Upload
kimvmedrano123
View
220
Download
0
Embed Size (px)
Citation preview
8/8/2019 Medsurg Integumentary Ana&Physio
1/16
THE INTEGUMENTARY SYSTEM
FUNCTIONS OF THE SKIN:
Protection of our internal organs against invasion by bacteria and otherforeign matter; protects from constant effects of trauma
Thicker in our feet
The skin will always adapt to its uses, more protection for those used often
Sensation pain, light touch and pressure
First line for stimulus
Sensory receptors are mostly in our hands and foot
F & E Balance has the capacity to absorb water; retains moisture
in SQ; water evaporates thru skin insensible losses
Even if you soak yourself in a tub you absorb water
On the other hand, it is also lost thru perspiration
1
8/8/2019 Medsurg Integumentary Ana&Physio
2/16
Temperature Regulation heat is dissipated thru skin by 3
processes:
Radiation transfer of heat to another object of lower temperature situated at adistance (ex. skin gets warm when sitting near a fireplace)
Conduction transfer of heat to a cooler object in contact with it (ex. seat getswarm when one is sitting on it for a long time)
Convection movement of warm molecules away from the body heat
transferred by conduction to the air surrounding the body is removed by
convection. (ex. heat dissipates from the body when you enter an air-conditioned room)
Vitamin Production UV light from sun synthesize Vitamin D.
LAYERS OF THE SKIN:
EPIDERMIS outermost layer of skin; consists of ff. cells:
Keratin dead cells, insoluble, fibrous portion that forms outer barrier of skin;
principal hardening ingredients or hair and nails.
Melanocytes (cell) produces the pigment melanin which colors skin and
tissue
Merkel receptor that transmit stimuli to the axon
2
8/8/2019 Medsurg Integumentary Ana&Physio
3/16
Langerhans plays a role in the cutaneous immune system reaction (antibodies
that pass through the skin brings them to the lymph system which activates T-Cells to kill the invaders)
o Rete Ridges junction between dermis and epidermis; serves as another
layer between the two (provides nutrients to the epidermis from the
dermis)
o Fingerprints produced by the interlocking between dermis and epidermis
(produces ripples)
DERMIS often referred to as true skin; second layer; makes up
the largest portion of the skin; provides structure and strength; has 2 layers: made
up of blood and lymph vessels; nerves; sweat and sebaceous glands; hair roots.
Papillary lies beneath epidermis; composed of fibroblast cells that produces
collagen (which is a component of connective tissue which makes our skinsupple)
Reticular also produces collagen and elastic bundles
SUBCUTANEOUS innermost layer; also known as
hypodermis; primarily adipose tissues; fats are stored here
Function: skin mobility, molds body contours, insulates the body
SKIN GLANDS
SEBACEOUS GLAND associated with hair follicles; ducts empty out
sebum onto space between hair follicle and hair shaft
SWEAT GLAND formed in most part of the body except glans penis,
margin of lips, external ear and nail bed.
