1. Integumentary system

2. You are likely to shed some 40 pounds of skin in a lifetime One sixth body's mass. Eyelids have the thinnest skin Sole of heel has the thickest skin (all layers) Hair grows approx. 1 cm a month Average head of hair is around 120,000 Nails grow approx. .5 mm per week
· You have 7 layers of flat, stacked cells.
· An adult has 20 sq.ft of skin.
· It’s your body’s largest organ.
· An average adult’s skin spans 21 square feet, weighs 9 pounds, and contains
more than 11 miles of blood vessels.
· The skin releases as much as 3 gallons of sweat a day in hot weather.
· Globally, dead skin accounts for about a billion tons of dust in the atmosphere.
Your skin sheds 50,000 cells every minute.

3. Crash Course: Skin Deep

4. 3 Main Layers of Tissue Epidermis Dermis
Subcutaneous fascia or hypodermis

6. Epidermis Outermost layer of skin
Does not contain nerve cells or blood vessels
Made of 5 smaller layers of skin
The 2 main layers are the:
Stratum corneum – the outermost layer – these cells are constantly shed and replaced by the new cells of the stratum germinativum
Stratum germinativum – the innermost layer

7. Dermis Also called corium or “true skin”
Contains blood vessels, lymph vessels, nerves, involuntary muscle, sweat and oil glands, and hair follicles.

8. Subcutaneous Fascia or Hypodermis
Innermost layer of the skin
Made of elastic and fibrous connective tissue and adipose (fatty) tissue
Connects skin to underlying muscles

9. Integumentary System has 2 Types of Glands
Sudoriferous glands (sweat glands)
Sebaceous glands (oil glands)

10. Glands Sudoriferous Glands Sweat glands
Coiled tubes that extend through dermis
Open on surface of skin called a pore
Eliminate sweat or perspiration that contains water, salts, and some body wastes

11. Sudoriferous gland (sweat gland)

12. Glands
Sebaceous Glands Oil glands Usually open on to a hair follicle Produce oil called sebum

13. Sebaceous Glands Produce Sebum (oil)
Keeps hair from becoming dry and brittle
Sebum is slightly acidic so it discourages growth of bacteria on skin
Antibacterial and antifungal secretion so it also helps prevent infections
Blackheads or pimples occur when oil glands become plugged with dirt and oil

14. Sebaceous Glands (oil glands)

15. Draw and Label Diagram of Skin
DHO pg. 146 – draw, label, color
Identify and label:
Epidermis, dermis, hypodermis (subcutaneous), sweat pore, sudoriferous gland, sebaceous gland, artery, vein, sensory nerve ending, hair follicle, adipose (fatty)tissue, dermal papilla, arrector pili muscle

16. Read BS&F page 67:
What are dermal papillae? What are the functions of papillae?
Read BS&F page 68:
What is the function of the arrector pili muscle?

17. Hair
Hair consists of a root that grows in a hollow tube called a follicle, and a hair shaft
Hair helps protect the body
Covers all body surfaces except for the palms of the hands and the soles of the feet

18. Hair follicle

19. Nails Protects the fingers and toes from injury
Are made of dead, ketatinized epidermal epithelial cells packed close together to form a thick, dense surface
Cells are formed in nail bed
If lost, nails will regrow if the nail bed is not damaged
Pink hue is from vascularized dermal tissue beneath nail bed
Lunula is active growing region

21. World’s Longest Nails!

22. Crash Course: Skin Deep Part 2

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

24. Protection Serves as a barrier for sun’s ultraviolet rays
Protects against invasion of pathogens or germs
Holds moisture in and prevents deeper tissues from drying out

25. Sensory Perception Nerves present in skin
Respond to pain, pressure, temperature (heat and cold), and touch sensations

26. Body Temperature Regulation
Blood vessels in skin help body retain and 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 glands also help cool body through evaporation of perspiration

27. 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

28. Absorption
Certain substances are absorbed through the skin such as transdermal medications (motion sickness patches, heart patches, nicotine patches

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

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

31. Create Foldable: Create a foldable of the 7 functions of the skin
Include the function/description and picture/drawing
Must be accurate, neat, interesting, colorful
Use notes & text:
DHO: pg 146
BS&F: pg 66

32. Pigmentation (skin color)
Skin color is inherited and determined by pigments in the epidermis
Melanin – brownish black pigment
1. leads to a black, brown, or yellow skin
tint depending on racial origin
2. absorbs ultraviolet light to tan the skin
3. small concentrated areas of melanin pigment form freckles

33. Carotene – yellowish-red pigment Albino – absence of color pigments
1. skin has a pinkish tint
2. hair is pale yellow or white
3. eyes are red in color and very sensitive to light

