1. Integumentary System
The Skin

2. Introduction Called a membrane because it covers the body
Also called organ because it contains several kinds of tissues
Most studies call it a system because it has organs and other parts that work together for a particular function

3. Did you know?
On an average adult the skin covers more than 3000 square inches of surface area and accounts for about 15% of total body weight
1 square centimeter of skin contains: 15 sebaceous glands, 1 yard of blood vessels, 700 sweat glands, 3000 sensory cells at the end of nerve fibers, 4 yards of nerves, 25 pressure apparatus for the perception of tactile stimuli, 200 nerve endings to record pain, 2 sensory apparatuses for cold, 12 sensory apparatuses for heat, 3,000,000 cells, and 10 hairs.

4. Layers of the Skin
Epidermis: Outermost layer of skin, made of 5-6 smaller layers; epithelial cells
Two main layers: Stratum corneum: outermost layer where cells constantly shed; cells have keratin which makes them waterproof; first line of defense against bacteria; thickest on palms and soles
Stratum germinativum: (reproductive layer) provides cells to replace cells in strata corneum
Contains no blood vessels or nerve cells (avascular)
Contains melanocytes that contain melanin
Contains Keratin, a fibrous water repellent protein

5. Dermis Also call dorium or true skin
Has framework of elastic connective tissue
Contains blood vessels (vascular), blood and lymph vessels, nerves, involuntary muscle, sweat and oil glands and hair follicles

6. Top of the Dermis Covered with papillae
Fit into ridges on the stratum germinativum of the epidermis
Ridges form lines or striations on the skin
Pattern of ridges is unique for each individual- pattern is used for finger/footprints, used for identification

7. Glands of skin Sebaceous glands: Oil glands
Usually open onto hair follicle
Produce oil called sebum, which keeps hair from becoming dry and brittle, pimples occur when clogged with dirt and oil
Antibacterial and antifungal properties due to slight acidity of sebum
Arrector pili muscle – smooth muscle attached to follicle; causes “goosebumps”

8. Glands of skin Sudoriferous glands: Sweat glands
Coiled tubes that extend through dermis
Open on surface of the skin at an opening called a pore
Sweat contains water, salt, and some body wastes
Sweat is odorless, body odor occurs when the sweat interacts with bacteria on the skin

9. Subcutaneous fascia or hypodermis
Innermost layer of skin
Made of elastic and fibrous connective tissue and adipose (fatty tissue)
Connects skin to underlying muscles

11. Other parts of the skin
Hair: consists of a root that grows in a hollow tube called a follicle, and a hair shaft, helps protect the body, covers all body surfaces except for the palms of the hands and soles of the feet
Alopecia or baldness: permanent loss of hair on the scalp, genetic condition, usually in men

12. Nails Protect the fingers and toes from injury
Made of dead keratinized epidermal epithelial cells, which are packed closely together to form a thick dense surface
Cells formed in nail bed
Cells can be replaced if lost if nail bed is not damaged

13. Functions of the Integumentary System
Protection
Sensory perception
Regulation of body temperature
Storage
Absorption
Excretion
Production

14. Protection: Barrier for sun’s ultraviolet rays
Protects against invasion of pathogens or germs
Holds moisture in and prevents deeper tissues from drying out

15. Sensory perception: Nerves present in skin
Respond to pain, pressure, temperature (heat and cold), and touch sensations

16. Regulation of body temperature :
Blood vessels in skin help body retain or 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 (sweat) glands also help cool body through evaporation of perspiration

17. 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

18. Absorption: Certain substances absorbed through skin, but limited
Examples: medication for motion sickness (gel), ointments and creams, and heart patches, nicotine patches to stop smoking, pain medicine patches. Transdermal medications are sticky patches placed on the skin

19. Excretion:
Helps body eliminate salt, a minute amount of waste, and excess water
Done through perspiration or sweat

20. Production:
Skin helps produce vitamin D
Uses ultraviolet rays from the sun to form an initial molecule of vitamin D that matures in the liver

21. Pigmentation Melanin and Carotene determine skin color
Melanin – brownish-black pigment; leads to a black, brown, or yellow skin tint, depending on racial origin; absorbs UV rays to tan the skin; small concentrated areas form freckles
Carotene – yellowish-red pigment; helps determine skin color
Albino- lack of pigmentation; skin has pinkish tint and hair is pale yellow or white; eyes also lack pigment and are red in color and very sensitive to light

22. Abnormal colors of the skin can indicate disease
Erythema – reddish color of skin; causes can be burns, congestion of blood in the vellels
Jaundice – yellow discoloration of the skin; causes can be bile in the blood from liver or gallbladder disease, also associated with diseases that involve the destruction of red blood cells
Cyanosis – bluish discoloration of the skin; caused by insufficient oxygen; may be associated with heart lung, circulatory diseases
Chronic poisoning may cause a gray or brown skin discoloration

23. REVIEW
Epidermis:
Dermis:
Hypodermis:

24. Functions 1. 2. 3. 4. 5. 6. 7.

26. Skin Eruptions: Ulcers
Also known as decubitus ulcers, pressure ulcers, or bed sores.
Localized areas of necrosis that develop when soft tissue is compressed between a bony prominence and an external surface for a prolonged period of time

27. Most common pressure points:
Sacrum
heels
Elbows
Nose, ear and genitalia from tubes(catheters)

28. Any shearing force..
Which is the force that stretches the skin during turning or moving in bed, decreases blood flow.

