Exam 2 (Ch. 24 & 25) PPT Flashcards
Skin Structures
What are the layers of the skin?
From outermost to deepest
- Epidermis:
Structure: The outermost layer, composed primarily of keratinized stratified squamous epithelium. It’s avascular (lacks blood vessels). Layers include the stratum corneum, lucidum (only in thick skin), granulosum, spinosum, and basale. - Dermis:
Structure: The middle layer, composed of connective tissue containing collagen and elastic fibers, blood vessels, nerves, hair follicles, and glands. Has two layers: papillary (superficial) and reticular (deep). - Subcutaneous Tissue (Hypodermis):
Structure: Deepest layer, composed mainly of adipose (fat) tissue and some connective tissue.
Skin Structures and Functions
What is the function of the epidermis?
Protection (against pathogens, water loss, abrasion), melanin production (for UV protection), and vitamin D synthesis.
Skin Structures and Functions
What is the function of the dermis?
Provides strength and elasticity, supports the epidermis, regulates temperature (via blood vessels), and provides sensation (via nerves).
Skin Structures and Functions
What is the function of the subcutaneous tissue (Hypodermis)?
Insulation, energy storage, and cushioning.
Skin Structures and Functions
What are the functions of the following skin appendages?
Nails
Hair
Sweat Glands
Sebaceous Glands
Nails: Protective plates of keratin.
Hair: Composed of keratin, provides some warmth and protection.
Sweat Glands: Produce sweat for thermoregulation (cooling). Types include eccrine (all over body) and apocrine (axillary and genital areas).
Sebaceous Glands: Produce sebum (oil) that lubricates skin and hair.
A client reports dry, itchy skin. Which of the following interventions would be appropriate to recommend to the client?
A. Use hot water when bathing.
B. Apply a fragrance-free moisturizer immediately after bathing.
C. Use a harsh, abrasive scrub when cleansing the skin.
D. Increase the frequency of bathing to remove irritants.
E. Use a humidifier in dry environments.
B, E
Rationale: Options B and E address the issue of dry skin by promoting moisture retention. Options A, C, and D would further dry or irritate the skin.
A client is diagnosed with a condition that causes decreased sebum production. Over time, what trends would the nurse expect to observe in this client’s skin?
A. Increased oiliness of the skin
B. Increased risk for skin infection
C. Increased hydration of the skin
D. Increased risk for skin breakdown and dryness
D
Rationale: Sebum helps lubricate and protect the skin. Decreased sebum leads to dryness and potential breakdown.
Which of the following are functions of the subcutaneous tissue (hypodermis)?
A. Producing new skin cells
B. Providing insulation
C. Storing energy
D. Providing sensation
E. Anchoring the skin to underlying tissues
B, C, E
Rationale: The subcutaneous tissue is primarily for insulation, energy storage, and connecting the skin to deeper structures. The epidermis produces new skin cells, and the dermis contains sensory receptors.
Functions of the Integumentary System
What are the functions of the integumentary system?
5
Protection
Insulation: The subcutaneous fat layer provides insulation, helping regulate body temperature.
Sensory Perception: The skin contains various sensory receptors that detect touch, pressure, temperature, and pain.
Control of Heat Regulation
Synthesis of Vitamin D: Vitamin D is synthesized in the skin when exposed to UV light. It plays a crucial role in calcium absorption and bone health.
Functions of the Integumentary System
What are the types of protection the integumentary system provides?
Physical Barrier: The skin acts as a barrier against abrasion, cuts, and other physical trauma.
Chemical Barrier: Skin secretions (sebum, sweat) create a slightly acidic environment that inhibits bacterial growth. Melanin protects against UV radiation.
Biological Barrier: Langerhans cells in the epidermis are part of the immune system and help fight pathogens.
Barrier from Bacteria and Viruses: The intact skin acts as the first line of defense against most pathogens.
Functions of the Integumentary System
What are some forms of heat regulation controlled by the integumentary system?
Sweat Production: Evaporation of sweat cools the body.
Vasodilation/Vasoconstriction: Blood vessels in the skin can dilate (to release heat) or constrict (to conserve heat).
Which of the following are ways in which the integumentary system contributes to thermoregulation?
A. Producing sweat for evaporative cooling.
B. Synthesizing vitamin D.
C. Dilating blood vessels to increase heat loss.
D. Constricting blood vessels to conserve heat.
E. Secreting sebum to lubricate the skin.
A, C, D
Rationale: Sweat glands and blood vessels in the skin play direct roles in temperature regulation. Vitamin D synthesis and sebum production are not directly involved in thermoregulation.