35. Abnormal colors
Erythema – reddish color; caused by burns or a congestion of blood vessels
Jaundice – yellowish discoloration; can indicate presence of bile in blood as a result of liver or gallbladder disease
Cyanosis – bluish discoloration; caused by insufficient oxygen; associate with heart lung and circulatory diseases

36. jaundice

37. cyanosis

38. Skin Lab Epidermis, dermis, hypodermis – terra cotta
Hair follicle/shaft – terra cotta
Sudoriferous gland – green
Sebaceous gland – yellow
Vein – blue
Artery – red
Page 146

39. Skin eruptions Macules – flat spots on the skin (freckles)
Papules – firm raised areas (pimples)
Vesicles – blisters or sacs full of fluid (chicken pox)
Pustules – sacs filled with pus (acne or pimples)
Crusts – areas of dried pus and blood (scab)
Wheals - itchy, elevated areas with an irregular shape (allergic reaction)
Ulcer – deep loss of skin surface that may extend into the dermis (deep cut)

40. macules

41. papules

42. vesicles

43. pustules

44. crusts

45. wheals

46. ulcer

47. Decubitus Ulcer Also called: bedsores or pressure sores Preventable
Primary concern of healthcare workers

48. Risk Factors Aging confined to bed/wheelchair Dehydration/malnutrition
Diminished reflexes
Diseases such as diabetes
Immobiliztion
Incontinence
Obesity
Exposure to shearing/friction

49. S&S of Decubitus Ulcer Discoloration:
light-skinned pt – red or dark purple
Dark-skinned pt – area may appear darker than normal
Odor
Swelling
Tenderness/pain
Drainage

50. Application: BS&F pages 76-78 1. What causes a decubitus ulcer?
2. List 5 common sites for decubitus ulcers to develop.
3. Identify the 4 stages of decubitus ulcers.
4. What are the 2 best treatments for decubitus ulcers?

51. What causes a decubitus ulcer?
They occur when a patient is constantly sitting or lying down in the same position without shifting his or her weight.
The constant pressure causes a decrease to the blood supply and tissue decay develops.

52. 5 Common Sites for Decubitus Ulcers to develop
Spine
Coccyx
Hips
Elbows
heels

53. Bony prominences where decubitus ulcers are prone to develop

54. 4 Stages of Decubitus Ulcers
Stage I – reddened, skin not broken
Tx: alleviate pressure

55. Stage II – blistered area
Broken or unbroken skin
Surrounding area red/irritated
Tx: protect and clean area and alleviate pressure

56. Stage III – skin break through all areas
High risk of infection
Tx: medical tx required to prevent infection and promote healing

57. Stage IV – ulcerated area extends through skin, muscles, tendons, and bone
Can be life-threatening
Tx: surgical removal of necrotic (dead) or decayed tissue and antibiotics.

58. Stage IV Ulcer with necrotic tissue

59. What are 2 best treatments for decubitus ulcers?
Prevention
Frequent turning (q2h) and relief of pressure on bony prominences.
Nursing staff must adhere to turning schedule.
Teach family members of in home patients to turn q2h.

60. Additional preventive measures:
Good diet – contributes to healing
Skin care – clean and well moisturized
Continence aids – pads, diapers, catheter
Frequent skin inspection
Products to relieve pressure – airbeds, alternating pressure mattresses, foam bed, gel pillows, continence aids

61. Application:
80 year old white female admitted to Room 310 with a dx of pneumonia. Appears thin and frail. Family reports she has become incontinent. Family reports she has been in bed for the past week.
1. What risk factors does she have for decubitus ulcers?
2. How would you assess this patient for decubitus ulcers?

62. Burns Traumatic injury resulting from Sun Water Steam fire Chemicals
Some medications increase your sensitivity to sunlight > chance of sunburn

63. Severe burns can lead to dehydration and infection
Both life-threatening conditions

64. Rule of Nines
Measures the percent of body burned

65. Classification of Burns
Burns classified as 1st, 2nd, 3rd degree burn depending on skin layers affected and symptoms

66. Application:
Read the section in text on the classification of burns: BS&F : pgs Make a trifold indicating the skin layers involved, symptoms, treatment, and approximate healing time for first, second and third degree burns

67. First Degree Epidermis only Sx: Redness, swelling, pain
Tx: application of cold water
Healing approx. 1week

68. Second Degree Epidermis and dermis
Sx: Pain, swelling, redness, blistering
Risk of infection
Tx: pain meds and sterile dressings
Healing approx. 2 weeks

69. Third Degree Epidermis, dermis, hypodermis
Sx: Loss of skin, eschar (blackened skin), possibly no pain
Can be life-threatening
Immediate hospitalization
Tx: prevent infection, contracture, fluid replacement