A senior nursing student has been elected president of the Student Nurses Association.
Which of the following qualities is essential to being a nursing leader?

Skin breakdown:

Prolonged exposure to urine, especially in the presence of incontinence briefs, can irritate and macerate the skin, leading to breakdown.

Factors contributing to skin breakdown:

Moisture from urine:

Creates a warm, moist environment ideal for bacterial growth.

Disrupts the skin's natural barrier function, making it more susceptible to damage.

Friction from incontinence briefs:

Can rub against the skin, causing irritation and further damage.

Chemical irritants in urine:

Ammonia and other substances in urine can further irritate and damage the skin.

Signs of skin breakdown:

Redness, warmth, tenderness, or swelling of the skin.

Blisters, erosions, or ulcers.

Pain or discomfort.

Prevention of skin breakdown:

Frequent changing of incontinence briefs (as soon as they become wet or soiled).

Thorough cleansing of the skin with mild soap and water after each change.

Application of a skin barrier cream or ointment to protect the skin.

Use of breathable incontinence briefs that allow air to circulate.

Monitoring of the skin for signs of breakdown and seeking prompt medical attention if any occur. Urinary tract infections (UTIs):

Bacteria from the skin can enter the urinary tract through the urethra, leading to infection.

Factors increasing UTI risk in those with incontinence:

Incomplete bladder emptying:

Residual urine in the bladder provides a breeding ground for bacteria.

Use of incontinence briefs:

Can trap moisture and bacteria near the urethra.

Difficulty with personal hygiene:

May lead to the spread of bacteria from the skin to the urinary tract.

Signs of a UTI:

Frequent urination.

Pain or burning during urination.

Urgency to urinate.

Blood in the urine.

Cloudy or foul-smelling urine.

Prevention of UTIs:

Maintaining good personal hygiene.

Drinking plenty of fluids to help flush bacteria from the urinary tract.

Promptly emptying the bladder when the urge to urinate is felt.

Seeking medical attention if any signs of a UTI occur.

Choice A rationale:
Immobility: A bed-bound client is at the highest risk for pressure ulcer development due to prolonged pressure on bony prominences. The lack of movement prevents adequate blood flow to the tissues, leading to ischemia and tissue breakdown.
Age: Older adults have thinner, more fragile skin that is more susceptible to injury. They also have decreased subcutaneous fat, which provides less cushioning for bony prominences.
Nutritional status: Malnutrition is a significant risk factor for pressure ulcers, as it impairs wound healing and tissue repair. Incontinence: Urinary and fecal incontinence can irritate the skin and increase the risk of breakdown.
Chronic medical conditions: Many chronic medical conditions, such as diabetes, peripheral vascular disease, and neurological disorders, can impair blood flow and sensation, further increasing the risk of pressure ulcers.
Choice B rationale:
Mobility: A client who uses a cane is still able to ambulate, which helps to redistribute pressure and reduce the risk of pressure ulcers.
Age: While a 75-year-old client is still considered an older adult, they are less likely to be at risk than a bed-bound client.
Choice C rationale:
Mobility: A client who uses a walker is able to ambulate, although their mobility may be limited. This still helps to reduce the risk of pressure ulcers compared to a bed-bound client.
Age: A 92-year-old client is at a higher risk due to their age, but their mobility helps to mitigate this risk. Choice D rationale:
Mobility: A mobile client is at the lowest risk for pressure ulcer development, as they are able to frequently reposition themselves and relieve pressure on bony prominences.
Age: While an 83-year-old client is still considered an older adult, their mobility significantly reduces their risk.