1. THE INTEGUMENTARY SYSTEM

2. 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.

3. 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.

4. 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.

5. WOUND CARE

6. 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!

7. 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.

8. 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

9. 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

10. WOUND CARE

11. 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.

12. 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)

13. 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

14. 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

15. WOUND CARE

16. 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

17. WOUND CARE

18. 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 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

19. 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

20. WOUND CARE

21. 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.

22. 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

23. WOUND CARE
Penrose Drain
Hemovac Drain
Jackson-Pratt Drain

24. WOUND CARE WOUND OBSERVATIONS Location Appearance Drainage Odour
Surrounding skin

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