1. SKINNY ON SKIN

2. Integumentary system
The integumentary system is the largest organ of the body
It is a membrane because it covers the body
It is called a system because it has organs and other parts that work together for a particular function

3. Layers of the skin Epidermis: this is the outer-most layer of the skin
This layer is made up of 5 smaller layers
The main layers are the stratum corneum- this is where cells constantly shed
and Stratum germinativum- provides cells to replace the cells in the strata corneum

4. Skinny on skin Layer #2 the Dermis
Also called the cornium or true skin
This has the framework of elastic connective tissue
It contains blood vessels, lymph vessels, nerves, involuntary muscle, sweat and oil glands and hair follicles

5. Skinny on Skin The top of the dermis is covered in papillae
A. Fits into ridges on the stratum germinativum of the epidermis
B. Ridges form lines or striations on the skin
C. Pattern of ridges is unique for each individual- this is you fingerprint or foot print used for ID

6. Skinny on Skin Layer #3 is the fascia or hypodermis
This is the innermost layer of skin
It is made from elastic and fibrous connective tissue and adipose tissue (fatty tissue)
It connects skin to the underlying muscles

8. Skinny on Skin Glands of the skin: Sudoriferous glands- sweat glands
These are coiled tubes that extend through the dermis
They open on the surface of the skin at an opening called a pore
They eliminate sweat that contains water, salts and body waste

9. Skinny on Skin Gland #2 Sebaceous glands- these are oil glands
They usually open to a hair follicle
They produce oil called sebum
Sebum is important to keep hair from becoming dry and brittle
Blackheads and pimples occur when an oil gland becomes plugged with dirt and oil

10. Skinny on Skin Other parts of the integumentary system: Hair
Hair consists of a root that grows in a hollow tube called a follicle and a hair shaft
Protects the body
Covers all surfaces of the body except for palms of hands and soles of the feet
Certain conditions cause people to loose hair called alopecia or baldness- genetic condition for hair lose on the scalp

11. Skinny on Skin Nails Protect the fingers and toes from injury
Nails are made of keratinized epidermal cells which are packed closely together to form a thick dense surface
Nail cells are formed in a nail bed
Cells will regrow if lost if nail bed is not damaged

12. Functions of the integumentary systems
1. protection- it is a barrier for ultraviolet rays from the sun
Protects against pathogens or germs
Holds moisture in and prevents deeper tissues from drying out

13. Skinny on Skin 2. sensory perception Nerves are present in the skin
Responds to pain, pressure, temperature, and touch

14. Skinny on Skin 3. regulation of body temp-
Blood vessels in the skin help the body to retain or lose heat
If blood vessels dilate or get larger, they allow excess heat to escape through the skin
If blood vessels constrict, they get smaller and retain heat
Sudoriferous glands help cool the skin through the evaporation of sweat

15. Skinny on Skin
4. storage
Skin has tissues for temporary storage of fat, glucose ( sugar) water vitamins and salts.
Skin stores adipose tissue (fat) in the subcutaneous connective tissue, which is a source of energy

16. Skinny on Skin
5. absorption- certain substances can be absorbed through the skin like medications for pain, motion sickness, heart medication and nicotine patches to stop smoking

17. Skinny on Skin 6. excretion
Skin helps the body eliminate salt , waste and water

18. Skinny on Skin 7. production Skin can help produce vitamin D.
It uses ultraviolet rays from the sun to form an initial molecule of Vit. D that matures in the liver

19. Skin color
Skin color or pigmentation is inherited and determined by pigments in the epidermis
Melanin:
1. Absorbs ultraviolet light to darken the skin
2. Small concentrated areas of melanin pigment form freckles

20. Skin color Albino- the absence of color pigment
Skin might have a pinkish tint
Hair can be yellow or white
Eyes are red in color and very sensitive to light

21. albinsim

22. Abnormal colors
Erythema- caused by burns or blockage of a blood vessel
Red color
See picture…..

23. erythema

24. Abnormal colors
Jaundice- yellowish discoloration caused by the presence of bile in the blood as a result of liver or gallbladder disease.
Also can be seen in diseases that destroy red blood cells
See picture……..