29. Guidelines to prevent:
Adequate nutrition is important. A diet high in protein with enough calories, vitamins and minerals.
Frequently turn and position client to relieve pressure. Turn every 1 to 2 hours.
Use specialized beds and mattresses to distribute pressure on dependent body parts

30. Assessing Damage
Pressure ulcer staging systems are based on the depth of the tissue destroyed. If the nurse cannot see the bottom of the sore, staging cannot be done.

31. Four Stages of Pressure Sores
Partial thickness skin loss involving epidermis and/or dermis
Ulcer is superficial and presents as a blister, abrasion or shallow crater
Stage 1
Nonblanchable erythema of intact skin.
May also have warmth, edema, induration or hardness

32. Stages, cont.
Stage 3
Full thickness skin loss involving damage of subcutaneous tissue that may extend to fascia
Presents as a deep crater
Stage 4
Full thickness skin loss with extensive destruction, damage to muscle, bone, or supporting structures

33. Pictures of pressure ulcers

34. More pictures…

35. Risk Assessment Early identification of at risk patients.
High risk/at risk patients include clients with neurological impairment, chronically ill long term care clients, and orthopedic clients.

36. Treatment
Stages 1, 2 and 3 : Local treatment: wound care, saline often used.
Occlusive dressings.
Use clean technique.
Stage 4: May involve surgery

37. Other skin eruptions: Macules – ex. freckles (ephelides)
Papules – ex. Pimples
Vesicles- ex. Blisters and Chicken pox
Pustules – ex. Pimples, ant bites
Crusts- ex. “scabs”, made up of dried pus and blood
Wheals- ex. Hives and insect bites
Nodules – ex. a cyst / a small solid bump

38. Medical Terminology – A- Melan/o -cyte Germin/o Sudor/I Seb/o Hypo
Derm, dermat/o
Lip/o
Adip/o
Tact/i

39. Diseases and Abnormal Conditions
Acne Vulgaris – inflammation of the sebaceous glands
Cause unknown, but usually occurs at adolescence. Hormonal changes and increased secretion of sebum are probably underlying causes
Symptoms: papules, pustules, and blackheads
Treatment: frequent, thorough washing, avoidance of creams and heavy makeup, antibiotic or vitamin A ointments, oral antibiotics, and/or ultraviolet light treatments

40. Athlete’s foot- contagious fungal infection that usually affects the feet
Symptoms: itching, blisters, and cracks that turn into open sores
Treatment: antifungal medication and keeping the area clean and dry
Contagious

41. Athlete’s foot

42. Skin Cancer- most common type of cancer. There are 3 main types:
Basal cell- cancer of basal cells in epidermis of skin. Slow growing and does not usually spread. Lesions can be pink to yellow-white. They are usually smooth with a depressed center and an elevated, irregular-shaped border

43. Basal cell

44. Squamous cell- affects thin cells of the epithelium but can spread quickly to other areas of the body. Lesions start as small, firm, red, flat sores that later scale and crust. Sores that don’t heal are frequently squamous cell carcinomas.

45. Squamous cell

46. Melanoma- develops in the melanocytes of the epidermis and is the most dangerous type of skin cancer. The lesions can be brown, black, pink, or multicolored. They are usually flat or raised slightly, asymmetric and irregular or notched on the edges.

47. melanoma

48. Skin cancer often develops from a mole or nevus that changes in color, shape, size, or texture. Bleeding or itching of a mole can also indicate cancer. Exposure to the sun, prolonged use of tanning beds, irritating chemicals, or radiation are the usual causes of skin cancer. Treatment involves surgical removal of the cancer, radiation, and/or chemotherapy.

