Integumentary System

Skin functions

  • Psychosocial- display, body image
  • Protection barrier
  • Homeostasis: fluid & temperature
  • Excretion
  • Synthesis
  • Sensory perception
1 of 32

Protection of the skin

  • physical damage, trauma and infection

    immune function

    inflammation and repair

2 of 32

Temperature regulation

heat loss by radiation, conduction, convection and evaporation

3 of 32

Sensation

  • Pain: superficial (acute) pain, deep (chronic) pain
  • Itch: mechanical (movement), chemical (histamine; kinins; bile salts)
  • Touch and pressure
4 of 32

Endocrine (Vit D. production)

  • Vit D. regulates calcium and phorporous levels
  • 7-dehydrocholestrol (in skin cells) + sunlight = cholecalceiferol.
  • Once in the liver and kidneys this is converted into Vit D.
5 of 32

Psychosocial

  • bonding
  • touch
  • body image
6 of 32

Sexual function

  • changes in puberty
  • changes due to arousal
7 of 32

Structures supporting key functions

  • Protective barrier
  • Homeostasis:
  • fluid
  • temperature
  • Excretion
  • Synthesis
  • Sensory perception
  • Communication/ relating
  • Epidermis & dermis
  • Microvasculature , extracellular spaces

  • Vessels, sweat,hair

  • Sweat glands

  • Vit D Epidermis (UV)

  • Sensory nerves, mechanoreceptors

8 of 32

Layers of the skin

  • epidermis
  • dermis
  • hypodermis (superficial fascia/subcutaneous tissue)
9 of 32

Epidermis

No blood vessels

0.1 mm (eyelids) - 1mm (palms/soles)

4 - 5 sub-sections (from top to bottom)

stratum corneum (horny layer)

s. lucidum*

s.granulosum;

s. spinosum;

s.basale (germinative layer)

10 of 32

Epidermal cells

11 of 32

Dermis

  • Dermal papillae interlocks with epidermis
  • Vascular
  • Connective tissue
  • Semifluid matrix
  • Protein fibres: collagen; reticulin and elastin
  • Ground substance
12 of 32

Dermal cells

13 of 32

Changing skin: intrinsic factors

  • Biological process: eg: microcirculation
  • Genetic predisposition
  • Hormones (e.g. menopause)
  • Illness
14 of 32

Changing skin: extrinsic factors

  • Photo damage (UV exposure)
  • Smoking
  • Pollutants
  • Irritants and allergens
  • Heating/low humidity
  • Overwashing
  • Therapeutic treatments (e.g. diuretics; radiotherapy; corticosteroids)
  • Nutrition
15 of 32

Skin Appendages: part of Integumentary system- nai

  • Nails: emerge from specialised epithelial cells from the nail root, growing out over the nail bed and become keratinised
  • Nail cuticle: fold of tissue covering the nail root
  • Nail body: the part we see
  • Tissue is very vascularised under the nail
  • Have a protective function
16 of 32

Skin Appendages: part of Integumentary system- hai

  • Composed of the fibrous protein-keratin like nails) as they move away from the growth base (follicle)
  • Key structures are the shaft (dead cells) - which extends down to the dermis to the follicle- from where the hair grows
  • Sebaceous gland- sebum
  • Key function: thermoregulation
17 of 32

Body surface area affected due to rash or burn

Clinicians estimate the extent of the body area affected by a rash or burn

Rule of nines: percentage body area for different regions

Head and neck: 9%

Each upper limb 9%

Each lower limb 9%

Trunk-front 18%, back & buttocks 18%

Perineum 1%

Varies for children and infants (see Colbert et al fig 9.4)

Hand palm: 1%

18 of 32

Disrupted barrier integrity

due to inflammation (infection, immune response) and trauma

19 of 32

Disrupted homeostatic control

dryness due to disease, ageing, burns

20 of 32

Disrupted circulation

due to pressure effects, poor nutrition, lymphoedema

21 of 32

Disrupted skin chemistry (pH) and flora

due to chemicals and pathogens

22 of 32

Categorisation of skin conditions

  • [Dry skin or xerosis]
  • Chronic inflammatory dermatoses
  • Rashes
  • Acne and rosacea
  • Infections
  • Infestations & insect bites/strings
  • Benign & malignant lesions (lumps & bumps)
  • Hair/scalp disorders
  • Nail disorders
  • Leg ulcers
  • Blistering diseases
  • Urticaria
  • Pressure ulcers
23 of 32

Dry skin and the Skin Barrier

  • Dry skin = xerosis: is common
  • Disruption to skin barrier with loss of integrity
  • Loss of skin moisture and oils (sebum)
  • Sometimes easier to feel than see
  • Observations that may be associated: scaling, erythema, soreness, roughness
  • Disease: disruption to normal skin barrier
  • Factors affecting: interior & climatic conditions
  • Effective nursing can prevent or restore dry skin
24 of 32

Common skin conditions causing dry skin

  • Atopic eczema
  • Asteatotic eczema
  • Ichthyoses (inherited)
  • Psoriasis
25 of 32

Atopic Eczema

In children it presents in 3 forms:

1. Infantile eczema - begins at 2-6 months

generally spontaneous remission by 3 years

2. Childhood - may follow infantile, occurs at

2 to 3 years old, and 90% will manifest by 5

years old

3. Preadolescent and adolescent - begins at 12

years old and may continue

26 of 32

Goals of management are to:

  • Relieve pruritis
  • Hydrate the skin
  • Reduce inflammation
  • Prevent or control secondary infection
27 of 32

Pressure Ulcers

  • Pressure ulcer localised injury to skin or underlying tissue usually over a bony prominence, due to pressure or pressure associated with shear (EPUPAP 2014)
  • Severity may range from superficial affecting skin surface to deep, affecting muscle and exposing bone.
28 of 32

Grade 1 Pressure Ulcers

Intact skin, non-blanchable redness over a bony prominence. Darkly pigmented skin may not have visible blanching; colour may differ from surrounding area. May be painful, firm, soft, warmer or cooler as compared to adjacent tissue.

29 of 32

Grade 2 Pressure Ulcers

Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough.

May also present as an intact or open blister.

30 of 32

Grade 3 Pressure Ulcers

Full thickness tissue loss, subcutaneous fat may be visible but bone, tendon or muscle are not exposed.

31 of 32

Grade 4 Pressure Ulcers

  • Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present. Often includes undermining and tunnelling.
  • At risk of osteomyelitis
32 of 32

Comments

No comments have yet been made

Similar Nursing resources:

See all Nursing resources »See all Integumentary System resources »