A client has a condition that reduces the number of functioning Langerhans cells in the epidermis. What trend would the nurse expect to observe in this client?
A. Increased risk of skin infections
B. Decreased ability to regulate body temperature
C. Increased sensitivity to touch
D. Decreased production of vitamin D
A
Rationale: Langerhans cells are immune cells in the skin. A reduction in their number would increase the risk of infection.
Assessment of the Integumentary System
When does the general assessment beigns?
With first contact with the patient and continues through the exam
Note overall condition of skin & hair
Assessment of the Integumentary System
What are some key aspects to note during the assessment?
Skin Color
Moisture
Temperature
Texture
Turgor
Integrity
Hair
Nails
See PPT for what to assess/inspect for each
During the initial assessment of a client’s integumentary system, which of the following actions would be most important for the nurse to perform?
A. Evaluate skin turgor.
B. Observe the client’s skin color and hair distribution.
C. Inspect the nails for capillary refill.
D. Ask the client about their history of skin problems.
E. Measure the client’s blood pressure.
A, B, C, D
Rationale: All options except measuring blood pressure are direct components of an integumentary assessment.
A client has been experiencing excessive sweating (diaphoresis) for several days. What trends would the nurse anticipate related to the client’s integumentary system?
A. Increased skin turgor
B. Potential for skin breakdown
C. Decreased risk of infection
D. Increased oiliness of the skin
B
Rationale: Excessive moisture can increase the risk of skin maceration and breakdown.
Subjective Data (Integumentary Focus)
What is some important subjective health information to obtain from the client?
Health History (EX: Past skin problems (e.i. eczema, psoriasis, acne, allergies, infections, etc.) History of skin cancer, Changes in skin, hair, or nails, and any Symptoms (itching (pruritus), pain, burning, tingling, numbness, etc.))
Medications (Prescription and over-the-counter medications used on the skin, Systemic medications that might affect the skin, & Recent use of antibiotics)
Surgery or Other Treatments (Surgeries or procedures involving the skin (e.g., mole removal, biopsies) or Radiation therapy or other treatments that could affect the skin)
Functional Health Patterns (Skin care habits (how often do they bathe, what products do they use), Sun exposure habits (use of sunscreen, tanning beds), Occupational or recreational exposures that could affect the skin, Nutritional status, & Changes in self-care practices related to skin or hair)
Which of the following statements by a client would be considered subjective data related to the integumentary system?
A. “My scalp has been really itchy lately.”
B. “I’ve noticed a dark spot on my arm that’s getting bigger.”
C. “I use a tanning bed several times a week.”
D. “My blood pressure is 130/80.”
E. “I’ve been using a new moisturizer that seems to be helping.”
A, B, C, E
Rationale: These are all based on the client’s perceptions, experiences, or habits related to their skin. Option D is a measurement (objective data).
A client reports a history of psoriasis. What trends would the nurse anticipate when gathering subjective data from this client?
A. Reports of joint pain or stiffness
B. Reports of decreased sensitivity to sunlight
C. Reports of improved skin texture and reduced scaling
D. Reports of decreased need for topical medications
A
Rationale: Psoriasis is an autoimmune disease that can affect the joints, causing psoriatic arthritis. Joint pain or stiffness is a common symptom reported by clients with psoriasis.
Objective Data (Integumentary Focus)
What is the critical factor in assessment of the skin?
Change
Objective Data (Integumentary Focus)
What should the general inspection of the integumentary envolve?
- Observation of the skin’s color, moisture, & integrity
- Assessment of hair distribution, thickness, & texture
- Inspection of nails for color, shape, & capillary refill
- Note any obvious deformities or abnormalities
Objective Data (Integumentary Focus)
What are Primary Skin Lesions?
- These are lesions that develop directly from the disease process.
- Examples: macules, papules, patches, plaques, wheals, nodules, tumors, vesicles, bullae, pustules.
- Document: location, size, color, shape, and arrangement.
Objective Data (Integumentary Focus)
What are secondary skin lesions?
- These are lesions that result from changes in primary lesions or are caused by external factors (e.g., scratching, infection).
- Examples: scales, crusts, erosions, ulcers, excoriations, fissures, scars, atrophy, lichenification.
- Document: location, size, color, shape, and arrangement.