25. jaundice

26. Abnormal color
Cyanosis- a bluish discoloration caused by insufficient oxygen, associated with heart, lung and circulatory diseases
See pic……

28. Abnormal color Vitiligo
A loss of pigment in certain areas, usually seen in autoimmune diseases like hashimoto’s thyroid
See pic……

29. vitiligo

30. tell your table buddy who had
vitiligo and was called the
king of pop

31. Abnormal color Bruising- Also called ecchymosis
Happens when blood escapes and clots beneath the skin
Hematoma- swollen hard bruised area
Vitamin C deficiency
Can be seen with hemophilia patients

33. Skin injuries Sun damage
Clumps elastin fibers which leads to leathery skin
Can lead to a temporary depression of the immune system
Can cause DNA alteration which can lead to skin cancer
See pic of melanoma……….

34. melanoma

35. Skin injury Sun types: Type 1- always burns needs spf 30
Type 2- always burns easily tans minimally fair skin needs spf 30-15
Type 3- burns moderately, tans gradually, fair to medium skin- spf 30-15
Type 4 burns minimally always tans well, medium skin needs spf
Type 5- rarely burns tans easily olive or dark skin spf 15-8
Type 6- never burns, very dark skin spf 8

36. Skin injury Sun burns can range: 1st degree- superficial
2nd degree- partial thickness
3rd degree- full thickness- may require hospitalization

37. 2nd degree burn

38. 3rd degree burn or full thickness

39. Skin eruptions Macules- macular rash Flat spots on the skin
Example : flat spots involved with disease (5th’s disease, or Rocky Mountain spotted fever)
See pic….

40. macular

41. Skin eruptions Papules- papular rash These are firm raised areas
Examples are chicken pox, pimples, and syphilis
See pic…..

42. papular

43. Skin eruptions Vesicles- these are blisters or sacs full of fluid
Sometimes seen with herpes patients

44. vesicles

45. Skin eruptions Pustules- sacs filled with pus Example: pimples or acne
No pic- sorry I’m sure you’ve all seen a pimple!

46. Skin eruptions
Crust- or scabs
These are dried areas of pus or blood

47. Skin eruptions
Wheals- itchy elevated areas as seen with hives or insect bites
See pic…..

48. wheals

49. psoriasis Patchy erythema and scales
This can be from chronic inflammatory disease- genetic
See pic……

50. psoriasis

51. Skin eruptions Impetigo: Very contagious
Erythema, vesicles with a sticky yellow crust
Infection with strep

52. impetigo

53. Skin eruptions warts Painless except for plantar warts
Caused by a virus
Can also be venereal HPV- there is a vaccine to help with several of the strains- very contagious

54. warts

55. Skin eruptions Herpes simplex I- These are cold sores
can be spread through kissing or sharing objects such as toothbrushes or eating utensils or general illness (from mild illnesses to serious conditions)fatigue, physical or emotional stress
Blisters that are inflamed around the mouth
Viral, no cure, contagious

56. Herpes simplex I

57. Skin eruptions Herpes zoster- shingles after chickenpox
Viral infection with fever and malaise
Vesicles run along nerve pathways, will only see shingles on one side
If you had chicken pox, the virus can lie dormant in the nerve root, and in times when the body is stressed, it can flare up

58. Herpes zoster

59. Skin eruptions tinea-dermatophytosis
Fungal infection, including athlete’s foot, called ringworm, jock itch
It is infectious and contagious
antifungal medications

60. tinea

61. Skin eruptions
Furuncles (boils) carbuncles (large swollen erythematous lesions)
Can be caused by staph or strep infections
May need surgical intervention

