Unit 3 Integumentary System

The integumentary system

• Contains the skin, hair, nails and sweat and oil glands

• It is the largest system in the body

• Integument means covering

Glands

• A group of cells that produces and secretes a substance

• Produce and secrete sweat and oil

Integumentary system functions

• Protects the body from injury, intrusion of harmful microorganisms, and ultraviolet rays of the sun

• Helps to maintain the proper internal temperature of the body

• Serves as a site for excretion of waste through perspiration

• Serves as a important sensory organ

Layers of the skin

1. Epidermis

2. Dermis

3. Subcutaneous

Epidermis

• Outer layer

• Responsibly for protection and secretion

• Does not contain blood vessels

• Special pigment cells that produce melanin

• Nerve endings reach into this outer layer that receive information about:

  • Heat

  • Cold

  • Pain

  • Pressure

  • Temperature regulation

Melanin

• Melanin is essential in screening UV radiation

• Variety of skin colour is caused mainly by melanin expression

• Melanin is produced in special cells called melanocytes

• Darker skin has more melanin

• Albinism is a condition where skin does not produce melanie

Dermis

• Second layer

• Contains connective tissue that holds capillaries, lymph cells, nerve endings, sebaceous glands, sweat glands, and hair follicles

• Top layer (papillary layer) fits into ridges on the stratum germinativum to form lines

  • On fingers = fingerprints

Subcutaneous layer

• Between the dermis and the inner organs

• Consists of fatty tissue and some layers of fibrous tissue

• Contains blood vessels and nerves

Goose Bumps

• Are caused by the contraction of an arrector pilli muscle connected to each hair follicle

• The contraction also causes the hair to stand on end

Hair

• The entire body except the palms of the hands and the soles of the feet is covered with hair

• Hair in the nose, eye and ear regions protect against dust, insects and foreign objects

• Hair on the head helps retain heat

• The shape of the hair follicle (from which hair grows) determines the shape of the hair – curly, straight, wavy.

• Hair colour is determined by the presence of melanin

• Gray hair occurs when we stop producing melanin

Nails

• Generally pink

• Blue could indicate poor oxygenation

• Whitish half-moon at the base of most nails is the lunula

• Narrow band of epidermis surrounds the nail of three sides is called the cuticle

What are nails made of

Hard keratin that cover the dorsal surface of the distal bone of the fingers and toes

Nail functions

• Protect fingertips and toes

• Helps us to grasp and scratch

• Health and nutritional status can be reflected in the nails

Sweat and body odour

• Sweat itself is odorless

• Body odour is caused by the action of the skin’s normal bacteria on the sweat

• Sweating = diaphoresis

Sweat consists of…

Water, salt and a small amount of wastes

Why do we sweat

• To cool off during exercise and in hot environments

• During stressful situations

• During hormonal changes

• With strong emotions

Sebaceous Gland

• Secrete an oily substance called sebum into the space near the hair shaft

• Sebum (oil) helps to keep the hair and skin soft and shiny and also inhibits the growth of bacteria on the surface of the skin.

Blue skin can indicate..

• Poorly oxygenated blood

• A condition called cyanosis

• Common during heart failure and severe breathing disorders

Red skin can indicate..

• Fever

• Inflammation

• Allergy

White (Pallor) skin can indicate..

• Low blood pressure

• Impaired blood flow into an area

• Emotional stress (fear, anger, and others)

Yellow (Jaundice) skin can indicate..

• Liver disorder in which excess bile pigments are absorbed into the blood, circulated throughout the body and deposited in body tissues

• Can be seen in the eyes as well

Blue/Black skin can indicate..

• Sites where blood has escaped from circulation and has clotted in the tissue spaces (=hematomas)

What is cancer

When cells multiply uncontrollably because the normal regulation of their division has been damaged

Malignant tumours

• A mass of abnormal cells that divide excessively and do not carry out normal functions

• These cells are often irregular in size and shape

• Can spread into neighboring tissues and distant sites

Metastasis

• The spread of cancerous cells to distant locations

• The initial tumor is called the primary tumor and those that develop in remote sites are called secondary tumors

Benign tumors

• Caused by cells that multiply abnormally and do not carry out their usual functions

• These tumors are contained and do not spread

Causes of cancer

• Carcinogens

• Heredity

Carcinogens

• Cancer-causing agents

• Smoking, viruses, UV radiation, etc.

• Damage specific genes (sections of DNA) called oncogenes that regulate cell division, growth, repair of damaged cells and the ability of a faulty cell to self-destruct

How does cancer start

• Damage from carcinogens

  • Carcinogens continually bombard cells and eventually affect genes (oncogenes) on chromosomes

• Permanent Damage

  • With time or higher-than-normal exposure to carcinogens, some of the genes suffer permanent damage

• Cells Become Cancerous

  • Eventually a number of oncogenes are permanently altered

  • The cell functions abnormally and may become cancerous

Basal cell carcinoma

• Most common form of skin cancer

• Usually appears as a small, pink bump or patch on the head or neck, and may occur on any part of the body

• If untreated, the area will begin to open, bleed, or crust repeatedly and can cause extensive damage to the area involved

• Grows slowly but rarely spread to other parts of the body

Squamous Cell Carcinomas

• Can look similar to basal cell carcinomas, but are usually more scaly and stick out further from the skin’s surface

• Often occur on the head and neck, and have a special tendency to grow on the ears, lips, and the backs of hands and arms

• If treated early, is curable

• If the tumor invades deeply, it can spread to the lymph nodes, which then must be removed