3
8/8/2019 Medsurg Integumentary Ana&Physio
4/16
ECCRINE GLAND ducts open directly to skin; produces thin,
watery sweat
APOCRINE GLAND larger and their secretion contains part ofsecretory cells; the ducts open to hair follicles; found in axilla, anal, scrotum
and labia majora; produces milky sweat
SKIN
APPENDAGES
HAIR
root formed in the dermis and shaftprojects beyond the skin
Cycles of Hair Growth
Anagen Phase growing phase everyday we grown 100,000/day)
Telogen Phase resting phase or shedding phase and you could loose 50 to 100/
day)
Function:
Provides protection
Provides insulation
Controlled by sex hormones: Androgens (beard, chest,back, legs); Testosterone (hirsutism in women)
4
8/8/2019 Medsurg Integumentary Ana&Physio
5/16
NAILS
Made of hard, transparent plate of keratin; grows from its root which lies under athin fold - cuticle:
Function: to protect finger, toes and their highly developed sensory function
Growth continues throughout life; fingernails grow faster than toenails
5
8/8/2019 Medsurg Integumentary Ana&Physio
6/16
SKIN ASSESSMENT:
COLOR:
Pallor pale (anemia, shock, albinism (absence of melanin), vitiligo
(destruction of melanocytes; patches of white
Cyanosis bluish (unoxygenated states)
Erythema red, pink (inc. blood flow, polycythemia vera RBC; carbon
monoxide poisoning, venous stasis
Jaundice yellowish (hepatic disorders)
Brown Tan bronzed (Addisons disease low levels of cortisol will stimulate
melanocytes to produce melanin)
6
8/8/2019 Medsurg Integumentary Ana&Physio
7/16
PRIMARY SKIN LESIONS:
Macule/Patch
Flat, non-palpable
Macule < 1 cm with circumscribed edges
Patch: > 1 cm, may have irregular borders
Ex: freckles, flat moles, petechia, vitiligo, ecchymosis
Papule/Plaque
Elevated, palpable solid mass with borders
Papule: < 0.5 cm
Plaque: > 0.5 cm
Vesicle/Bulla
Circumscribed, elevated, palpable mass containing serous fluid.
Vesicle: < 0.5 cm (ex. Herpes simplex, chicken pox, secondary burn blister
7
8/8/2019 Medsurg Integumentary Ana&Physio
8/16
Bulla: > 0.5 cm. (contact dermatitis; large bun blisters)
Pustule
Pus-filled vesicle or bulla
Ex: acne, impetigo, furuncles, carbuncles
Wheal
Elevated mass with transcalent borders; often irregular size and color vary Ex: urticaria, hives, insect bites
Nodule/Tumor
Elevated, palpable, solid mass; extends deeper into the dermis
Nodule: 0.5 to 2 cm circumscribed. (ex: lipoma, poorly absorbed injection)
babies after injection apply hot compress
Tumor: >1 to 2 cm; does not always have sharp borders (ex. larger lipoma
and carcinoma)
SECONDARY SKIN LESIONS:
Erosion
8
8/8/2019 Medsurg Integumentary Ana&Physio
9/16
Ulcer skin loss is past epidermis (bed sores)
Fissure linear crack in skin (chapped lips)
Scales desquamated dead skin (dry skin during cold or after beach or
swimming in pool)
Crust residue of serum, blood, pus on skin surface
Scar Cicatrix; healed wound or healed surgery incision Keloid hypertrophied scar tissue
Lichenification thickening and roughing of skin
VASCULAR SKIN LESIONS:
Petechiae: red, pinpoint macule associated with bleeding (ex. Denguehemorrhagic stage)
Ecchymosis associated with trauma and bleeding
9
8/8/2019 Medsurg Integumentary Ana&Physio
10/16
Cherry angioma red/purple, papular and round; N-age-related skin
alteration; no clinical significance
Spider angioma red, arteriole (S/SX: liver cirrhosis) lesions associatedwith liver disese. Vitamin B. Deficiencies
Telangiectasia venous star; varicosities
COMMON NAIL DISORDERS
10
8/8/2019 Medsurg Integumentary Ana&Physio
11/16
ALOPECIA/BALDNESS
LABORATORY/DIAGNOSTIC EXAMINATIONS
SKIN BIOPSY
Tissue of skin removed for exam
Either by scalpel excision or skin punch instrument
Dermal punch: an electrical punch that can penetrate skin to a
certain depth
Mgt: Clean area with antiseptic solution; local anesthesia applied;specimen examined by histologist.
