THE INTEGUMENTARY SYSTEM

THE INTEGUMENTARY SYSTEM The integumentary system is the largest system of the body and weighs about 10 lbs. It includes the skin, hair, nails, sweat and oil glands and is the body’s first line of defence. Skin is made up of epithelial, connective and nerve tissue.

THE INTEGUMENTARY SYSTEM The skin has 3 layers: The epidermis: the outer layer which contains living and dead cells. The epidermis has no blood vessels or direct blood supply and few nerve endings. The epidermis has several layers The dermis: the inner layer of the skin made of connective tissue. Blood vessels, nerves, hair roots, sweat and oil glands are all found in the dermis. The dermis has 2 layers. The hypodermis (subcutaneous) layer: made up mostly of adipose (fatty) tissue and provides a cushion for internal organs. The hypodermis contains blood vessels.

THE INTEGUMENTARY SYSTEM The skin prevents bacteria from entering the body, prevents excessive amounts of water from leaving the body and provides protection for internal organs. Nerves protect the body by sensing cold, pain, and pressure. Hair in the nose, eyes and ears offer protection from foreign objects. Nails protect the fingers and toes and allow us to pick up small objects. Sweat glands help to regulate body temp, rid the body of wastes. Sebaceous (oil) glands moisten hair and waterproof the skin.

WOUND CARE

WOUND CARE The skin is the body’s first line of defence Preventative skin care is one of the PSW’s most important tasks. As the PSW you spend the most time with the residents. You are the eyes of the RN/RPN Older adults and those with disabilities are at a greater risk for skin breakdown!

WOUND CARE A wound is a break in the skin or mucous membrane and can be caused by: Surgery Trauma An accident or injury A pressure ulcer is a wound that occurs due to poor skin care and immobility.

WOUND CARE TYPES OF WOUNDS Abrasions Contusion Incision Laceration Penetrating wound Puncture wound Wounds can be: Intentional/unintentional Open/closed Clean/clean-contaminated Contaminated Infected Chronic Partial/full thickness

WOUND CARE Clients at risk are those who: SKIN TEARS A skin tear is a break or rip in the skin. They can be caused by: Friction Shearing Pressure Skin tears can happen very easily because older adults have very fragile skin. Clients at risk are those who: Need help moving/transferring Have poor nutrition Are poorly hydrated Have altered mental awareness

WOUND CARE

WOUND CARE PRESSURE ULCERS A pressure ulcer is an injury caused by unrelieved pressure. It usually occurs over a bony prominence (shoulder blades, elbows, hip bones, sacrum, heels) Pressure from body weight can reduce circulation to the affected area.

WOUND CARE CAUSES Pressure – occurs when the skin over a bony prominence is squeezed between hard surfaces. Friction – scrapes the skin Shearing – occurs when the skin sticks to a surface, the deeper tissues move downward and exerts pressure on the skin. Pressure ulcers can also occur when to bony areas rub together (knees, ankles)

WOUND CARE CLIENTS AT RISK FOR PRESSURE ULCERS Bedridden Incontinence Poor nutrition Altered mental awareness Circulation problems Obesity Very thin SIGNS OF PRESSURE ULCERS Pale or reddened skin

WOUND CARE Preventing a pressure ulcer is easier then treating them. PREVENTION & TREATMENT Preventing a pressure ulcer is easier then treating them. Good skin care is essential A physician and wound care nurse will direct the treatment TREATMENT DEVICES Bed cradle Heel elevators Flotation pads Eggcrate mattress Special beds

WOUND CARE

WOUND CARE LEG & FOOT ULCERS Some diseases can affect blood flow to and from the legs and feet. Circulatory ulcers – open wounds on the lower legs and feet caused by decreased blood flow through the arteries and veins. Stasis ulcers – open wounds on the lower legs and feet caused by poor blood return through the veins. Arterial ulcers – open wounds on the lower legs and feet caused by poor arterial blood flow

WOUND CARE

WOUND CARE PROCESS OF WOUND HEALING The healing process has 3 phases Inflammatory phase (3 days, scab, inflammation) Proliferation phase (day 3-21, tissue repairs) Maturation phase (day 21- 1-2 yrs, scar tissue) TYPES OF WOUND HEALING Primary intention – the wound is closed Secondary intention – for infected wounds. Wound is left open Tertiary intention – leaving the wound open and then closing it

WOUND CARE COMPLICATIONS Hemorrhage – excessive blood loss in a short period of time Infection – wound contamination Dehiscence – separation of wound layers Evisceration – separation of wound layers along with the protrusion of abdominal organs

WOUND CARE

WOUND CARE WOUND DRAINAGE Serous drainage – clear watery fluid. Sangineous drainage – bloody drainage Serosangineous drainage – thin, watery, blood tinged drainage. Purulent drainage – thick green, yellow, brown drainage.

WOUND CARE DRAINS When large amounts of drainage are expected, a drain may be inserted. Penrose – open drain Hemovac – closed drain Jackson-Pratt – closed drain

WOUND CARE Penrose Drain Hemovac Drain Jackson-Pratt Drain

WOUND CARE WOUND OBSERVATIONS Location Appearance Drainage Odour Surrounding skin

WOUND CARE PSW RESPONSIBILITIES Prevention Comfort Ambulation Nutrition Hydration Oxygenation Controlling odour Temperature Skin care/skin integrity Recognizing complications