• If treatment is unsuccessful, squamous cell carcinoma spreads internally and results in death

Malignant Melanoma

• A cancer in melanocytes, or pigment-producing cells, in the skin

• Usually appears as an irregular brown spot or changing mole

• Can spread to other areas of the body, or metastasize

• Can arise from normal skin or from a mole, which has turned bad

• If caught early, is usually curable

• If it spreads to other parts of the body, it can result in death

Melanoma risk factors

• A mole that is changing

• Having a mole that is >15mm in diameter and has been present since birth

• White race

• A prior skin cancer

• A close family member with melanoma

• Using a tanning bed ten times a year or more before age 30

• More than 50 moles on your body

• Suppression of the immune system

• The tendency to burn and freckle instead of tan

Skin cancer prevention

• Avoid sun exposure. Severe sunburn is a major risk factor

• Apply generous amounts of sunscreen

• Avoid the peak hours of sun intensity (10 a.m. to 4 p.m.)

• Ask your doctor if your medications increase your sensitivity to the sun, because many medications make your skin more vulnerable to sun damage

• Avoid tanning salons

Burns

• Caused when body tissue is in contact with extreme heat, corrosive chemicals, radiation, or high voltages

• Skin damage occurs when skin touches anything over 44°C

• A burn victim is at risk for infection, shock, pain, loss of body heat and fluids, swelling of breathing passages and death

First-degree burns

• Superficial burns

• Involves only the epidermis

• Characterized by pain, redness and swelling

Second-degree burns

• Involves the epidermis and dermis

• Pain, redness, swelling and blistering

• Should treat any 2nd degree burn that affects 1% or more of the body surface

• Shock is likely to develop if injuries affect more 9% of body surface

• Can be life-threatening

Third-degree burns

• Involve all layers of skin and often underlying muscles and bones

• Skin often looks charred and black

• Always requires medical attention

Guidelines for Treating Burns

• Anything sticking to the burn should not be removed

• Butter, lotions or ointments should NOT be applied to the burn unless prescribed.

• The burn should be cooled with large amounts of cold water and covered with a sterile sheet or plastic bag

• Burns to the face however should not be covered

• Emergency medical personnel should be contacted for serious burns

• In burns to the mouth and throat, the airways should be checked to see if there is any swelling

• Burns to the head are always more serious than burns to other body parts

Wounds

• A break in the skin or mucous membrane that becomes a portal of entry for microbes

• When injury does occur, infection is a major threat, so wound care is important for preventing infection and further injury to the wound and nearby tissues

Abrasion

A partial-thickness wound caused by the scraping away or rubbing of the skin

Contusion

A closed wound caused by a blow to the body

Incision

A open wound with clean, straight edges (usually intentionally created)

Laceration

An open wound with torn tissues and jagged edges

Penetrating wound

An open wound in which the skin and underlying tissues are pierced

Punctured wound

An open wound made by a sharp object; entry of the skin and underlying tissues may be intentional or unintentional

What is a skin tear?

• An acute traumatic wound resulting from external friction and/or shearing forces that separate the epidermis from the dermis

• Usually present on hands and upper extremities

What are the risk factors for skin tears

• Occurs in individuals with fragile skin

• Older adults at high risk

• Previous skin tears

• Compromised nutrition

• Cognitive impairment

• Impaired mobility

• Dry skin/Dehydration

• Presence of pressure or shear

• Impaired sensory perception

Prevention and treatment of skin tears

• LIFT do not drag patients

• Avoid tape or adhesives

• Exercise caution during bathing, dressing, and transferring

• Pad bed rails, wheelchair arm and leg supports

• Maximize nutrition and hydration

What are Pressure Ulcers?

• An area of the skin that has broken down because of constant pressure or friction

• The skin becomes injured because of lack of circulation, which destroys the tissue

• Also called decubitus ulcers, bed sores or pressure sores

• If untreated they become large and painful

• The wound must be kept extremely clean, since it provides a portal of entry into a susceptible host

• Standard precautions are used when treating a resident with a pressure ulcer

What increases the risk of pressure ulcers

• Immobility and limited activity

• Moisture, particularly when due to incontinence or poor hygiene

• Poor nutrition or hydration

• Friction and shearing forces

• Loss of sensory perception (unable to feel)

• Atrophic skin (as skin ages, it becomes thinner, fragile and less elastic)

• Residents who are paralyzed, diabetic, unconscious, obese, or very thin

Where do pressure ulcers commonly occur

• Over bony prominences

  • Shoulder blades

  • elbows

  • knees

  • heels

  • ankles

  • the back of the head

Stage 1 pressure ulcer

• Skin remains intact, but there has been a colour change to either extreme whiteness or redness

Stage 2 pressure ulcer

• Skin is broken or cracked through the epidermis, dermis or both

• The sore is considered superficial and may look like a blister or a tear in the skin

Stage 3 pressure ulcer

• Full thickness tissue loss

• Subcutaneous fat may be visible but bone, tendon or muscle are not exposed

Stage 4 pressure ulcer

• Involves the breakdown of the tissue, muscle, tendons, etc.

• Slough may be present on some parts of the wound

• Often include tunneling

Good skin care

• Clean and dry

• Free of moisture from urine, stool, perspiration and wound drainage.

• Change linens and clothing as needed

• Apply moisturizers on dry areas

Protective devices for pressure ulcers

• Bed cradle (Anderson frame)

• Elbow protectors

• Heel elevators

• Floatation pads

• Eggcrate-like mattress

ABCD’s of moles

Characteristics of skin damage that doctors look for when diagnosing and classifying melanomas