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Integumentary System
The Skin
What is the Largest organ?
What are some structures that make up the integumentary system?
Introduction
Called a membrane because it covers the body
Also called organ because it contains several kinds of tissues
Most studies call it a system because it has organs and other parts that work together for a particular function
Did you know?
On an average adult the skin covers more than 3000 square inches of surface area and accounts for about 15% of total body weight
1 square centimeter of skin contains: 15 sebaceous glands, 1 yard of blood vessels, 700 sweat glands, 3000 sensory cells at the end of nerve fibers, 4 yards of nerves, 25 pressure apparatus for the perception of tactile stimuli, 200 nerve endings to record pain, 2 sensory apparatuses for cold, 12 sensory apparatuses for heat, 3,000,000 cells, and 10 hairs.
Layers of the Skin Epidermis: Outermost layer of skin, made of
5-6 smaller layers; epithelial cells Two main layers:
Stratum corneum: outermost layer where cells constantly shed; cells have keratin which makes them waterproof; first line of defense against bacteria; thickest on palms and soles
Stratum germinativum: (reproductive layer) provides cells to replace cells in strata corneum
Contains no blood vessels or nerve cells (avascular)
Contains melanocytes that contain melanin Contains Keratin, a fibrous water repellent
protein
Dermis
Also call dorium or true skinHas framework of elastic
connective tissueContains blood vessels
(vascular), blood and lymph vessels, nerves, involuntary muscle, sweat and oil glands and hair follicles
Top of the Dermis
Covered with papillaeFit into ridges on the stratum
germinativum of the epidermisRidges form lines or striations on the
skinPattern of ridges is unique for each
individual- pattern is used for finger/footprints, used for identification
Glands of skin
Sebaceous glands: Oil glands Usually open onto hair follicle Produce oil called sebum, which keeps hair
from becoming dry and brittle, pimples occur when clogged with dirt and oil
Antibacterial and antifungal properties due to slight acidity of sebum
Arrector pili muscle – smooth muscle attached to follicle; causes “goosebumps”
Glands of skin
Sudoriferous glands: Sweat glandsCoiled tubes that extend through
dermisOpen on surface of the skin at an
opening called a poreSweat contains water, salt, and some
body wastesSweat is odorless, body odor occurs
when the sweat interacts with bacteria on the skin
Subcutaneous fascia or hypodermis
Innermost layer of skinMade of elastic and fibrous
connective tissue and adipose (fatty tissue)
Connects skin to underlying muscles
Other parts of the skin
Hair: consists of a root that grows in a hollow tube called a follicle, and a hair shaft, helps protect the body, covers all body surfaces except for the palms of the hands and soles of the feet
Alopecia or baldness: permanent loss of hair on the scalp, genetic condition, usually in men
Nails
Protect the fingers and toes from injury
Made of dead keratinized epidermal epithelial cells, which are packed closely together to form a thick dense surface
Cells formed in nail bedCells can be replaced if lost if nail
bed is not damaged
Let’s Review!!!
What percentage of body weight does the skin make up?
What is the outermost layer of the skin?
What is the Avascular layer?This layer is vascular?What hormone largely controls the
production of sebaceous glands?Which type of gland produces
sebum? What does sebum do?
Functions of the Integumentary System
ProtectionSensory perceptionRegulation of body temperatureStorageAbsorptionExcretionProduction
Protection:
Barrier for sun’s ultraviolet raysProtects against invasion of
pathogens or germsHolds moisture in and prevents
deeper tissues from drying out
Sensory perception
Nerves present in skinRespond to pain, pressure,
temperature (heat and cold), and touch sensations
Regulation of body temperature
Blood vessels in skin help body retain or lose heat
Dilate: blood vessels get larger and allow excess heat to escape through the skin
Constrict: blood vessels get smaller and retain heat
Sudoriferous (sweat) glands also help cool body through evaporation of perspiration
Storage:
Skin has tissues for temporary storage of fat, glucose (sugar), water, vitamins, and salts
Stores adipose tissue in the subcutaneous fascia, which is a source of energy
Absorption:
Certain substances absorbed through skin, but limited
Examples: medication for motion sickness (gel), ointments and creams, and heart patches, nicotine patches to stop smoking, pain medicine patches. Transdermal medications are sticky patches placed on the skin
Excretion:
Helps body eliminate salt, a minute amount of waste, and excess water
Done through perspiration or sweat
Production:
Skin helps produce vitamin DUses ultraviolet rays from the
sun to form an initial molecule of vitamin D that matures in the liver
PigmentationMelanin and Carotene determine skin
colorMelanin – brownish-black pigment; leads
to a black, brown, or yellow skin tint, depending on racial origin; absorbs UV rays to tan the skin; small concentrated areas form freckles
Carotene – yellowish-red pigment; helps determine skin color
Albino- lack of pigmentation; skin has pinkish tint and hair is pale yellow or white; eyes also lack pigment and are red in color and very sensitive to light
Abnormal colors of the skin can indicate disease
Erythema – reddish color of skin; causes can be burns, congestion of blood in the vellels
Jaundice – yellow discoloration of the skin; causes can be bile in the blood from liver or gallbladder disease, also associated with diseases that involve the destruction of red blood cells
Cyanosis – bluish discoloration of the skin; caused by insufficient oxygen; may be associated with heart lung, circulatory diseases
Chronic poisoning may cause a gray or brown skin discoloration
NAME THAT ABNORMAL COLOR….
