Integumentary System: Anatomy and Function

Importance of Integumentary System

• The integumentary system, which includes skin, hair, and nails, serves as a protective barrier against injuries and pathogens.
• Changes in the appearance and function of the integumentary system can indicate underlying pathologies in other body systems.
• Assessments and nursing interventions are crucial for maintaining the body's protective shield.

Anatomy, Physiology, and Function

• The skin is composed of the epidermis and dermis, which perform functions like protection, temperature regulation, vitamin D metabolism, sensation, and excretion.
• A vital role is maintained by the skin for homeostasis, protecting the body from the external environment and assisting with temperature regulation.
• Vitamin D metabolism that occurs in the skin is important for calcium absorption in the body.
• The dermis contains sensory functions controlled by nerve receptors that communicate with the central nervous system.
• Waste is excreted through sweat glands in the skin through fluid loss and body cooling.

Skin Composition and Functions

• The skin accounts for approximately 15% of body weight and needs 33% of the body's blood volume.
• Reduced mobility and sensory perception can heighten the skin's vulnerability to damage.
• Pressure injuries arise from medical devices putting pressure on the skin.
• Nursing interventions are important for promoting adequate skin tissue perfusion.

Epidermis Structure and Function

• The epidermis is the outermost skin layer that creates a barrier against pathogen invasion.
• Keratinocytes in the epidermis produce keratin, which is a waterproof protein that protects the skin and hair.
• There are five layers of keratinocytes in the epidermis, with cells in the stratum corneum shedding.
• Langerhans cells in the epidermis are involved in the immune response.
• Melanocytes produce melanin, which determines skin color and protects against UV damage.
• Merkel cells are touch-sensitive cells that detect light touch stimuli.

Dermis Structure and Components

• The dermis is 2 to 4 mm thick and consists of blood vessels, nerves, immune cells, collagen, elastin, hair follicles, and glands.
• Structures in the dermis support the skin's functions like temperature regulation and sensation.
• Collagen and elastin in the dermis offer structural support and elasticity to the skin.
• Macrophages and mast cells in the dermis assist in immune response.
• Sweat and sebaceous glands in the dermis secrete lubricating fluids, and skin protection.

Subcutaneous Tissue and Hair

• The subcutaneous tissue consists of adipose tissue, nerves, and blood vessels, which provide insulation and support to deeper structures.
• Adipose tissue distribution is impacted by gender, genetics, and lifestyle.
• Hair serves cosmetic purposes, reduces heat loss, and shields the skin from sun exposure.
• Keratinocyte-composed hair follicles anchor in the dermis and protrude into the epidermis.

Hair Growth Cycle

• The hair shaft alternates between growth and rest phases.
• The growth phase includes tightly packed dead keratinocytes that push toward the skin surface, lengthening the hair shaft.
• The resting phase doesn't have active keratinocyte accumulation but retains the hair shaft to minimize hair loss.
• Baldness or alopecia can be caused by the death of a hair follicle, influenced by heredity, stress, and illness.

Nail Structure and Growth

• Nails protect fingertips and toes and are composed of hard keratin with slow continuous growth.
• The nail matrix contains dividing basale keratinocytes forming the nail root.
• The nail body is the visible part adhering to the nail bed.
• Nail condition show overall health, nutrition, occupation, and self-care habits.
• Nail bed coloration shows perfusion status of distal body locations.

Importance of Skin Assessment

• Skin, hair, and nail examination includes history and physical assessment.
• Skin assessments help identify existing skin conditions, care practices, and risk factors.
• Interventions are enabled to promote skin integrity and maintenance.
• Proactive nursing care is crucial for skin health and protection.

Demographics and Skin Aging

• Age and race impact skin functions, with older adults showing increased fragility and decreased tissue layers.
• The physiological changes in older skin include reduced subcutaneous tissue and sensory receptors.
• The discussion of skin changes with older patients is essential for addressing alterations in skin function.

Pigmentation Disorders and Skin Conditions

• Pigmentation disorders like vitiligo and albinism affect people of various races and skin colors.
• Vitiligo is acquired from melanocyte loss and has a genetic background.
• Albinism comes from an autosomal recessive condition, leading to generalized depigmentation.
• Skin phototype (SPT) is determined by constitutive and inducible melanin pigmentation.

Comorbid Conditions and Skin Health

• Advancing comorbidities can affect skin, nail, and hair due to inadequate oxygen and nutrient delivery.
• Conditions like diabetes, cardiovascular disease, and obesity affect skin tissue perfusion.
• Medications, such as corticosteroids, can impact skin appearance and function.
• Family history is important since many skin conditions are genetically linked.

Nutrition and Skin Health

• A decent intake of nutrients is crucial for healthy skin, hair, and nails.
• Protein, vitamins, and minerals are essential for skin repair and maintenance.
• Wounds require increased intake of nutrients like protein, B vitamins, and minerals for healing.
• The evaluation of nutrition through plasma protein levels and BMI is important.

