Week 3 - integumentary system Flashcards
functions of the skin
Protection – waterproof, resilient; protection from physical, chemical, thermal, light wave injury.
Prevention of penetration – a barrier that keeps out micro-organisms, prevents loss of water and electrolytes.
Perception – sensory end organs for touch, pain, temperature, and pressure all reside in the skin.
Temperature regulation – sweat glands and subcutaneous insulation for heat dissipation and storage.
Identification – unique facial characteristics, hair, skin color, fingerprints.
Communication – face and body posture signal emotional states (ie. Blushing).
Wound repair – allows for cell replacement.
Absorption and excretion – some excretion of metabolic wastes (ie. Minerals, sugars, amino acids, cholesterol, uric acid, urea).
Production of vitamin D – UV light converts cholesterol into vitamin D on the surface of the skin.
layers of the skin
Epidermis – the outer, thin but tough layer. Cells are constantly shedding (desquamation) and are fully replaced every 4 weeks. *Think about how this relates to wound assessment and healing
Dermis – the inner, supportive layer; mostly consists of connective tissue (collagen); gives skin its stretch. Nerves, sensory receptors, blood vessels, and lymphatic vessels are contained in the dermis.
Subcutaneous later – beneath the dermis, is adipose tissue (fat cells); provides insulation/thermoregulation and cushioning/protection.
subjective data: health history
Previous history of skin disease (allergies, hives, psoriasis, or eczema)
Pruritus =itching; most common skin symptom
Excessive dryness or moisture
Change in pigmentation
Change in mole (size or colour)
Rash or lesion= very common reason for seeking health care. For any abnormal symptoms, and especially for rashes, the LOTTARRPP acronym is helpful to elicit subjective data:
Location
Onset
Type
Timing
Aggravating
Alleviating
Radiating
Related symptoms
Personal perception
Precipitating event
Excessive bruising
Medications
Hair loss
Change in nails
Environmental or occupational hazards
Self-care behaviours
LOTTARRPP
Location
Onset
Type
Timing
Aggravating
Alleviating
Radiating
Related symptoms
Personal perception
Precipitating event
older adults
- the epidermis thins and flattens = easier entry of microorganisms or chemicals into the skin (loss of protective barrier).
- the dermis experiences a loss of connective tissue (collagen) = risk of shearing and tearing.
- the subcutaneous layer decreases = less cushioning from physical injury
- decrease in amount of sweat and sebaceous glands = skin is dry, less thermoregulatory response.
- psychological impact of a loss of youthful appearance, linked to self-esteem (wrinkling skin, thinning and greying hair, dull skin tone and age spots). Compounded by culture, beliefs, media, social norms and roles.
objective data: skin color
- general pigmentation: freckles, moles, birthmarks
- widespread color changes: pallor, erythema, cyanosis, jaundice
objective data: skin-inspect and palpate
texture - smooth, firm, ridges, uneven
thickness - thin and shiny, or thick and callused
edema - extra fluid that accumulates in the intercellular spaces “pitting”
mobility and turgor - mobility is the skin’s ease of rising and turgor is its ability to return to place when released (reflects elasticity)
vascularity or bruising - smooth, slightly raised bright red dots that commonly appear in adults older than 30 yrs, are not usually significant
temperature - differences between core and extremities
moisture - risk for skin breakdown if area is moist
objective data: hair
colour
texture
distribution
lesions
objective data: nails
shape and contour
consistency
colour
cap refill time
- assess on hands and feet bilaterally. < 3 sec is normal, > 2 sec is delayed
ABCDE rule
A: asymmetry
B: border irregularity
C: colour variation
D: diameter
E: elevation and enlargement
pressure injury
assess high pressure areas: head, scapulae, ribs, elbows, coccyx, hips, ankles, heels
pressure injury - stage 1
intact skin appears red, but unbroken
localized erythema, blanchable (turns light with pressure, then back to skin color)
pressure injury - stage 2
partial thickness, loss of epidermis +/- dermis
looks like and abrasion or open blister
pressure injury - stage 3
full thickness, extends to subQ tissue
looks like a crater, may see subQ tissue
pressure injury - stage 4
full-thickness, involves all skin layers, and extends into supporting tissue; muscle, tendon, bone may be exposed, black or brown necrotic tissue (eschar)
non-blanchable rashes
petechiae and purpura
- may signal a bleeding disorder, such as thrombocytopenia (abnormal clotting) or septicemias (infection in the blood stream). These are considered serious rashes that must be medically investigated.
congenital dermal melanocytosis
a.k.a. Mongolian spots
can be a normal skin condition and is quite common, especially in infants and young children of indigenous, black, east Indian, or Hispanic descent. Be cautious not to assume this is bruising, unless there is other indications for suspicion of abuse. If in doubt, always elicit another provider’s experienced opinion.
Lyme disease
the most common vector-borne disease in Canada. Has a characteristic bulls-eye pattern. Health promotion opportunities for people who engage in outdoor activities in heavily wooded areas in the Spring and Summer months.
