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Chapter 3 INTEGUMENTARY SYSTEM. The skin is the largest and most visible organ of the body Weighs 8-10 pounds and covers an area of 22 square feet Combining forms: Derm/o Cutane/o Dermatology is the medical specialty.

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chapter 3 integumentary system
Chapter 3INTEGUMENTARY SYSTEM
  • The skin is the largest and most visible organ of the body
    • Weighs 8-10 pounds and covers an area of 22 square feet
  • Combining forms:
    • Derm/o
    • Cutane/o
  • Dermatology is the medical specialty
functions of the skin 5
FUNCTIONS OF THE SKIN (5)
  • (1) Protection
    • Body’s first level of defense against invasion by bacteria and other harmful agent
    • Protects against mechanical injury
    • Guards against excessive exposure to sun
  • (2) Regulation (temperature control)
    • Raises or lowers body temperature as necessary
functions continued
FUNCTIONS (continued)
  • (3) Sensation
    • Contains millions of microscopic nerve endings
    • Act as sensory receptors for pain, touch, heat, cold, pressure, and pleasure
functions continued5
FUNCTIONS (Continued)
  • (4) Secretion
    • Glands secrete:
      • Perspiration (sweat glands)
      • Oils – sebaceous Glands
functions
FUNCTIONS
  • (5) Water retention
    • Acts as a barrier between internal organs and the environment
skin anatomy
SKIN ANATOMY
  • Made up of 3 layers:
    • Epidermis – outer (top) layer (epi)
    • Dermis - inner support layer (middle)
    • Subcutaneous – bottom layer –adipose tissue (sub)
epidermis layer
EPIDERMIS LAYER
  • Consists of 5 layers
    • New skin cells are formed in the lowest level
        • New skin cells contain keratin
    • Melan/o – brown/black color
      • Melanocytes are cells that produce melanin (pigment) which give skin and hair its color.
    • New skin cells move up to the top layer-all replaced about every 28 days.
dermis layer
DERMIS LAYER
  • Composed of dense, fibrous connective tissue called collagen.
  • Contains nerves, sensory receptors , blood vessels.
    • Essential to thermoregulation
  • Contains hair follicles
  • Contains sebaceous and sweat glands
sebaceous glands
SEBACEOUS GLANDS
  • Sebum – oily substance made up of fats and lipids
    • protects skin
sweat glands
SWEAT GLANDS
  • Glands all over the body
  • Duct of gland
    • Conduit to surface for sweat
  • Sweat cools body as the moisture evaporates
    • Palms of hands
    • Feet
subcutaneous layer
SUBCUTANEOUS LAYER
  • Fat cells stored for energy
  • Provides heat insulation
  • Connects the skin to underlying structures
slide13
HAIR
  • Formed within follicles
    • Papilla at base of follicle
    • Shaft is visible part
  • Hair fiber is filled with keratin
  • Melanocytes at root of follicles
    • Pigment provides color
    • Gray hair- no melanin produced
nails
Nails
  • Composed of hard keratin
physiology of the skin
PHYSIOLOGY OF THE SKIN
  • Identification function
    • Unique facial characteristics, hair, skin color, fingerprints
    • Communication
      • Expressions – expressing our emotions
    • Sensory functions
      • Pain, pressure, temperature
  • Production of vitamin D
    • Exposure of skin to ultraviolet light
physiology con t
PHYSIOLOGY (con ‘t)
  • Protection
    • Skin is first line of defense against the outside world – goal is integrity
    • Skin is waterproof and tough
      • Melanin prevents harmful ultraviolet rays from penetrating
      • Keratin is a waterproofing agent
      • Stratum corneum (outermost, horny cell layer) protects against pathogens, chemicals, prevents tears
temperature control
TEMPERATURE CONTROL
  • Raises and lowers body temperature as necessary
  • When body needs to lose heat:
    • Blood vessels in skin dilate – bringing blood to surface for cooling by radiation
    • Sweat glands secrete more sweat for cooling by evaporation
temperature control con t
TEMPERATURE CONTROL(con’t)
  • When body needs to conserve heat, nervous system causes constriction of skin’s blood vessels
    • Allows more heat-carrying blood to circulate to the muscles and other vital organs
  • Skeletal Muscles
    • Produce heat during movement
    • Raises body’s core temperature
  • Produce heat during movement
  • Increases body’s core temperature
wellness illness
WELLNESS & ILLNESS
  • General assessment
    • Overview
    • General hygiene
      • Well developed, well nourished, or other ?