62. carbuncle

63. Skin eruptions Ulcers- deep loss of skin that may extend to the dermis
Decubitis - on or over boney prominences, can also be called bed sores
Can be staged:
Stage I- redness, firm, heat, intact skin
Stage II – blister or open area can be through the dermis
Stage III- open to the fascia
Stage IV- full thickness down through muscle or bone

64. Pressure ulcer stage I

65. Pressure ulcer stage II

66. Pressure ulcer stage III

67. Pressure ulcer stage IV

68. Do NOT put pillows under your knees. It puts pressure on your heels.
NEVER drag yourself to change your position or get in or out of bed.
Dragging will cause skin breakdown.
Get help if you need moving in bed or getting in or out of bed.
If someone else moves you, they should lift you or use a draw sheet
(a special sheet used for this purpose) to move you.
Change your position every hours to keep the pressure off any one spot.
Sheets and clothing should be dry and smooth, with no wrinkles.
Remove any objects such as pins, pencils or pens, or coins from your bed.
Do not raise the head of your bed to more than a 30-degree angle.
Being flatter keeps your body from sliding down. Sliding may harm your skin.

69. Skin eruptions
Paronychia- this is an infected hangnail

70. paronychia

71. Skin eruptions
Sebaceous cyst- blockage of duct of a sebaceous gland

72. Sebaceous cyst

73. Skin eruptions Diaper rash- can be dark red areas Can have swelling
Will have irregular borders and usually irritated where the diapers are more constricting

74. Diaper trash- jk rash

75. Other skin considerations
Venomous bites-brown recluse
Area will become necrotic (dark purple to black) and begin to slough
Causes skin to erode and for an open wound
Many people mistake MRSA for spider bites
See pic…..

76. Brown recluse

77. MRSA Methicillin Resistant Staphylococcus Aureaus
A staph infection from the staph aureus bacteria that has become resistant to Methicillin antibiotics
Very contagious spread by contact- use precautions

78. MRSA

79. Body lice
Body lice are parasitic insects that live on clothing and bedding used by infested persons.
Body lice frequently lay their eggs on or near the seams of clothing.
Body lice must feed on blood and usually only move to the skin to feed.

80. BODY LICE

81. scabies
Human scabies is caused by an infestation of the skin by the human itch mite
The microscopic scabies mite burrows into the upper layer of the skin where it lives and lays its eggs.
The most common symptoms of scabies are intense itching and a pimple-like skin rash. The scabies mite usually is spread by direct, prolonged, skin-to-skin contact with a person who has scabies
prescription lotion

82. scabies

83. burns
First degree- This means a superficial burn. The surface of the skin is damaged, but the epidermis is still intact, and therefore able to perform its functions (control temperature and protect from infection or injury)

84. Burns
2nd degree:
This means damage that has extended through the epidermis and into the dermis . Second-degree burns also are known as partial-thickness burns. The presence of second degree burns indicates a loss of skin function. Blisters are the first sign of a second-degree burn. As the epidermis is destroyed, it begins to separate from the dermis.

85. Burns Third degree or full thickness:
This indicates the burn has destroyed both the epidermis and dermis. The victim has the same trouble with fluid loss, heat loss, and infection that come with second-degree burns. Full-thickness burns also cause nerve death, so the victim may not be able to feel anything in the area of the burn.

86. Burns
Rule of nines:
You can estimate the body surface area on an adult that has been burned by using multiples of 9.
An adult who has been burned, the percent of the body involved can be calculated as follows:
Head = 9%
Chest (front) = 9%
Abdomen (front) = 9%
Upper/mid/low back and buttocks = 18%
Each arm = 9%
Each palm = 1%
Groin = 1%
Each leg = 18% total (front = 9%, back = 9%)
As an example, if both legs (18% x 2 = 36%), the groin (1%) and the front chest and abdomen were burned, this would involve 55% of the body.

87. How would you use the rule of 9's to determine % of surface area burned in a patient with burns on the face, chest and front of one arm.

88. Exit ticket
Develop a plan, using 3 simple things, to prevent pressure sores from happening in bed-bound patients.