PATCH TESTING
Identifies substances to which the patient is sensitive to
Patch left 24 to 48 hours
20 minutes after, it is removed a reading is made
11
8/8/2019 Medsurg Integumentary Ana&Physio
12/16
Reading
Weak (+): redness, fine bumps, itching
Moderate (+): fine blisters, papules, severe itching
Strong (+): blisters, pain, ulceration
SKIN SCRAPINGS
Samples are scraped from a suspected fungal lesion with a scalpel
blade which is moistened with oil
Sample are transferred to the slide to be examined
TZANCK SMEAR
Examine cells of blistering conditions (herpes zoster, varicella,
herpes simplex)
Secretions are transferred to a glass slide and stained and examined
IMMUNOFLUORESCENCE
Identify site of an immune reaction Combines antigen or antibody with a fluorochrome dye
Antigen/antibody can be made fluorescent by attachment to dye
Detects auto-antibodies directed against portion of the skin
WOOD LIGHTS EXAMINATION
Uses a special lamp which produces long warm UV rays which results in darkpurple fluorescence
Differentiates epidermal from dermal lesions; hyperpigmentation/hypopigmentation
from normal skin
Color of light best seen in darkened room
Light not harmful to skin and eyes
Lesions with melanin disappears with light
Lesions without melanin increased in whiteness with light
CLINICAL PHOTOGRAPHS
Photographs are taken to record extent and progression of skindisorder
Before and after photos
GOALS OF CARE FOR INTEGUMENTARY SYSTEM
1. Protecting the skin (bathing, using mild soap, drying thoroughly, changingdressings)
2. Preventing secondary infections (adhere to standard precautions, handwashing &
gloving, proper disposal of contaminated dressings; keep nails short & avoidscratching)
3. Reversing inflammatory Process (local or topical medications)
12
8/8/2019 Medsurg Integumentary Ana&Physio
13/16
INTERVENTIONS:
1. WOUND CARE
Wound a disruption in the continuity and regulatory processes of tissue cells
Wound Healing the restoration of the skin continuity; may or may not restore
normal cellular function
I. PHYSIOLOGY OF WOUND HEALING
A. Inflammatory Phase (lasts 1-5days) vascular & cellular response
B. Proliferative Phase (lasts 2-20 days) granulation periodC. Maturation Phase (21 days to months & even years) collagen production & scar
formation
II. TYPES OF WOUND HEALING
A. First-Intention Healing (Primary Union)
Wounds are made aseptic with a minimum of tissue damage & tissue reaction;
wound edges are properly approximated with sutures
Granulation tissue is not visible and scar formation is typically minimal
B. Second-Intention Healing (Granulation)
Wounds are left open to heal spontaneously or surgically closed at a later date
Examples: burn, traumatic injuries, ulcers, suppurative infected wounds
Produces a deeper, wider scar
III. DEGREE OF CONTAMINATION
A. CLEAN: an aseptically made wound, as in surgery, that does not enter thealimentary, respiratory, or genito-urinary tracts
B. CLEAN-CONTAMINATED: as aseptically made wound that enters the
respiratory, alimentary, or GU tracts; wounds have a slightly higher probability of
wound infection than do clean woundsC. CONTAMINATED: wounds exposed to excessive amounts of bacteria; wounds
may be open or accidentally made or the result of surgical operations in which
there are major breaks in aseptic techniques or gross spillage from GI tractD. INFECTED: a wound that retains devitalized tissue or involves existing infection
or perforated viscera; such wounds are left open to drain
IV. DRESSINGS
Principles:
a. Dressing change depends on patient, wound & dressing assessment not onstandardized routines; but traditionally 3-4x/day
b. Natural wound healing process should not be disrupted; chronic wounds covered
for 48-72 hours; acute wounds covered for 24hours; unless wound is with heavydischarges
Purposes:
a. Protect the wound from mechanical injury
13
8/8/2019 Medsurg Integumentary Ana&Physio
14/16
b. Splint or immobilize the wound
c. Absorb drainage
d. Prevent contamination from bodily discharges (feces, urine)e. Promote hemostasis, as in pressure dressings
f. Debride the wound by combining capillary action & the entwining of necrotic