    • Inspection and palpation
      • Color, appearance, temperature, turgor
      • Vascularity
      • Lesions or abnormalities
infants
INFANTS
  • Commonly seen conditions
    • Vernix caseosa
    • Lanugo – fine hair
    • Mongolian spots
    • Café au lait spots
    • Port-wine stain (nevus flammeus)
    • Erythema toxicum-rash
    • Acrocyanosis
    • Physiologic jaundice
adolescents
ADOLESCENTS
  • Acne
    • Active sabaceous glands
    • Types:
      • Open comedones (blackheads)
      • Closed comedones (whiteheads)
    • May also include
      • Papules
      • Pustules
      • Nodules
pregnant women
PREGNANT WOMEN
  • Skin stretches:
    • Striae –stretch marks
    • Caused by elastic collagen fibers breaking down
  • Linea nigra – midline of abdomen
  • Chloamsa – hyperpigmentation
  • Vascular spiders – tiny red lines
adults seniors
ADULTS & SENIORS
  • Middle-aged adults
    • Skin changes
      • Angiomas on trunk
      • Skin tags
    • Increased/decreased hair growth
    • Alopecia – male pattern balding
  • Seniors
    • Skin’s gradual breakdown: dryness,wrinkling
    • Skin more fragile
      • Trauma – senile purpura
      • Liver spots
      • Keratoses
general skin conditions
GENERAL SKIN CONDITIONS
  • Ringworm –fungus
  • Dermatitis –inflammation associated with an allergic reaction
    • Allergen touches skin – contact dermatitis
    • Ingestion of allergic substance
    • Rash may be urticarial – hives, itchy
  • Atopic dermatitis
    • Chronic inflammation – usually caused by allergy
      • Psoriasis
      • Seborrhea – cradle cap, dandruff
  • Lesions
    • Nevi – birth marks/beauty marks
    • Hemangioma – collection of blood vessels
skin cancers
SKIN CANCERS
  • Melanoma
    • Cancer that develops in the pigment cells
      • An overgrowth of melanocytes
      • Most dangerous form of skin cancer
        • Can spread ( metastasize)
      • A-B-C-D changes in lesion
melanoma
MELANOMA
  • A-B-C-D changes that indicate malignancy
    • Asymmetry
    • Border
    • Color
    • Diameter
skin cancers continued
SKIN CANCERS (Continued)
  • Cancers of the epithelial cells
    • Appear in areas exposed to sunlight, such as the face
    • Basal cell
      • 75% of a skin cancers
      • Smooth, pearly papule
      • Slow growing
      • Do NOT metastasize
      • Treatment: surgical removal
skin cancers continued28
SKIN CANCERS (Continued)
  • Squamous cell
    • Painless, firm red nodule or plaque
    • May develop surface scales, ulcerations or crusting
    • Tends NOT to metastasize
    • Treatment: surgical removal
  • Kaposi sarcoma
    • Associated with AIDS
    • Distinct brown lesions on the legs
    • Can metastasize
primary skin lesions
Primary Skin Lesions
  • Skin signs are objective evidence of an illness or disorder
  • Various lesions are described in specific terms
    • Primary or initial lesions
    • Secondary – result of primary lesions
slide30
Cyst
  • An encapsulated, fluid-filled area in the dermis or subcutaneous layer
bulla
Bulla
  • A fluid-filled lesion larger than 1 cm that is thin-walled and ruptures easily
    • Example – blister
macule
Macule
  • A round, flat, pigmented area
    • Example − measles, freckles
nodule
Nodule
  • A solid, raised area larger than 1 cm
  • A larger papule
    • Example − acne vulgaris
papule
Papule
  • A palpable (something that can be felt) lesion that is rounded, solid, and raised (less than 1 cm)
    • Example – pimple, mole
plaque
Plaque
