Ch49

Integumentary System Overview

Introduction

  • Focus on the assessment of skin, hair, and nails in medical-surgical nursing.

  • Overview of the role of the integumentary system in health and disease.

Anatomy of the Skin

  • Functions: Protection, temperature regulation, vitamin D metabolism, sensation, and excretion.

  • Layers of the Skin:

    • Epidermis: Outermost layer; contains strata like the stratum corneum and stratum basale.

    • Dermis: Contains nerve endings, blood vessels, and various glands (sebaceous and sweat glands).

    • Subcutaneous Tissue: Hypodermis; composed of fat and connective tissue.

  • Cells of the Epidermis:

    • Keratinocytes: Main cell type, responsible for the strength of the skin.

    • Melanocytes: Produce melanin, affecting skin color.

    • Langerhans Cells: Immune response.

    • Merkel Cells: Touch sensation.

Hair Structure

  • Anatomical Parts:

    • Hair Shaft: Visible part of hair.

    • Hair Root: Embedded in the skin.

    • Follicle: Contains several structures including sebaceous glands and blood vessels.

  • Functions: Reduce heat loss and shield the skin from UV radiation.

Nails Structure

  • Components:

    • Nail Plate: Visible part; protects fingertips.

    • Nail Bed: Skin beneath the nail plate.

    • Lunula: White crescent shape at the base of the nail.

    • Eponychium (Cuticle): Protects the area between the nail and the skin.

Assessment in Clinical Practice

History Taking

  • Collect demographics, personal, and family history related to integumentary health.

  • Medication history and its effects on skin health.

  • Environmental factors that may impact skin conditions (e.g., sun exposure, allergens).

Physical Assessment

  • Visual Inspection:

    • Color and temperature of the skin.

    • Moisture level, integrity, and cleanliness.

    • Signs of any tissue changes.

  • Braden Scale:

    • Assesses risk for pressure injuries through sensory perception, moisture, activity, mobility, nutrition, and friction/shear.

Hair Assessment

  • Evaluate the following:

    • Color, cleanliness, quantity, thickness, texture, and distribution of hair.

Nail Assessment

  • Check for:

    • Color, shape, consistency, and lesions present on nails.

Follow-up Questions: Understanding Diagnosis and Treatment

  1. Affected Skin Layers: (C) Both epidermis and dermis are affected by dermatitis.

  2. Specimen Collection Technique: (C) Rotate swab on clean wound tissue appropriately.

  3. Site Care Instructions: (B) Emollients for moisturizing and crust removal.

  4. Vesicle Description: (A) Less than 1 cm, circumscribed, elevated, serous-filled.

  5. Surveillance Cells Role: (D) Langerhans cells present allergens to T cells.