Integumentary system

You are likely to shed some 40 pounds of skin in a lifetimeOne 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.

3 Main Layers of Tissue

1. Epidermis2. Dermis3. 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

1. Sudoriferous glands (sweat glands)2. 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 GlandsOil glands

Usually open on to a hair follicleProduce oil called sebum

Sebaceous Glands Produce Sebum (oil)

• Sebum:– 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)

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!

• http://www.youtube.com/watch?v=d-IJhAWrsm0

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

Pigmentation (skin color)

• Skin color is inherited and determined by pigments in the epidermis

• Melanin – brownish black pigment1. leads to a black, brown, or yellow skin tint depending on racial origin2. absorbs ultraviolet light to tan the

skin3. 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

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:

• 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?

1. Prevention2. 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

• http://www.youtube.com/watch?v=HGpJWK0T28Q

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. Indicate 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

• http://www.youtube.com/watch?v=CNQ_uW66LfU