The Interesting (often overlooked, yet totally obvious)

Integumentary System

Ms. Bjorge

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The Interesting Integumentary System

• Inte = whole

• gument = body covering

• System consists of the skin, hair, nails– Also includes some glands, muscles, nerves

and connective tissues

• Most visible body system

What does the Integumentary System do?

• Creates a boundary between the outside and our insides.– Protects against bacterial infection.– Protects against ultraviolet light.

• Helps maintain constant body temperature.

• Provides some sensory information about the environment.

Layers of the Skin

Layers of the Skin - Epidermis

• 90% of cells are keratinocytes (they make keratin)

• 8% of cells are melanocytes (pigment)

• Langerhans cells– Made from red bone marrow– Aid in immune responses

against microbes

• Merkel cells– Fewest number of cells, in

deepest layer (Stratum basale)

– They contact nerve cells and allow sense of touch

Layers of the Skin

• Dermis– Superficial = papillary

region• Dermal papillae connect to

epidermis, contain capillaries

• Meissner corpuscles – sense touch (pressure)

– Deeper = reticular region• Collagen and other

connective cells• Adipose cells, hair folicles,

sebaceous (oil) and sudoriferous (sweat) glands

How does the skin provide protection?

• Against dehydration:

– Lipids are released from lamellar granules found in keratinocytes.

– Sebaceous gland secretions are oily

How does the skin provide protection?

• Against microbes:

– Keratinocytes are tightly interlocked, resist bacterial entry into deeper layers.

– Sebaceous gland secretions can have antimicrobial properties.

– Langerhans cells in epidermis can signal to immune system

How does the skin thermoregulate?

• Skin releases sweat through the sudoriferous glands– Evaporation once at surface lowers body

temperature.

• Dermis contains network of blood vessels that contain 8-10% of blood flow in resting adult.– When blood vessels in dermis constrict, blood moves

away from skin.• Skin temperature decreases.• Internal body temperature tends to increase.

Common Skin Disorders

• Acne – Affects teenagers and women in their thirties– Exact cause unknown (involves sebaceous glands,

hair follicles and hormones)

• Eczema (Atopic Dermatitis)– Itchy, dry, hypersensitive skin– Exact cause unknown (hereditary, hay fever/asthma)– Skin can thicken, turn into crusty rash

• Skin Cancer

Shingles

• Caused by virus that also causes chickenpox

– Virus remains dormant in nerve cells then reactivates.

– Reactivation enhanced by depression of immune system

Shingles

• Symptoms– burning pain or tingling, extreme sensitivity in one

area of the skin

– 2-3 days later: red rash occurs

– Group of blisters with a red base (looks like chicken pox); generally last two to three weeks

• Blisters accumulate pus, crust over, then disappear

– Pain• May be long lasting. • Doctors may prescribe painkillers.

Shingles

• Appearance– Generally affects one side of the body– Blisters common on trunk, buttocks, genitalia.

Shingles

• Complications– Post-herpetic neuralgia: constant/episodic pain – Infection of blisters (treat with antibiotics) – High fever and spread of disease over entire body – Blisters in eye area can cause permanent damage. A

specialist should be consulted.

Soft Tissue Injuries

Soft Tissue:

The top layers of skin, muscle, fat that protect the underlying body structures.

All soft tissue injuries are called wounds

Includes: open/closed wounds and burns

Soft Tissue Injuries

Closed wounds

Bruises

Open wounds

Abrasion

Laceration

Avulsion

Puncture

Burn Victims

• Stop the burn, make sure that your patient can breathe, has heartbeat.

• What affects burn severity?– Depth of burn– Type of burn (chemical, wet heat, dry heat)– If heat – temperature– Contact time– Thickness of skin

• Complication: children and elderly have thinner skin

Burn Victims – Initial Assessment

• Can the burn get worse?– Contact with heat or chemical source– Decrease in blood flow and shock– Infection

• How deep is the burn?– Depth defined by how

much of epidermis and dermis is destroyed by heat source.

