Integumentary system

You are likely to shed some 40 pounds of skin in a lifetime One sixth body's mass. Eyelids have the thinnest skin Sole of heel has the thickest skin (all layers) Hair grows approx. 1 cm a month Average head of hair is around 120,000 Nails grow approx. .5 mm per week · You have 7 layers of flat, stacked cells. · An adult has 20 sq.ft of skin. · It’s your body’s largest organ. · An average adult’s skin spans 21 square feet, weighs 9 pounds, and contains more than 11 miles of blood vessels. · The skin releases as much as 3 gallons of sweat a day in hot weather. · Globally, dead skin accounts for about a billion tons of dust in the atmosphere. Your skin sheds 50,000 cells every minute.

Crash Course: Skin Deep

3 Main Layers of Tissue Epidermis Dermis Subcutaneous fascia or hypodermis

Epidermis Outermost layer of skin Does not contain nerve cells or blood vessels Made of 5 smaller layers of skin The 2 main layers are the: Stratum corneum – the outermost layer – these cells are constantly shed and replaced by the new cells of the stratum germinativum Stratum germinativum – the innermost layer

Dermis Also called corium or “true skin” Contains blood vessels, lymph vessels, nerves, involuntary muscle, sweat and oil glands, and hair follicles.

Subcutaneous Fascia or Hypodermis Innermost layer of the skin Made of elastic and fibrous connective tissue and adipose (fatty) tissue Connects skin to underlying muscles

Integumentary System has 2 Types of Glands Sudoriferous glands (sweat glands) Sebaceous glands (oil glands)

Glands Sudoriferous Glands Sweat glands Coiled tubes that extend through dermis Open on surface of skin called a pore Eliminate sweat or perspiration that contains water, salts, and some body wastes

Sudoriferous gland (sweat gland)

Glands Sebaceous Glands Oil glands Usually open on to a hair follicle Produce oil called sebum

Sebaceous Glands Produce Sebum (oil) Keeps hair from becoming dry and brittle Sebum is slightly acidic so it discourages growth of bacteria on skin Antibacterial and antifungal secretion so it also helps prevent infections Blackheads or pimples occur when oil glands become plugged with dirt and oil

Sebaceous Glands (oil glands)

Draw and Label Diagram of Skin DHO pg. 146 – draw, label, color Identify and label: Epidermis, dermis, hypodermis (subcutaneous), sweat pore, sudoriferous gland, sebaceous gland, artery, vein, sensory nerve ending, hair follicle, adipose (fatty)tissue, dermal papilla, arrector pili muscle

Read BS&F page 67: What are dermal papillae? What are the functions of papillae? Read BS&F page 68: What is the function of the arrector pili muscle?

Hair Hair consists of a root that grows in a hollow tube called a follicle, and a hair shaft Hair helps protect the body Covers all body surfaces except for the palms of the hands and the soles of the feet

Hair follicle

Nails Protects the fingers and toes from injury Are made of dead, ketatinized epidermal epithelial cells packed close together to form a thick, dense surface Cells are formed in nail bed If lost, nails will regrow if the nail bed is not damaged Pink hue is from vascularized dermal tissue beneath nail bed Lunula is active growing region

World’s Longest Nails!

Crash Course: Skin Deep Part 2

Functions of the Integumentary System Protection Sensory perception Regulation of body temperature Storage Absorption Excretion Production

Protection Serves as a barrier for sun’s ultraviolet rays Protects against invasion of pathogens or germs Holds moisture in and prevents deeper tissues from drying out

Sensory Perception Nerves present in skin Respond to pain, pressure, temperature (heat and cold), and touch sensations

Body Temperature Regulation Blood vessels in skin help body retain and 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 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 are absorbed through the skin such as transdermal medications (motion sickness patches, heart patches, nicotine patches

Excretion Helps body eliminate salt, a minute amount of waste, and excess water Done through perspiration and sweat

Production Skin helps in production of vitamin D Uses ultraviolet rays from the sun to form an initial molecule of vitamin D that matures in the liver

Create Foldable: Create a foldable of the 7 functions of the skin Include the function/description and picture/drawing Must be accurate, neat, interesting, colorful Use notes & text: DHO: pg 146 BS&F: pg 66

Pigmentation (skin color) Skin color is inherited and determined by pigments in the epidermis Melanin – brownish black pigment 1. leads to a black, brown, or yellow skin tint depending on racial origin 2. absorbs ultraviolet light to tan the skin 3. small concentrated areas of melanin pigment form freckles

