Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 64: Introduction to the Integumentary System By: P.K. Williams,RN 01/ 29 Pg 1025

Words to Know [19] 02/29 Pg 1023 Apocrine glands Debridement Demis Eccrine glands Epidermis Hyphae Integument Keratin Melanin Pheromones Pressure sores Sebaceous glands Sebum Shearing Skin tear Stratum corneum Sweat glands Wood’s lamp

Learning Objectives [11] 03/29 Pg 1023 On completion of this chapter, you will be able to: Name the structures that form the integument. List four functions of the integumentary system. Identify the purpose of sebum and melanin. Differentiate between eccrine and apocrine glands. Name at least three facts about the integument that are pertinent to document when obtaining a health history Give the characteristics of normal skin. Describe the criteria for staging pressure sores.

Learning Objectives [11] 04/29 Pg 1023 List characteristics of hair assessed during a physical examination. Describe the characteristics of normal nails. Name four diagnostic tests performed to determine the etiology of skin disorders. 11. Describe seven medical and surgical techniques for treating skin disorders.

Skin*** 05/29 Pg 1023 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 06/29 Pg 1023/1024 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***

Integumentary*** System 07/29 Pg 1023 Structures covering the body’s exterior surface Figure 64-1, pg 1024

Question*** 08/29 Pg 1023 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 09/29 Pg 1024 True. The top superficial layer of the dermis contains the ridges which comprise the fingerprints.

Skin Functions*** 10/29 Pg 1024 /1025 Protection*** Temperature Regulation*** Radiation*** Conduction*** Evaporation*** Convection*** Sensory Processing*** Chemical Synthesis*** REVIEW: Gerontologic Considerations, pg 1025

Question 11/29 Pg 1023/1024 Is the following statement true or false? One of the primary functions of the skin is to protect the underlying structures.

Answer 11/29 Pg 1023/1024 True. One of the primary functions of the skin is to protect the underlying structures. Protection from pathogens and also from dehydration.

Hair*** 13/29 Pg 1025 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*** 14/29 Pg 1025 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 15/29 Pg 1025 Is the following statement true or false? Apocrine glands secrete fluid during perspiration.

Answer 16/29 Pg 1025 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*** 17/29 Pg 1026 Hard keratin; Protective function; Nail root Abundant capillary blood supply; Lunula [Like the quarter Moon]

Assessments*** 18/29 Pg 1026 HISTORY (Subjective) REVIEW: Bullet Points pg 1026 PHYSICAL (Objective) Skin Assessment

Assessments*** 19/29 Pg 1026 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**** 20/29 Pg 1027 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 D. Stage IV

Pressure Sore Staging*** 21/29 Pg 1023 Prevention Know common locations: See Figure 64-4, Identify at Risk: Box 64-1 pg 1029 REVIEW: Nutrition Notes 64-1 pg 1030 Stage 1 Redness = 0 Blanching [ Stage 2 Red & Blistering/ Shallow Break in skin Stage 3 Shallow Crater to Sub-Q tissue Stage 4 Deeply Ulcerated to Muscle & Bone

Assessments*** 22/29 Pg 1027 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:***23/29 Pg 1031/1031 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 24/29 Pg 1031 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***25/29 Pg 1032 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*** 26/29 Pg 1032 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*** 27/29 Pg 1032 Surgical Excision*** Laser therapy Acronym for LASER [Light Amplificationby the Stimulated Emission of Radiation]*** Precautions (cover eyes, prevent fires & burns from heated instruments) Cryosurgery [liquid nitrogen] Electrodessication [electrical heat; warts] Radiation Therapy: Treatment of malignant skin lesions

Medical, Surgical Treatment of Skin Disorders*** 28/29 Pg 1032 Photochemotherapy*** Combination of psoralen methoxsalen and ultraviolet Type 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!! 29/29 By: PK Williams,RN pkwilliams@DNI.edu