• 1st Degree: epidermis only• 2nd Degree: epidermis and part of dermis involved.• 3rd Degree: epidermis AND dermis destroyed.

Burn Victims – Rule of Nines

• Whole Head = 9 %

• Front = 18%

• Back = 18%

• Each arm = 9%

• Groin = 1%

• Each Leg = 18 %

Treatment of First Degree Burn Victims

• Patient Challenges– They will be in PAIN!– Can involve young children

• Appearance– Red and dry

• Treatment – Cool Burned skin

• Prognosis– Burn should heal within 5 to 6 days without permanent scaring

Treatment of Second Degree Burn Victims

• Patient Challenges– They will be in PAIN!– Can involve young children

• Appearance– Pink to red appearance– Blister formation

• CAUTION: Frequently, epidermis does not lift off the dermis for 12 to 24 hours and what appears initially to be a first degree is actually a second-degree burn.

• Treatment – Clean wound– Apply neomycin or water-soluble topical antibiotic. Could instead apply

synthetic skin substitute.• Antibiotics may slow healing, though.

– May need to apply soft gauze dressing.• Prognosis

– If no infection, wound healed in 7-14 days.– Minimal scarring

Treatment of Third Degree Burn Victims

• Appearance– Initial: tissue is a waxy white color– If burn produces char or extends into fat:

leathery brown or black appearance, surface coagulation veins. 

– Wound has coarse non-pliable texture to touch. 

• Treatment – Transfer to Burn Center– Gentle washing with antibacterial soap. – Silver sulfadiazine using a closed dressing twice a day. – Or use of a silver impregnated dressing – Cold is not beneficial once the burning has stopped as pain is minimal.

• Prognosis– Except for a very small wound, the burn wound will require excision

and a skin graft.

Severity of Burn

Types of Burns:1.Heat (Thermal)2.Chemical3.Electrical4.Radiation

Thermal (Heat) Burns

Assess and monitor breathing

3 basic steps:

Cool the burned area

Cover burned area

Minimize shock

Other types of burns

Chemical

Flush with water

Electrical

Do not cool with water

Cover and minimize shock

Radiation

Solar or other type of radiation

Sunburn is the most common

Cellular Basis of Skin Color

• Melanocytes in epidermis produce melanin– Number of melanocytes is the same for ALL races.

• Melanin is produced from tyrosine– Enzyme = tyrosinase– Tyrosinase activity increases with exposure to UV

light.

• Other skin pigments include carotene and hemoglobin

Skin Color as a Diagnostic Tool

• Cyanosis– Skin, nail beds and mucous membranes

appear blue.– Blood lacks oxygen

Skin Color as a Diagnostic Tool

• Jaundice– Skin and “whites” of

eyes appear yellow– Caused by build up of

bilirubin, a pigment– Breakdown of blood

cells produces bilirubin– Could mean that too

many blood cells are being destroyed or the liver isn’t able to remove from system.

Skin color as a Diagnostic Tool

• Erythema– Redness of skin– Caused by dialated capillaries

• Become engorged with blood

– Causes:• Injury• Heat exposure• Infection• Inflammation• Allergic reactions

Skin Color as a Diagnostic Tool

• Petichia (plural – petichiae)– Tiny red spots in skin caused by broken

capillaries (hemorrhage)– Can be a sign of low platelet counts in blood

Interesting Facts about the Integumentary System

• Your skin is the largest organ of your body.

• For the average adult, your skin:– covers about 2 square meters.– weighs about 10-11 pounds (this is 16% of

total body weight)

Homework and Review

Read in book pages 243 – 249 (Dressings, Role of the First Responder, and Infection)

Complete Matching and Case Study 12.1 and 12.2

Quiz on Burns, Wounds, Dressings on Wednesday

Body Systems Presentation

• System Order:– Integumentary System– Muscular System – Skeletal System– Nervous System– Endocrine System– Cardiovascular System– Lymphatic System – Respiratory System– Digestive System– Urinary System