tissue within its mesh
g. Inhibit or kill microorganisms by using dressings with antiseptic or antimicrobialproperties
h. Provide physiologic environment conducive to healingi. Provide mental & physical comfort for the patient
TYPES OF DRESSINGS:
A. WET DRESSINGS
Wet compress is applied to skin
Indicated for acute weeping, inflammatory lesions (vesicles, bullae, pustules,
ulcers)
Could be sterile or clean technique depending on the disorder
Purposes:
a. Reduce inflammation by producing constriction of blood vessel
b. Clean exudates, crusts, & scalesc. Maintain drainage of infected areas
d. Promote healing by facilitating free movement of epidermal cells across
involved skin so new granulation could form
Wet-to-Dry Dressing:
Particularly useful for untidy or infected wounds that must be debrided & closedby secondary intention
Gauze saturated with sterile saline or antimicrobial solution is packed into the
wound
The wet dressing is then covered by dry dressing
As drying occurs, wound debris & necrotic tissue are absorbed into gauze
dressing
The dressing is changed when it becomes dry
Wet-to-Wet Dressing:
Used on clean open wounds or on granulating surfaces; sterile saline or anantimicrobial agent may be used to saturate the gauze
Provide a more physiologic environment (warmth & moisture) which can enhancethe local healing processes as well as assure patient of greater patient comfort;
thick exudates is more easily removed
Disadvantage surrounding tissues can become macerated, the risk of infection
may rise, and bed linens become damp
B. MOISTURE-RETENTIVE DRESSINGS
Performs same function as wet dressing
14
8/8/2019 Medsurg Integumentary Ana&Physio
15/16
More efficient in removing exudates because of moisture-vapor transmission rate
Has reservoir that can hold excessive exudates
Already impregnated with saline solution, zinc-saline solution, hydrogel,
antimicrobial agents
Advantages: reduced pain, fewer infections, less scar tissue, gentle debridement,
frequency of dressing change
Forms: Hydrogels, Hydrocolloids, Foams, Ca. Alginates
C. DRY-TO-DRY DRESSINGS
Used primarily for wounds closing by primary intention
Offers good wound protection, absorption of drainage, & provides pressure (if
needed) for hemostasis
Disadvantage they adhere to the wound surface when drainage dries; removal can
cause pain & disruption of granulation tissue
D. OCCLUSIVE DRESSINGS
Commercially produced or from sterile or clean gauze squares or wrap Purpose: cover topical meds applied to dermatosis
Kept airtight by using plastic film (thin & readily adapts to size, body shape & skin
surface)
Should be used no more than 12 hours each day
WOUND DRAINAGE
Placed on wounds only when abnormal fluid collections are present or expected
Collection of body fluids in wounds can be harmful: provides media for bacterial
growth, pressure in wound site interfering with blood flow to the area, causespressure on the adjacent area, causes local irritation & necrosis due to fluids such as
pus
Commonly made of soft rubber or plastic & placed within wounds typicallyattached to portable suction with a collection bottle
Drains within wounds are removed when the amount of drainage over a period of
days
2. THERAPEUTIC BATH
BALNEOTHERAPY bath or soaks; useful when large areas of skin are affected
Purposes:
a. Removes crusts, scales & old medications
b. Relieve inflammation & itching that accompany acute dermatoses
Principles: water temperature must be comfortable to the patient; should not exceed20-30 minutes to avoid skin maceration
15
8/8/2019 Medsurg Integumentary Ana&Physio
16/16
Bath Solutions:
a. Water same effect as wet dressing; fill the tub half-fullb. Saline for widely disseminated lesions; keep water at comfortable temperature
c. Colloidal (Aveeno, Oatmeal) antipruritic, soothing; dont allow water to cool
excessivelyd. Sodium Bicarbonate (Baking Soda) cooling; use bath mat; causes tub to be
slipperye. Starch soothing; same mgt as baking soda
f. Medicated Tars (Balnetar, Doak Oil, Lavatar) for psoriasis, chronic eczema;apply emollient cream to damp skin after bath
g. Bath Oils antipruritic & emollient action
16