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

2. 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

3. 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.

4. 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.

5. Skin*** /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***

6. 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***

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

8. Question*** /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.

9. Answer /29 Pg 1024
True.
The top superficial layer of the dermis contains the ridges which comprise the fingerprints.

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

11. Question /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.

12. Answer /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.

13. 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

14. 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

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

16. Answer /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.

17. Finger, Toenails*** 17/29 Pg 1026
Hard keratin; Protective function; Nail root
Abundant capillary blood supply; Lunula
[Like the quarter Moon]

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

19. Assessments*** /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

20. 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

21. Pressure Sore Staging*** 21/29 Pg 1023
Prevention
Know common locations: See Figure 64-4,
Identify at Risk: Box pg 1029
REVIEW: Nutrition Notes 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

22. 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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. Don’t even THINK
about going to sleep…
What TIME
is it???
NCLEX
Q & A TIME!!
29/29
By: PK Williams,RN