49. Dermatitis- inflammation of the skin
Dermatitis- inflammation of the skin. Can be caused by any substance that irritates the skin and is frequently an allergic reaction to detergents, cosmetics, pollen, or certain foods.
Ex. Poison ivy, poison oak, poison sumac
Symptoms: dry skin, erythema, itching, edema, macular-papular rashes, and scaling
Treatment: eliminating the cause, anti-inflammatory ointments, antihistamines, and/or steroids also used

50. dermatitis

51. Eczema- noncontagious, inflammatory skin disorder caused by an allergen or irritant. Diet, cosmetics, soaps, medications, and emotional stress can all cause eczema.
Symptoms: dryness, erythema, edema, itching, vesicles, crusts, and scaling
Treatment: removing the irritant, application of corticosteroids to reduce the inflammatory response

52. eczema

53. Impetigo- highly contagious, skin infection usually caused by streptococci or staphylococci organisms
Symptoms: erythema, oozing vesicles, pustules, and the formation of a yellow crust
Wash lesions with soap and water and keep dry.
Treatment: antibiotics (oral and topical)

54. impetigo

55. Psoriasis- chronic, noncontagious skin disease with periods of exacerbations and remission.
Exact cause unknown, but is an immune disorder. Scientists believe the immune system mistakenly activates a reaction in the skin cells, which speeds up the growth cycle of skin cells.
Stress, cold weather, sunlight, pregnancy, and endocrine changes tend to cause an exacerbation of the disease

56. Symptoms: thick, red areas covered with white or silver scales
No cure, but treatment includes: coal/tar or cortisone ointments, ultraviolet light, and/or scale removal

57. psoriasis

58. Ringworm- highly contagious fungal infection of the skin or scalp
Characteristic symptom- formation of a flat or raised circular area with a clear central area surrounded by an itchy, scaly, or crusty outer ring
Treatment: antifungal medicines, both oral and topical, are used

59. ringworm

60. Verrucae, or warts- viral infection of the skin
Plantar warts usually occur at pressure points on the sole of the foot. A rough, hard, elevated, rounded surface forms on the skin
Treatment: some may disappear spontaneously, but others must be removed with electricity, liquid nitrogen, acid, chemicals, or laser

61. Sebaceous cyst
Cyst of a sebaceous (oil) gland that contains yellow, fatty material
Commonly found on face, neck, and trunk
Benign, can cause problems with become large; can be painful; can become infected
Surgically removed, can return if all of “sac” not removed

63. Boil
A boil, also known as a furuncle is a skin abscess, a painful bump that forms under the skin - it is full of puss. A carbuncle is collection of boils that develop under the skin. When bacteria infect hair follicles they can swell up and turn into boils.
Cause: bacteria infect hair follicles
Treatment: hot packs and lancing

64. Petechiae
pinpoint, round spots that appear on the skin as a result of bleeding under the skin
Caused from capillaries bleeding into the skin
Usually indicate another problem
Possible causes: disruption of blood clotting mechanisms; thrombocytopenia (low platelet count); side effect of some drugs; leukemia; lupus; measles; mononucleosis; rheumatoid arthritis; vitamin K deficiency (infants)

66. Cellulitis
A type of bacterial skin infection; appears as a swollen, red area of skin that feels hot and tender, and it may spread rapidly
More commonly affects lower legs
Can spread to blood and lymph systems, causing systemic life threatening infection

68. Lupus erythematosus
chronic inflammatory disease that occurs when your body's immune system attacks your own tissues and organs (autoimmune). Inflammation caused by lupus can affect many different body systems, including your joints, skin, kidneys, blood cells, heart and lungs
More common in women
Some people often have a characteristic butterfly-shaped rash on bridge of nose and cheeks

70. Pediculosis (lice)
tiny, wingless, parasitic insects that feed on your blood. Lice are easily spread through close personal contact and by sharing belongings.
Lice can appear on scalp, body, pubic area
s/s : itching; tingling feeling; small red bumps; visible lice or eggs

72. Scabies
a condition of very itchy skin caused by tiny mites that burrow into your skin
Spread by close contact with someone who has scabies. Scabies can also be spread by sharing towels, bed sheets, and other personal belongings.
Direct skin to skin contact
Treatment: scabicide drug (Elimite (permethrin)

73. Keloid
raised growth of fibrous scar tissue that forms over an area of trauma to the skin and extends beyond the area of the original injury.
more common in young women and African Americans.
Scar tissue normally grows in response to a wound, but a keloid is an overgrowth of scar tissue over a healed wound

75. Chloasma (melasma)
brownish pigmentation on the face that develops slowly and fades with time. The pigmentation is due to overproduction of melanin by the pigment cells, melanocytes.
Usually seen in women; more common in people that tan well or have naturally dark skin
Causes: genetic predisposition; pregnancy; contraceptives; sun exposure; unknown

77. Birthmarks
Port wine stain: large, reddish purple discoloration of the face or neck; laser treatment
Strawberry hemangioma: soft, raised birthmark; dark, reddish purple growth is a benign tumor of newly formed blood vessels; usually resolve by 7 yoa but can be treated; benign but can be disfiguring

80. Hives (urticaria)
Skin condition characterized by localized swelling accompanied by itching that is associated with an allergic reaction
urtic – rash
Aria – means connected with
Treatment: steroid creams, antihistamines