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Chapter 5 Integumentary System Jane Rice, RN, CMA-C.

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Presentation on theme: "Chapter 5 Integumentary System Jane Rice, RN, CMA-C."— Presentation transcript:

1 Chapter 5 Integumentary System Jane Rice, RN, CMA-C

2 Slide 26Acne Video Slide 31Skin Cancer Video Slide 34Wound Cultures Video Slide 68Wound Repair Animation Slide 69Wound Care Video Slide 75TB Testing Video Slide 85Decubitus Ulcer Video Slide 90Eczema Video

3  The integumentary system is composed of the skin and its accessory structures: hair, nails, sebaceous glands, and sweat glands.

4 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice

5  External covering of the body; it is the largest organ in the body and is well supplied with blood vessels and nerves.  The four main functions of the skin:  Protection  Regulation  Sensation  Secretion

6  PROTECTS AGAINST BACTERIA  PROTECTS AGAINST INJURY OF DELICATE CELSS BENEATH EPIDERMIS.  INHIBITS EXCESSIVVE LOSS OF WATER AND ELECTROLYTES, AND PROVIDES A RESERVIOR FOR STORING FOOD AND WATER.  GUARDS AGAINST EXCESSIVE EXPOSURE TO THE SUN  PRODUCES BODY’S SUPPLY OF VITAMIN D.

7  Blood vessels dilate to increase blood flow to the surface. Loose heat through Radiation.  Sweat glands are secreting more sweat for cooling through Evaporation.  When need to conserve heat, vessels constrict allowing more heat carrying blood to circulate to the muscles and organs.

8  Pain  Touch  Heat  Cold  Presure

9  Sudoriferous Gland (sweat gland)- millions of glands in the body.  Perspiration is largely water and small amount of salt and other compounds.  When left to accumulate, causes body odor, especially where it is trapped among hairs  Sebaceous Gland (oil glands)-  Sebum-oily secretion that acts to protect the body from dehydration and possible absorption of harmful substances.

10 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.1 The integument: the epidermis, dermis, subcutaneous tissue, and its appendages.

11  The two layers of the skin are the epidermis and the dermis.

12  Epidermis  Stratum Corneum The outermost, horny layer, consisting of dead cells filled with a protein substance called keratin. It forms the protective covering of the body that varies in thickness.

13  Epidermis  Stratum Lucidum A translucent layer lying directly beneath the stratum corneum. Is not seen in thin skin and is also composed of dead or dying cells.

14  Epidermis  Stratum Granulosum Consists of several layers of living cells that are in the process of becoming a part of the previously mentioned strata.

15  Epidermis  Stratum Germinativum The innermost layer is composed of several layers of living cells capable of mitosis or cell division. It is also called the mucosum or malpighii and is responsible for regeneration of the epidermis.

16  Dermis  Composed of connective tissue containing lymphatics, nerves and nerve endings, blood vessels, sebaceous and sweat glands, elastic fibers, and hair follicles.  Attached to underlying structures by subcutaneous tissue that supports, nourishes, insulates, and cushions the skin.  Also called the corium or true skin.

17  Dermis  Upper or Papillary Layer Arranged into parallel rows of microscopic structures called papillae. (produces ridges that are one’s fingerprints or footprints).

18  Dermis  Lower or Reticular Layer Composed of white fibrous tissue that supports the blood vessels.

19  Hair  A thin, threadlike structure formed by a group of cells that develop within a hair follicle or socket.  Each hair is composed of a shaft, which is the visible portion, and a root, which is embedded within the follicle.

20  Hair  At the base of the follicle is the: Hair papilla Pilomotor muscle

21  Nails  Horny cell structures of the epidermis that are composed of hard keratin.  Nail growth may vary with age, disease, and hormone deficiency.  The crescent-shaped white area of a nail is known as the lunula.

22  Nails  A nail consists of three parts: Body Root Matrix or nailbed

23 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.2 The fingernail, an appendage of the integument.

24  Sebaceous glands  The oil-secreting glands of the skin.  The tiny ducts open into the hair follicle, and their secretion lubricates the hair and the skin.  Sebum secretion, which is controlled by the endocrine system, varies with age, puberty, and pregnancy.