REVIEW
Epidermis:
Dermis:
Hypodermis:
Functions
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4.
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Skin Eruptions: Ulcers
Also known as decubitus ulcers, pressure ulcers, or bed sores.
Localized areas of necrosis that develop when soft tissue is compressed between a bony prominence and an external surface for a prolonged period of time
Most common pressure points:
SacrumheelsElbowsNose, ear and genitalia from
tubes(catheters)
Any shearing force..
Which is the force that stretches the skin during turning or moving in bed, decreases blood flow.
Guidelines to prevent:
Adequate nutrition is important. A diet high in protein with enough calories, vitamins and minerals.
Frequently turn and position client to relieve pressure. Turn every 1 to 2 hours.
Use specialized beds and mattresses to distribute pressure on dependent body parts
Assessing Damage
Pressure ulcer staging systems are based on the depth of the tissue destroyed. If the nurse cannot see the bottom of the sore, staging cannot be done.
Four Stages of Pressure SoresStage 1Nonblanchable
erythema of intact skin.
May also have warmth, edema, induration or hardness
Stage 2Partial thickness
skin loss involving epidermis and/or dermis
Ulcer is superficial and presents as a blister, abrasion or shallow crater
Stages, cont.
Stage 3Full thickness
skin loss involving damage of subcutaneous tissue that may extend to fascia
Presents as a deep crater
Stage 4Full thickness
skin loss with extensive destruction, damage to muscle, bone, or supporting structures
Pictures of pressure ulcers
More pictures…
Risk Assessment
Early identification of at risk patients.
High risk/at risk patients include clients with neurological impairment, chronically ill long term care clients, and orthopedic clients.
Treatment
Stages 1, 2 and 3 : Local treatment: wound care, saline often used.
Occlusive dressings.Use clean technique.Stage 4: May involve surgery
REVIEW QUESTIONS…..
Other skin eruptions:Macules – ex. freckles (ephelides)Papules – ex. PimplesVesicles- ex. Blisters and Chicken poxPustules – ex. Pimples, ant bitesCrusts- ex. “scabs”, made up of dried
pus and bloodWheals- ex. Hives and insect bitesNodules – ex. a cyst / a small solid
bump
Medical Terminology – Appendix A of green text
A-Melan/o-cyteGermin/oSudor/ISeb/o
HypoDerm, dermat/oLip/oAdip/oTact/i
Diseases and Abnormal ConditionsAcne Vulgaris – inflammation of the
sebaceous glandsCause unknown, but usually occurs at
adolescence. Hormonal changes and increased secretion of sebum are probably underlying causes
Symptoms: papules, pustules, and blackheads
Treatment: frequent, thorough washing, avoidance of creams and heavy makeup, antibiotic or vitamin A ointments, oral antibiotics, and/or ultraviolet light treatments
Athlete’s foot- contagious fungal infection that usually affects the feet
Symptoms: itching, blisters, and cracks that turn into open sores
Treatment: antifungal medication and keeping the area clean and dry
Contagious
Athlete’s foot
Skin Cancer- most common type of cancer. There are 3 main types:
Basal cell- cancer of basal cells in epidermis of skin. Slow growing and does not usually spread. Lesions can be pink to yellow-white. They are usually smooth with a depressed center and an elevated, irregular-shaped border
Basal cell
Squamous cell- affects thin cells of the epithelium but can spread quickly to other areas of the body. Lesions start as small, firm, red, flat sores that later scale and crust. Sores that don’t heal are frequently squamous cell carcinomas.
Squamous cell
Melanoma- develops in the melanocytes of the epidermis and is the most dangerous type of skin cancer. The lesions can be brown, black, pink, or multicolored. They are usually flat or raised slightly, asymmetric and irregular or notched on the edges.
melanoma
Skin cancer often develops from a mole or nevus that changes in color, shape, size, or texture. Bleeding or itching of a mole can also indicate cancer. Exposure to the sun, prolonged use of tanning beds, irritating chemicals, or radiation are the usual causes of skin cancer. Treatment involves surgical removal of the cancer, radiation, and/or chemotherapy.
Dermatitis- inflammation of the skin. Can be caused by any substance that irritates the skin and is frequently an allergic reaction to detergents, cosmetics, pollen, or certain foods.
