care

★ Must-know

• SHARED documentation records:
  • Situation
  • History
  • Assessment
  • Risks
  • Escalation
  • Documentation and plan

📌 Culturally safe, person-centred care respects cultural beliefs about skin and healing, uses inclusive non-judgemental language, involves family or support persons when appropriate, acknowledges anxiety or embarrassment, and adapts education to cultural needs.

Further detail

• A SHARED note for a red, painful lower-leg wound can record diabetic and chronic venous disease history, increased warmth with exudate and pain, infection and delayed-healing risks, RN notification and requested medical review, and wound care performed according to policy or procedure.

• Addressing patient anxiety involves: acknowledging concerns, providing clear explanations, offering reassurance without minimising concerns, encouraging questions, maintaining dignity and privacy

💡 Memory Hook

SHARED: Situation, History, Assessment, Risks, Escalation, Documentation and plan

📊 Synthesis Tables

Acute and Chronic Skin Conditions

Dimension	Acute conditions	Chronic conditions
Onset	Sudden	Long-term or recurrent
Duration	Short duration	More than 6 weeks
Course	May resolve with treatment	Require ongoing management
Common pattern	Often inflammatory or infectious	Often inflammatory or degenerative