Integumentary System Flashcards
What is the Primary Function of the Skin?
Protection
Which of the following are age-related changes in the hair and nails? (select all that apply)
a. Oily Scalp
b. Scaly Scalp
c. Thinner Nails
d. Thicker, brittle nails
e. Longitudinal ridging
b, d, e
The nurse assessed the client’s skin lesions as firm, edematous, and irregularly shaped with variable diameter. What are these lesions called?
Wheals
On inspection of the client’s skin, the nurse notes the complete absence of melanin pigment in patchy areas on the client’s hands. What is the assessment finding called?
Vitiligo
Individuals with dark skin are more likely to develop which of the following?
a. Keloids
b. Wrinkles
c. Rashes
d. Skin Cancer
A. Keloids
Under what circumstance is diagnostic testing recommended for skin lesions?
a. When a health history cannot be obtained
b. When a more definitive diagnosis is needed
c. When percussion reveals abnormal findings
d. When treatment with precribed medication has failed
B. When a more definitive diagnosis is needed
When assessing self-care habits in relation to the skin, what does the nurse question the client about?
a. Joint pain
b. Use of sunscreen products
c. Recent changes in exercise products
d. Family history of melanoma
B. Use of sunscreen products
During the physical examination of a client’s skin, which of the following would the nurse do?
a. Use a flashlight if the room is poorly lit
b. Note cool, moist skin as normal findings
c. Pinch up a fold of skin to assess for turgor
d. Perform a lesion specific examination first and then general inspection
C. Pinch up a fold of skin to assess for turgor
Epidermis
- Outer layer of the skin
- Relatively thin
- No lymphatic or vascular structures
- Superficial
- Breaks easily
- Sheds/Regenerates every 28 days
Dermis
Connective tissue below the epidermis
Highly vascular
Contains nerves, lymphatic vessels, hair follicles, sebaceous glands, and specialized cells such as mast cells and macrophages that protect the body from external stimuli
Wound will bleed with injury
Variety of thickness
Subcutaneous Tissue
While not part of the skin it attaches to the skin to underlying tissues such as muscle and bone
Contains loose connective tissue and fat cells that provide insulation, cushioning, temperature regulation, and energy storage
The distribution of subcutaneous tissue varies with gender, heredity, age, and nutritional status
Skin Appendages
Skin appendages include the hair, nails, and glands
What is the primary role of the integumentary system?
to protect the underlying tissues of the body from the external environment
The skin acts as a barrier against invasion by bacteria and viruses and prevents excessive water loss
What does fat do in the integumentary system?
The fat in the subcutaneous layer, insulates the body and provides protection from trauma
How does the skin regulate heat loss?
The skin regulates heat loss by responding to changes in internal and external temperature with vasoconstriction, vasodilation, and excretion of sweat
What provides sensory information in the skin?
Nerve endings and receptors located within the skin provide sensory information on environmental stimuli to the brain related to pain, temperature, touch, pressure, and vibration
What is some subjective data that needs to be collected for the Integumentary system?
Past medical history
Medications
Surgery or other treatments
Family history (ie., skin cancer)
Nutritional History (ie., vitamins that are essential to healthy skin such as vitamin A, D, and E. Food allergies that cause rashes.
Hydration Status
Social, Environmental, and Occupational Health History (ie., contact dermatitis)
Cognitive-Perceptual (ie., the patients perception to cold, pain, and touch. Joint pain and the mobility of joints)
Coping Abilities
What is some objective data that the nurse should collect for the integumentary system?
Inspection & Palpation
What do you inspect with the integumentary system?
Pigmentation, vascularity, bruising and the presence of lesions or discolouration
Nail beds, oral mucosa
Note the presence of tattoos and piercings
The colour, size, height, distribution, location, and shape of any lesions should be noted
Distribution and quantity of hair
Clubbing to nails
What does palpating the skin provide information about?
Palpating the skin provides information about temperature, turgor and mobility, moisture, and texture
What is a Punch Biopsy?
Provides full-thickness skin for diagnostic purposes
Includes dermis and some fat
Suturing may or may not be done
Scalpel blades
What is an Excisional Biopsy?
Skin closed with subcutaneous and skin sutures
Useful when good cosmetic results or entire removal or both are desired
Take a measurement with regards to the skin- called the “Safety Margin”
Ex: Take a border from around mole and then sent to a lab for diagnostics
The hope is to find “Clear Borders”
What is an incisional biopsy?
Wedge shaped incision made in lesion too large for an excisional biopsy. Useful when larger specimen than shave biopsy is needed
Ex: Skin Tag is snipped from the top of the skin.
Does not go any lower than the epidermis
Localized freezing, no deep freezing
What is a shave biopsy?
Single-edged razor blade used to shave off superficial lesions or small sample of a large lesion
Provides a thin specimen for diagnostic purposes
Shave off the epidermis and a bit of the dermal layer
What do cultures do for the skin?
Tests fungal, bacterial, and viral organisms
For bacteria= material is obtained from intact pustules or abscesses
What is Wood’s Lamp Test (Black Light)?
Identifies certain conditions on your skin, scalp, and hair. It’s often used to diagnose fungal, bacterial and parasitic infections.
Uses ultraviolet (UV) light to make certain cells show color or appear fluorescent
What is the mechanism of cell death?
The mechanisms of actual cell death may include the deterioration of the nucleus (nuclear shrinking), karyolysis (dissolution of the nucleus), disruption of cell metabolism, the rupture of the cell membrane
What does microbial invasion often result in?
Microbial invasion often results in cell injury and death
How does infection occur?
Infection occurs when pathogens invade and multiply in body tissue
What is apoptosis?
Programmed Cell Death
When does apoptosis occur?
Occurs in some regenerating tissues to create homeostasis , such as bone marrow, skin, and gut epithelium
What is necrosis?
tissue death that occurs as a result traumatic injury, infection, ischemia, or exposure to a toxic chemical that causes a local inflammatory response, which results from the release of intracellular contents after the rupture of the outer membrane of the dead cells
Defense against injury:
Mononuclear Phagocyte System
Phagocytic cells located in various tissues and organs
The functions of the macrophage system include recognition and phagocytosis of foreign material such as microorganisms, removal of old or damaged cells from circulation, and participation of the immune response
Defense Against Injury:
Inflammatory Response
A biological response to cell injury caused by pathogens, irritants, or chronic health conditions (ie., arthritis)
What does the intensity of the inflammatory response depend on?
The intensity of the response depends on the extent and severity of the injury and on the reactive capacity of the injured person
What happens to the inflammatory agent during the inflammatory response?
-the inflammatory agent is neutralized and diluted
- necrotic materials are removed
- An environment suitable for healing and repair is established
Defense Against Injury: Inflammatory Response
What occurs after cell injury as a vascular response?
After cell injury, vasoconstriction occurs to prevent bleeding by the movement of platelets to adhere to the vessels of the injured area forming a blood clot
This then releases Histamine which causes vasodilation
What part of the blood releases histamine?
Causes vasodilation to stop blood flow to the wound- platelets release histamine by causing some vasodilation to the area to fight off infection
Defense Against Injury: Inflammatory Response
In the Cellular Response, what do neutrophils do?
First leukocytes to arrive at the site of inflammation
They phagocytize (engulf) bacteria, other foreign material, and damaged cells
When dead neutrophils accumulate with other cell debris this collects and forms pus