Carotene – yellowish-red pigment Albino – absence of color pigments 1. skin has a pinkish tint 2. hair is pale yellow or white 3. eyes are red in color and very sensitive to light

Abnormal colors Erythema – reddish color; caused by burns or a congestion of blood vessels Jaundice – yellowish discoloration; can indicate presence of bile in blood as a result of liver or gallbladder disease Cyanosis – bluish discoloration; caused by insufficient oxygen; associate with heart lung and circulatory diseases

jaundice

cyanosis

Skin Lab Epidermis, dermis, hypodermis – terra cotta Hair follicle/shaft – terra cotta Sudoriferous gland – green Sebaceous gland – yellow Vein – blue Artery – red Page 146

Skin eruptions Macules – flat spots on the skin (freckles) Papules – firm raised areas (pimples) Vesicles – blisters or sacs full of fluid (chicken pox) Pustules – sacs filled with pus (acne or pimples) Crusts – areas of dried pus and blood (scab) Wheals - itchy, elevated areas with an irregular shape (allergic reaction) Ulcer – deep loss of skin surface that may extend into the dermis (deep cut)

macules

papules

vesicles

pustules

crusts

wheals

ulcer

Decubitus Ulcer Also called: bedsores or pressure sores Preventable Primary concern of healthcare workers

Risk Factors Aging confined to bed/wheelchair Dehydration/malnutrition Diminished reflexes Diseases such as diabetes Immobiliztion Incontinence Obesity Exposure to shearing/friction

S&S of Decubitus Ulcer Discoloration: light-skinned pt – red or dark purple Dark-skinned pt – area may appear darker than normal Odor Swelling Tenderness/pain Drainage

Application: BS&F pages 76-78 1. What causes a decubitus ulcer? 2. List 5 common sites for decubitus ulcers to develop. 3. Identify the 4 stages of decubitus ulcers. 4. What are the 2 best treatments for decubitus ulcers?

What causes a decubitus ulcer? They occur when a patient is constantly sitting or lying down in the same position without shifting his or her weight. The constant pressure causes a decrease to the blood supply and tissue decay develops.

5 Common Sites for Decubitus Ulcers to develop Spine Coccyx Hips Elbows heels

Bony prominences where decubitus ulcers are prone to develop

4 Stages of Decubitus Ulcers Stage I – reddened, skin not broken Tx: alleviate pressure

Stage II – blistered area Broken or unbroken skin Surrounding area red/irritated Tx: protect and clean area and alleviate pressure

Stage III – skin break through all areas High risk of infection Tx: medical tx required to prevent infection and promote healing

Stage IV – ulcerated area extends through skin, muscles, tendons, and bone Can be life-threatening Tx: surgical removal of necrotic (dead) or decayed tissue and antibiotics.

Stage IV Ulcer with necrotic tissue

What are 2 best treatments for decubitus ulcers? Prevention Frequent turning (q2h) and relief of pressure on bony prominences. Nursing staff must adhere to turning schedule. Teach family members of in home patients to turn q2h.

Additional preventive measures: Good diet – contributes to healing Skin care – clean and well moisturized Continence aids – pads, diapers, catheter Frequent skin inspection Products to relieve pressure – airbeds, alternating pressure mattresses, foam bed, gel pillows, continence aids

Application: 80 year old white female admitted to Room 310 with a dx of pneumonia. Appears thin and frail. Family reports she has become incontinent. Family reports she has been in bed for the past week. 1. What risk factors does she have for decubitus ulcers? 2. How would you assess this patient for decubitus ulcers?

Burns Traumatic injury resulting from Sun Water Steam fire Chemicals Some medications increase your sensitivity to sunlight > chance of sunburn

Severe burns can lead to dehydration and infection Both life-threatening conditions

Rule of Nines Measures the percent of body burned

Classification of Burns Burns classified as 1st, 2nd, 3rd degree burn depending on skin layers affected and symptoms

Application: Read the section in text on the classification of burns: BS&F : pgs 74-76 Make a trifold indicating the skin layers involved, symptoms, treatment, and approximate healing time for first, second and third degree burns

First Degree Epidermis only Sx: Redness, swelling, pain Tx: application of cold water Healing approx. 1week

Second Degree Epidermis and dermis Sx: Pain, swelling, redness, blistering Risk of infection Tx: pain meds and sterile dressings Healing approx. 2 weeks

Third Degree Epidermis, dermis, hypodermis Sx: Loss of skin, eschar (blackened skin), possibly no pain Can be life-threatening Immediate hospitalization Tx: prevent infection, contracture, fluid replacement