25  Sweat (sudoriferous) glands  The approximately 2 million sweat glands are coiled and tubular in structure.  They are distributed over the entire surface of the body with the exception of the margin of the lips, glans penis, and the inner surface of the prepuce.  The sweat glands secrete sweat or perspiration, which: Helps to cool the body by evaporation. Rids the body of waste through the pores of the skin.

26  In the fetus, the skin is transparent and blood vessels are clearly visible.  Vernix caseosa (a cheeselike substance) covers the fetus until birth.  At approximately weeks, lanugo hair develops, and at weeks, the skin is reddish and wrinkled.

27

28  Newborns are more sensitive to heat and cold because of a lack of subcutaneous fat.  Skin conditions can be acute or chronic, local, systemic, or congenital.  The hair of a child will vary in texture, quality, and distribution. It can become dry and brittle due to improper nutrition and lose color due to severe illness.

29  Age-associated disorders of the skin may include:  Milia White pinhead-size pimples that appear on the face and sometimes the trunk of a newborn.  Acne Also known as pimples, is an inflammatory condition of sebaceous glands and hair follicles.

30 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.3 Acne. (Courtesy of Jason L. Smith, M.D.)

31  The skin becomes looser (due to dermal papilla growing less dense).  Collagen and elastic fibers of the upper dermis decrease, skin loses its elastic tone, and skin wrinkles more easily.  The hair of older adults becomes somewhat gray, with scalp hair thinning, and becomes dry and brittle in both men and women.

32  Older women have an increase in facial hair, and men have an increased growth of the hair of the nares, eyebrows, or helix of the ears.  The nails flatten and become discolored, dry, and brittle.

33  Skin conditions common to older adults include:  Xerosis Dryness  Pruritus Itching  Premalignant/malignant skin lesions Carcinomas frequently appear on the nose, eyelid, or cheek. Basal cell carcinoma (BCC) accounts for 80% of skin cancers in the older adult.

34 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.4 Basal cell carcinoma. (Courtesy of Jason L. Smith, M.D.)

35 Click here to view a video on the topic of skin cancer.here Back to Directory

36 Click here to view a video on the topic of wound cultures.here Back to Directory

37 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.5 Photodermatitis. (Courtesy of Jason L. Smith, M.D.)

38 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.6 Alopecia areata. (Courtesy of Jason L. Smith, M.D.)

39 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.7 Male pattern alopecia. (Courtesy of Jason L. Smith, M.D.)

40 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.8 Brown recluse spider bites. (Courtesy of Jason L. Smith, M.D.)

41 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.9 Tick bite. (Courtesy of Jason L. Smith, M.D.)

42 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.10 Flea bites. (Courtesy of Jason L. Smith, M.D.)

43 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.11 Bulla. (Courtesy of Jason L. Smith, M.D.)

44 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.12 Burn, second degree. (Courtesy of Jason L. Smith, M.D.)

45 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.13 Candidiasis. (Courtesy of Jason L. Smith, M.D.)

46 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.14 Carbuncles. (Courtesy of Jason L. Smith, M.D.)

47 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.15 Cellulitis. (Courtesy of Jason L. Smith, M.D.)

48 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.16 Wound dehiscence, back. (Courtesy of Jason L. Smith, M.D.)

49 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.17 Dermatitis, poison ivy. (Courtesy of Jason L. Smith, M.D.)

50 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.18 Erythema infectiosum (Fifth disease). (Courtesy of Jason L. Smith, M.D.)

51 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.19 Staphylococcal folliculitis. (Courtesy of Jason L. Smith, M.D.)

52 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.20 Herpes labialis. (Courtesy of Jason L. Smith, M.D.)

53 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.21 Urticaria (hives). (Courtesy of Jason L. Smith, M.D.)

54 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.22 Impetigo. (Courtesy of Jason L. Smith, M.D.)

55 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.23 Keloid. (Courtesy of Jason L. Smith, M.D.)

56 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.24 Miliaria. (Courtesy of Jason L. Smith, M.D.)

57 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.25 Nevus (mole). (Courtesy of Jason L. Smith, M.D.)

58 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.26 Onychomycosis. (Courtesy of Jason L. Smith, M.D.)

