Integumentary Disorders Q 31

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Dr. Martinez prescribes an emollient for a client with pruritus of recent onset. The client asks why the emollient should be applied immediately after a bath or shower. How should the nurse respond?

  

    A. “This makes the skin feel soft.”

    B. “This prevents evaporation of water from the hydrated epidermis.”

    C. “This minimizes cracking of the dermis.”

    D. “This prevents inflammation of the skin.”

    

    

Correct Answer: B. “This prevents evaporation of water from the hydrated epidermis.”

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Applying an emollient immediately after taking a bath or shower prevents evaporation of water from the hydrated epidermis, the skin’s upper layer. The water content of the stratum corneum ranges from 10% to 30% in healthy skin, as compared to 75% to 85% water content of stratum basale. This gradient is a key feature in its function as a barrier.

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Option A: Although emollients make the skin feel soft, this effect occurs whether or not the client has just bathed or showered. The role of water within the stratum corneum is pivotal to the maintenance of normal skin integrity and turnover. Water allows for the increased flexibility of the tissues and is a crucial component of the enzymatic reactions responsible for cleavage of the corneodesmosome connections between corneocytes during the desquamation process.

Option C: An emollient minimizes cracking of the epidermis, not the dermis (the layer beneath the epidermis). The stratum corneum contains high concentrations of osmotically active molecules, including amino acids and their derivatives, lactic acid, urea, and electrolytes. These molecules form from the breakdown of filaggrin and are referred to as natural moisturizing factor (NMF). The molecules that make up NMF are hygroscopic and absorb atmospheric water at concentrations as low as 50%.

Option D: An emollient doesn’t prevent skin inflammation. The goals of moisturizing the skin are to improve the appearance and function of the skin. In patients with medical conditions associated with impaired barrier function of the skin, like atopic dermatitis, the diligent use of moisturizers is a fundamental component of their treatment.

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