Integumentary System

Question 1

1.What are the functions of the integumentary system?

Answer 1

Protection - barriers are 3 types:
Physical
Chemical
biological
Thermoregulation
Excretion
Cutaneous sensation
Vitamin D synthesis
Blood reservoir

Question 2

2.Name two layers of the skin.

Answer 2

Epidermis - thinner, superficial portion of skin
Dermis - lies deep to epidermis
Hypodermis (superficial fascia or subcutaneous layer) lies deep to the dermis

Question 3

3. What is the hypodermis? Where is it located?

Answer 3

Hypodermis (superficial fascia or subcutaneous layer) lies deep to the dermis

Question 4

4. What are the primary tissue types in the hypodermis?

Answer 4

areolar and adipose tissue

Question 5

5. Describe the function(s) of the hypodermis.

Answer 5

Hypodermis anchors to skin to underlying organs
Acts as shock absorbed and insulates the deeper body tissues
Contains major blood vessels that supply the skin

Question 6

*53. Describe the progressive stages of pressure ulcers.

Answer 6

Stage I
Skin is intact with nonblanchable redness of a localized area, usually over bony prominence. Darkly pigmented skin may not have visible blanching; color may differ from surrounding area. May be painful, soft, firm, warmer or cooler compared to adjacent tissues/ May be difficult to detect in individuals with dark skin tones. May indicate “at-risk” person (heralding risk).

Stage II
Parietal thickness loss of dermis presents as shallow open ulcer with red-pink wound bed without slough. May present as intact or open or rupture serum filled blister. Presents as a shiny or dry shallow ulcer without slugh or bruising. This stage should not be used to describe skin tears, tape burns. Perineal dermatitis, maceration or denudement

Stage III
Full thickness tissue loss. Subcutaneous fat may be visible but bone, tendon or muscle is NOT exposed. Slough may be present but does not obscure depth of tissue loss. May include undermining and tunneling./ Depth of this stage ulcer varies by anatomic location. Bridge of nose, occiput, eat and malleolus do not have adipose subcutaneous tissue; and stage III ulcers can be shallow. Contrasting areas with significant adipose tissue can develop extremely deep pressure ulcers stage III. Bone or tendon not visible or directly palpable.

Stage IV
Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present on some parts of the wound bed/ Often includes undermining and tunneling. Varies by anatomic location. Differs from stage III in that they extend into muscle and/or supporting structures like fascia, tendon, or joint capsules, making osteomyelitis possible. Bone or tendon visible and directly palpable.

UNSTAGEABLE
Full thickness tissue loss in which the base of the ulcer is completely obscured by the slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown, black) in wound bed. Until enough slough and/or eschar are removed to expose the base of the wound, the true depth, and therefore stage, cannot be determined. Stable (dry, adherent, intact without erythema or fluctuance) eschar on the heels serves as “the natural (biologic) cover of the body” and should not be removed

Question 7

*54. How does the Braden Scale assess for pressure ulcers?

Answer 7

Six parameters
Sensory perception (ability to respond meaningfully to pressure related discomfort)
Moisture (degree to which skin is exposed to moisture)
Activity (degree of physical activity)
Mobility (ability to change and control body position)
Friction and shear
Additionally, age, heavy sedation and anesthesia, anemia, paralysis by restrictive devices, circulatory disorders, dehydration, edema and history are other parameters.

Question 8

*55. What would you document if you detect a pressure ulcer?

Answer 8

Evaluates level of risk for ulcer development
Sensory perception
Moisture
Activity level
Mobility
Nutrition
Friction shear
Low score means patient has low functional status and increased risk for ulcer formation
15-18 mild risk, 13-14 moder risk, 10-12 high risk, 9 or les Very high risk

Document all skin assessments. Record any skin changes, patient’s risk score, positions, turning intervals, distribution devices, and other prevention measures.

Question 9

superficial fascia:

Answer 9

aka hypodermis or subcutaneous layer

pressure wound

Question 10

44. The ABCDE mnemonic is a way to remember the key detection points of melanoma. What does each letter of the mnemonic represent?

Answer 10

Asymmetry of lesion: one side different from other
Borders: irregular (uneven, lumpy edges)
Color :Blue/black pr variegated; not uniform pigmentation
Diameter greater than 6 mm
Evolving: change in size, shape, color; itching or bleeding

Question 11

*51. Determine key anatomical areas to assess for pressure ulcers.

Answer 11

Sacrum, coccyx, ischial tuberosities, greater trochanters, heels, scapulas, iliac crests and lateral and medial malleoli

Question 12

*52. Identify patients at risk for pressure ulcers.

Answer 12

Incontinence
Chronic moisture from fecal and urinary incontinence compromises protective barrier of skin and may overhydrate it, making it more susceptible to breakdown

Friction and shear

Immobility
Restricts a patient’s ability to change and control body position, thus increasing the pressure over bony prominences

Loss of sensory perception
Decreases the individual’s ability to respond to increased, prolonged pressure in an area of the body and change positions accordingly

Level of activity
Person bed bound is at greater risk for skin breakdown than a person who is fully or partially mobile

Poor nutrition

Question 13

Tonofilament:

Answer 13

Tonofilament: intermediate filaments composed of pre-keratin

Question 14

Erythemia:

Answer 14

redness of the skin caused by dilation and congestion of the capillaries (quigley 437)
ceruminous gland

Question 15

6. What types of cells are found in the epidermis? Which of these is the primary cell type?

Answer 15

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