59 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.27 Pediculosis capitis. (Courtesy of Jason L. Smith, M.D.)

60 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.28 Purpura. (Courtesy of Jason L. Smith, M.D.)

61 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.29 Roseola. (Courtesy of Jason L. Smith, M.D.)

62 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.30 Scabies. (Courtesy of Jason L. Smith, M.D.)

63 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.31 Photoaging solar elastosis; senile keratosis. (Courtesy of Jason L. Smith, M.D.)

64 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.32 Squamous cell carcinoma. (Courtesy of Jason L. Smith, M.D.)

65 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.33 Striae. (Courtesy of Jason L. Smith, M.D.)

66 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.34 Tinea corporis. (Courtesy of Jason L. Smith, M.D.)

67 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.35 Leg ulcer radiation site. (Courtesy of Jason L. Smith, M.D.)

68 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.36 Varicella (chickenpox). (Courtesy of Jason L. Smith, M.D.)

69 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.37 Planar wart. (Courtesy of Jason L. Smith, M.D.)

70 Click here to view an animation on the topic of wound repair.here Back to Directory

71 Click here to view a video on the topic of wound care.here Back to Directory

72  Emollients  Substances that are oily in nature.  Keratolytics  Promote loosening of the horny (keratin) layers of the skin.  Local anesthetic agents  Inhibit the conduction of nerve impulses from sensory nerves and thereby reduce pain and discomfort.  Antipruritic agents  Prevent or relieve itching.

73  Antihistamine agents  Act to prevent the action of histamine.  Antibiotic agents  Destroy or stop the growth of microorganisms.  Antifungal agents  Destroy or inhibit the growth of fungi and yeast.  Antiviral agents  Agents that combat specific viral diseases.

74  Anti-inflammatory agents  Relieve the swelling, tenderness, redness, and pain of inflammation.  Consist of: Topical corticosteroids. Treat dermatitis and psoriasis. Oral corticosteroids Used when symptoms are severe. Treats contact dermatitis, such as poison ivy.

75  Antiseptic agents  Prevent or inhibit the growth of pathogens.  Other Drugs  Retin-A (tretinoin) Used to treat acne vulgaris.  Rogaine (minoxidil) Used to stimulate hair growth.  Botulinum Toxin Type A (Botox Cosmetic) Approved by the FDA to temporarily improve the appearance of moderate to severe frown lines between the eyebrows.

76  Tuberculosis Skin Test  Test performed to identify the presence of the Tubercle bacilli.  The tine, Heaf, or Mantoux test may be used.

77 Click here to view a video on the topic of TB testing.here Back to Directory

78  Scratch (epicutaneous) or prick Test  Test involves the placement of a suspected allergen in the uppermost layers of the epidermis, usually on the skin of the forearm or back.  Redness or swelling at the scratch site within 10 minutes indicates allergy to the substance, rendering a positive test result.  If no reaction occurs, the test result is negative.  Sweat Test (chloride)  Test performed on sweat to determine the level of chloride concentration on the skin. In cystic fibrosis there is an increase in skin chloride.

79  Tzanck Test  Microscopic examination of a small piece of tissue that has been surgically scraped from a pustule to identify type of viral infection.  Wound Culture  Test done on wound exudates to determine the presence of microorganisms.  Biopsy (skin)  Small piece of living tissue from any skin lesion that exhibits signs or characteristics of malignancy is examined microscopically to establish a diagnosis.

80 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice

81  An area of skin and tissue that becomes injured or broken down.  The word decubitus, which means lying down, indicates the cause of pressure ulcers.  When a person sits or lies in a position too long, without shifting his or her weight, the constant pressure causes a decrease of blood supply to the area.  Without blood, the tissue dies and infection may occur, leading to systemic problems.

82  The ulcers are staged as follows:  Stage I  Stage II  Stage III  Stage IV

83 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.38 Pressure ulcer staging. (Courtesy of Sandra Quigley, Children’s Hospital, Boston, MA)

84 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.38 (continued) Pressure ulcer staging. (Courtesy of Sandra Quigley, Children’s Hospital, Boston, MA)

85 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.38 (continued) Pressure ulcer staging. (Courtesy of Sandra Quigley, Children’s Hospital, Boston, MA)

86 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.38 (continued) Pressure ulcer staging. (Courtesy of Sandra Quigley, Children’s Hospital, Boston, MA)

87 Click here to view a video on the topic of decubitus ulcers.here Back to Directory

88  A chronic skin disorder characterized by scaly and itching rashes.  It is most common in infants, and usually a chronic condition in adults.  Is also called atopic or contact dermatitis.