Ex. Poison ivy, poison oak, poison sumacSymptoms: dry skin, erythema, itching,
edema, macular-papular rashes, and scaling
Treatment: eliminating the cause, anti-inflammatory ointments, antihistamines, and/or steroids also used
dermatitis
Eczema- noncontagious, inflammatory skin disorder caused by an allergen or irritant. Diet, cosmetics, soaps, medications, and emotional stress can all cause eczema.
Symptoms: dryness, erythema, edema, itching, vesicles, crusts, and scaling
Treatment: removing the irritant, application of corticosteroids to reduce the inflammatory response
eczema
Impetigo- highly contagious, skin infection usually caused by streptococci or staphylococci organisms
Symptoms: erythema, oozing vesicles, pustules, and the formation of a yellow crust
Wash lesions with soap and water and keep dry.
Treatment: antibiotics (oral and topical)
impetigo
Psoriasis- chronic, noncontagious skin disease with periods of exacerbations and remission.
Exact cause unknown, but is an immune disorder. Scientists believe the immune system mistakenly activates a reaction in the skin cells, which speeds up the growth cycle of skin cells.
Stress, cold weather, sunlight, pregnancy, and endocrine changes tend to cause an exacerbation of the disease
Symptoms: thick, red areas covered with white or silver scales
No cure, but treatment includes: coal/tar or cortisone ointments, ultraviolet light, and/or scale removal
psoriasis
Ringworm- highly contagious fungal infection of the skin or scalp
Characteristic symptom- formation of a flat or raised circular area with a clear central area surrounded by an itchy, scaly, or crusty outer ring
Treatment: antifungal medicines, both oral and topical, are used
ringworm
Verrucae, or warts- viral infection of the skin
Plantar warts usually occur at pressure points on the sole of the foot. A rough, hard, elevated, rounded surface forms on the skin
Treatment: some may disappear spontaneously, but others must be removed with electricity, liquid nitrogen, acid, chemicals, or laser
Sebaceous cyst
Cyst of a sebaceous (oil) gland that contains yellow, fatty material
Commonly found on face, neck, and trunk
Benign, can cause problems with become large; can be painful; can become infected
Surgically removed, can return if all of “sac” not removed
Boil
A boil, also known as a furuncle is a skin abscess, a painful bump that forms under the skin - it is full of puss. A carbuncle is collection of boils that develop under the skin. When bacteria infect hair follicles they can swell up and turn into boils.
Cause: bacteria infect hair follicles Treatment: hot packs and lancing
Petechiae pinpoint, round spots that appear on
the skin as a result of bleeding under the skin
Caused from capillaries bleeding into the skin
Usually indicate another problemPossible causes: disruption of blood
clotting mechanisms; thrombocytopenia (low platelet count); side effect of some drugs; leukemia; lupus; measles; mononucleosis; rheumatoid arthritis; vitamin K deficiency (infants)
Cellulitis A type of bacterial skin infection;
appears as a swollen, red area of skin that feels hot and tender, and it may spread rapidly
More commonly affects lower legsCan spread to blood and lymph
systems, causing systemic life threatening infection
Lupus erythematosuschronic inflammatory disease that
occurs when your body's immune system attacks your own tissues and organs (autoimmune). Inflammation caused by lupus can affect many different body systems, including your joints, skin, kidneys, blood cells, heart and lungs
More common in womenSome people often have a
characteristic butterfly-shaped rash on bridge of nose and cheeks
Pediculosis (lice)tiny, wingless, parasitic insects that
feed on your blood. Lice are easily spread through close personal contact and by sharing belongings.
Lice can appear on scalp, body, pubic area
s/s : itching; tingling feeling; small red bumps; visible lice or eggs
Scabies a condition of very itchy skin caused
by tiny mites that burrow into your skin
Spread by close contact with someone who has scabies. Scabies can also be spread by sharing towels, bed sheets, and other personal belongings.
Direct skin to skin contactTreatment: scabicide drug (Elimite
(permethrin)
Keloid
raised growth of fibrous scar tissue that forms over an area of trauma to the skin and extends beyond the area of the original injury.
more common in young women and African Americans.
Scar tissue normally grows in response to a wound, but a keloid is an overgrowth of scar tissue over a healed wound
Chloasma (melasma) brownish pigmentation on the face
that develops slowly and fades with time. The pigmentation is due to overproduction of melanin by the pigment cells, melanocytes.
Usually seen in women; more common in people that tan well or have naturally dark skin
Causes: genetic predisposition; pregnancy; contraceptives; sun exposure; unknown
Birthmarks
Port wine stain: large, reddish purple discoloration of the face or neck; laser treatment
Strawberry hemangioma: soft, raised birthmark; dark, reddish purple growth is a benign tumor of newly formed blood vessels; usually resolve by 7 yoa but can be treated; benign but can be disfiguring
Hives (urticaria)
Skin condition characterized by localized swelling accompanied by itching that is associated with an allergic reaction
urtic – rashAria – means connected withTreatment: steroid creams,
antihistamines
REVIEW QUESTIONS…