Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 64: Introduction to the Integumentary System

Skin Introduction The integument includes structures that cover the body’s exterior surface Primary structure is skin, which contains sebaceous/sweat glands/sensory nerve endings Includes hair & nails Protects the body from environmental injuries, helps regulate temperature, serves as sensory organs & facilitates the synthesis of Vitamin D

Skin Two Layers Epidermis: Replaced ≈ every 35 to 45 days Dermis: Ridges: Create a unique pattern of finger, palm, and footprints; Facilitate the ability to grip and hold objects Subcutaneous tissue: Skin attached to muscle, bone; Connective tissue, fat cells Melanin gives the skin its color

Structures covering the body’s exterior surface Integumentary System Structures covering the body’s exterior surface Figure 64-1, pg 1024

Question Is the following statement true or false? The epidermis is replaced with new cells every 35 – 45 days. The next layer, the dermis, contains the ridges which comprise the fingerprints.

Answer True. The top superficial layer of the dermis contains the ridges which comprise the fingerprints.

Skin Functions Protection Temperature Regulation Radiation; Conduction Evaporation; Convection Sensory Processing Chemical Synthesis REVIEW: Gerontologic Considerations, pg 1025

Question Is the following statement true or false? One of the primary functions of the skin is to protect the underlying structures.

Answer True. One of the primary functions of the skin is to protect the underlying structures. Protection from pathogens and also from dehydration.

Hair Originates in hair follicle in dermis Vellus hair; Terminal hair Keratin + amino acids = hair Scalp hair grows most rapidly Hair growth slows by midlife Decreased melanin production causes graying hair

Sebaceous, Sweat Glands Connected to each hair follicle Secrete sebum (oily substance) More active during puberty Sweat Glands Eccrine glands Apocrine glands REVIEW: Gerontologic Considerations, pg 1026

Question Is the following statement true or false? Apocrine glands secrete fluid during perspiration.

Answer True. Apocrine glands secrete fluid during perspiration. They also secrete a substance in the external ear canals called cerumen. In animals, apocrine glands secrete pheromones.

Finger, Toenails Nails Hard keratin; Protective function; Nail root Abundant capillary blood supply; Lunula

Assessments HISTORY (Subjective) REVIEW: Bullet Points pg 1026 PHYSICAL (Objective) Skin Assessment

Assessments REVIEW: Skin Color Variations, Table 64-1 pg 1027 REVIEW: Various Skin Lesions, Table 64-2 pg 1028 REVIEW: Stop Think & Respond 64-2 pg 1029 REVIEW: Pharmacy Considerations, pg 1027 REVIEW: Gerontologic Considerations, pg 1027

Pressure Sore Staging Pressure Sore Staging Stage I: Redness Stage II: Blistering or skin tear Stage III: Shallow crater with drainage Stage IV: Deep ulcerated tissue; Exposed muscle and bone; Sepsis

Pressure Sore Staging Prevention Know common locations: see Figure 64-4, pg 1029 Identify at Risk: Box 64-1 pg 1029 REVIEW: Nutrition Notes 64-1 pg 1030

Assessments Scalp, Hair Assessment Skin: Smooth; Intact; Free of lesions Assess: Color, texture, and distribution Abnormal findings: Nits or lice; Scales, flaking skin, tight shiny skin = edema/fluid retention Nail Assessment Check for normal structure Assess: Change in shape or thickness; Color of nailbed; Capillary refill time

Integumentary Diagnostic Tests, pg 1030 -1031 Visual Inspection Culture and Sensitivity Tests Allergy Tests Wood’s Light Examination Potassium Hydroxide Test Fungal Culture Skin Biopsy

Medical, Surgical Treatment of Skin Disorders Drug Therapy Corticosteroids; Antihistamines Antibiotics; Antiseptics Scabicides; Pediculicides Antiseborrheic agents Keratolytics Standard precautions in application of topical medication over impaired skin REVIEW: Pharmacy considerations pg 1032

Medical, Surgical Treatment of Skin Disorders Wet Dressings Cooling, soothing effect Sterile procedure for broken skin Dry gauze placed on area is saturated with prescribed solution Dressing anchored Left in place until dry as a method of debridement

Medical, Surgical Treatment of Skin Disorders Therapeutic Baths No soaps; Warm water Gentle application of solution to submerged parts Inflammation and itching relief Aid in removal of crusts and scales Products used: Oatmeal; Cornstarch; Baking soda; Mineral oil

Medical, Surgical Treatment of Skin Disorders Surgical Excision Laser therapy Acronym for LASER Precautions (cover eyes, prevent fires & burns from heated instruments) Cryosurgery Electrodessication Radiation Therapy: Treatment of malignant skin lesions

Medical, Surgical Treatment of Skin Disorders Photochemotherapy Combination of psoralen methoxsalen and ultraviolet A light Lifestyle Changes Tiredness or emotional stress aggravates condition Rest, sleep, and diet are important factors in treatment

Don’t even THINK about going to sleep… What TIME is it??? NCLEX Q & A TIME!!