89  Medical treatment is stage dependent:  Weepy lesions Treated with moisturizers, mild soap, or wet dressings.  Dry scaly lesions Treated with mild anti-itch lotions or low-potency topical corticosteroids.

90  Medical treatment is stage dependent:  Chronic dry, thickened lesions Treated with ointments or creams that contain tar compounds, medium to very high potency corticosteroids, and ingredients that lubricate and soften the skin.  Severe cases Systemic corticosteroids to reduce inflammation.

91  The latest eczema treatment is a new class of nonsteroidal skin medications called topical immunomodulators (TIMS).

92 Click here to view a video on the topic of eczema.here Back to Directory

93  Common skin condition characterized by frequent episodes of redness, itching, and thick, dry scales on the skin.  Commonly begins in individuals between the ages of 15 and 35.  Thought to be an inherited, autoimmune disease.

94  The disease presents with a buildup of dead skin cells and the formation of thick scales within a few days versus the normal one-month period of time that it takes new skin cells to move up from lower layers to the surface.

95  Treatment varies with the extent and severity of the disorder:  Severe or resistant cases can require hospitalization.  Mild cases treated with topical medications.  Other treatments include nonpharmacologic and phototherapy.

96 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.39 Psoriasis, lower extremities. (Courtesy of Jason L. Smith, M.D.)

97  Disease in which malignant cells are found in the epidermis.  Three types of skin cells include squamous cells (flat, scaly cells on the surface), basal cells (round cells), and melanocytes (give skin its color).  Basal cell and squamous cell cancers  Melanoma

98  The ABCDs of melanoma describe the changes that occur in moles and include: A. Asymmetry B. Border C. Color D. Diameter

99 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.40 Melanoma, forearm. (Courtesy of Jason L. Smith, M.D.)

100  Objective evidence of an illness or disorder, which can be seen, measured, or felt.  May be described as lesions that are circumscribed areas of pathologically altered tissue.

101 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.41 Skin signs are objective evidence of an illness or disorder. They can be seen, measured, or felt.

102  First-Degree (superficial)  When only the outer layer of the skin is burned. The skin is red with some degree of swelling and pain  Cool the burn with running water or cold compresses to reduce swelling by conducting heat away from the skin.  DO NOT USE ICE  Cover the burn with clean gauze to keep air off the burned skin, reduce pain, and protect blistered skin.

103  Second-Degree (partial thickness)  The second layer of skin is burned. Blisters develop and the skin takes on an intensely reddened, splotchy appearance that presents with severe pain and swelling.  CALL 911 for emergency assistance if necessary: Remove the victim from contact with smoldering materials or exposure to smoke and heat, however DO NOT REMOVE BURNT CLOTHING.

104  Second-Degree (partial thickness)  Don’t immerse severe large burns in cold water because this could cause the victim to go into shock.  Check for signs of circulation and if indicated, start cardiopulmonary resuscitation (CPR).  Cover the area of the burn with cool, moist, sterile bandages, clean, moist cloth or moist towels.

105  Third-Degree (full thickness)  Burns involve all three layers of skin, usually destroying the sweat glands, hair follicles, and nerve endings.  Areas involved are generally charred black or appear dry and white.  Since the nerve endings have been burned, there is usually no pain involved.

106  The Rule of Nines estimates the extent of burns received by the patient.  It is expressed as a percentage of body surface area.  The body is divided into either sections, multiples, or divisions of 9 percent to accurately estimate the extent of the burns for fluid replacement therapy.

107 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.42 Characteristics of burns by depth of thermal injury.

108 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.43 Rule of Nines for burns (all numbers are percent of body surface).

109 Copyright ©2008 by Pearson Education, Inc. Pearson Prentice Hall Upper Saddle River, NJ Medical Terminology, 6e By Jane Rice Figure 5.44 Poison ivy. (Source: Pearson Education/PH College)


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