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

2. 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

3. 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

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

5. 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.

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

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

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

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

10. 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

11. 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

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

13. 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.

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

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

16. 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

17. 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

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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. 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

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