  • An area of papules that are merged to form a lesion larger than 1 cm
    • Example − psoriasis
pustule
Pustule
  • A round, raised, pus-filled lesion
    • Example – chicken pox in acute stage
urticaria
Urticaria
  • An intensely itchy (pruritic) area of wheals that have merged
    • Wheals are raised, red, and irregularly shaped
    • Due to an allergic reaction
    • Usually itchy
vesicle
Vesicle
  • A raised, clear fluid-filled sac,up to 1 cm in size
    • Example – blister
secondary skin lesions
SECONDARY SKIN LESIONS
  • Primary skin lesions that have changed as a result of manipulation (scratching) or natural/pathologic progression
crust
Crust
  • A thickened, dried area from broken pustules or vesicles
    • Examples: impetigo, chicken pox (when drying) scabs, eczema
erosion
Erosion
  • A superficial, scooped-out area that does not extend into the dermal layer
excoriation
Excoriation
  • Reddened abrasions, usually from scratching
    • Example – scabies, insect bites
fissure
Fissure
  • A linear crack or slit that extends through the epidermis into the dermis
    • Example – athlete’s foot
keloid
Keloid
  • Excess scar tissue; most commonly seen in African-Americans
    • Forms at site of injury or incision
scale
Scale
  • A thin flaky, dry, silvery or white form of shedding keratin cells
    • Examples – ringworm, eczema, psoriasis
slide46
Scar
  • Connective tissue that remains after a skin lesion has healed
    • Examples − chicken pox scar, acne
ulcer
Ulcer
  • A deep depression that extends into the dermis
    • Also called erosion,crater
    • Pressure ulcer (decubitus or bedsore)
      • Caused by lack of circulation to avulnerable area – a bony prominence
      • Can lead to necrosis
      • Potentially very serious
hair nails general conditions
HAIR & NAILS −GENERAL CONDITIONS
  • Hair
    • Hirsutism − abnormal hair growth (increased)
    • Alopecia – absence of hair, baldness
  • Nails
    • Paronychia – inflammation around nail
    • Onycholysis – loosening of nail plate
diagnosing treating tests
DIAGNOSING & TREATING: TESTS
  • Biopsy
    • To determine diagnosis
  • Patch test
    • To identify specific allergies
  • Scratch test
    • Scratching surface of skin with allergens
  • Intradermal injections
    • Local inflammatory response
      • PPD – TB
  • Wood’s lamp
    • Ultraviolet light to diagnose tinea (ringworm)
procedures
PROCEDURES
  • Surgical
    • Debriding – burns (eschar)
    • Laser – to remove lesions, unwanted hair
    • Dermabrasion
      • Removes scars
    • Chemical peel
      • Removes small lines and scars
  • Cosmetic:
    • Fillers and injectables – Botox
    • Topicals
    • Surgery
      • Many types of plastic surgery
pharmacologic agents
PHARMACOLOGIC AGENTS
  • Mostly topical agents
    • Abrasives
    • Acne preparations
    • Antibacterials
    • Antifungals
    • Atopic dermatitis – use anti-inflammatory agent
burns
BURNS
  • Injury to tissue caused by heat, fire, chemical agents, electricity, lightening or radiation
  • Classified according to degree or depth of skin damage and percent of body surface area (BSA) involved
    • Superficial/partial thickness (first degree)
    • Partial thickness (second degree)
    • Full thickness (3rd degree)
burns53
Burns
  • To determine extent of burns (percentage) use either
    • Rule of Nines
      • Divides body into areas of 9’s
      • Each arm = 9 %
      • Each leg = 9%
    • Lund and Brower
      • Divides body into small areas
      • Estimates BSA involved