Environmental Factors and Skin Integrity

• Occupational exposures, lifestyle habits, and sun exposure impact skin health.
• Chemical exposures can cause skin inflammation or burns.
• Allergic contact dermatitis is a hypersensitivity reaction to substances.
• Lifestyle habits like smoking can lead to vasoconstriction and skin damage.
• Sun exposure speeds up skin aging and increase the risk of skin cancers.

Visual Inspection and Palpation

• Visual Inspection and Palpation should be conducted in a well-lit area.
• Visual inspection and manual palpation is used to detect abnormalities.
• Observations include color, moisture, lesions, temperature, and texture.
• Abnormalities result in the consideration of endogenous and exogenous causes.
• Individualized solutions are devised based on identified causes.

Importance for Acutely or Chronically III Patients

• Skin inspections should be comprehensive for all deviations from normal.
• Changes in color, texture, and lesions may indicate new complications.
• There should be a focus on pressure points for at-risk populations.
• Factors increasing pressure injury risk include sensory perception and mobility decrease.
• Early detection assists in preventing skin deterioration and complications.

Documentation of Observations

• Characteristics documented include color, temperature, moisture, integrity, cleanliness, tissue changes, vascular markings, and lesions..
• Detailed documentation assists in formulating individualized care plans.
• Education is provided to patients/caregivers for improved skin care regimen.

Skin Color Evaluation

• Skin color is influenced by circulatory status and genetics.
• A variation in color can indicate changes in blood flow or inflammation.
• Assessments should include palpation for temperature changes.

Moisture Level Assessment

• Moisture level predicts skin breakdown risk.
• Dry skin is prone to fissures, while moist skin fosters bacterial invasion.
• Incontinence-related moisture can lead to skin irritation and breakdown.
• Strategies are put in place to manage moisture, thus preventing skin complications.
• Moisture impacts the skin's protective barrier.

Skin Integrity Examination

• Skin integrity shows the intactness of the skin.
• Factors like moisture, pruritus, and immobility threaten skin integrity.
• Management strategies are in place to preserve skin health.
• Working with a healthcare team helps identifying and addressing underlying causes.
• Document lesion characteristics and subjective findings.

Importance of Cleanliness

• Poor hygiene habits can lead to skin problems and infections.
• Observation of self-care habits helps evaluate functional status.
• Identification of areas occurs for health-related education and intervention.
• Hygiene has an impact on skin health and overall well-being.
• Strategies are in place to promote cleanliness and prevent skin breakdown.

Understanding Tissue Changes

• Wound classifications are created based on underlying etiology.
• Identification of partial vs. full-thickness wounds and their identified healing capacities.
• Tissue damage on skin influences scar formation processes

Vascular Markings and Skin Lesions

• Vascular markings should be identified, and their significance should be noted.
• Benign findings like spider angiomas and cherry angiomas should be able to be differentiated.
• Port-wine stains and their implications should be understood.
• Recognition of petechiae and ecchymosis in various clinical contexts occurs in this setting.
• Vascular markings should be assessed for systemic health evaluation.

Classification and Description of Lesions

• Classification system used for describing skin conditions.
• Primary and secondary lesions should be able to be differentiated based on causative factors.
• Lesion characteristics should be documented in detail for treatment planning.
• Distribution and arrangement of lesions occurs for comprehensive assessment.

Assessment of Nevi

• Nevi, or moles, are benign epidermal or dermal growths that are less than 1 cm in size.
• Nevi are common in lighter-skinned patients.
• Nurses evaluate moles for cancerous cell changes.
• Guidelines help identify when moles require evaluation provided by a skin care expert.

Assessment of Dark Skin

• Skin color in dark-skinned individuals is determined by genetic predisposition and melanocyte activity.
• It is more challenging to identify Erythema, cyanosis, and pallor in darker skin tones.
• Nurses rely on patient history, physical inspection, and palpation for accurate assessment.
• Identifying initial color changes in darker skin that can lead to delayed pressure injury identification is difficult.

Braden Scale for Pressure Injury Risk

• The Braden scale assesses risk factors like sensory perception, moisture, activity, mobility, nutrition, friction, and shear.
• Scores range from 6 to 23, with lower scores indicating higher risk for skin damage.
• Mobility category scores of 1 or 2 are sensitive indicators for pressure injury risk.
• Scores of 18 or lower help nurses implement prevention strategies tailored to patient needs.

Hair Assessment

• This assessment includes an evaluation of hair color, cleanliness, quantity, thickness, texture, and distribution during skin assessment.
• Changes in hair texture or pattern may indicate underlying illness, nutritional deficits, or medication side effects.
• Nurses assess for abnormalities like lesions, erythema, and lice infestation.
• Variations hair quantity, quality, and distribution provide insights into overall health.

Nail Assessment

• Systemic illness, local infection, and occupational exposures can affect nail variations.
• A thorough history collection and documentation are key nursing interventions for nail abnormalities.
• Nail color, shape, consistency, and lesions offer important information about health status.
• Nail bed color, shape alterations, consistency, and lesions indicate chronic disease states.

Structural Changes in Aging Skin

• As dermis vascularity decreases with age, this leads to slower healing rates and a thinner dermis.
• Epidermis maturation slows, which affects wound contraction leading to a 50% change.
• The reduction of rete ridges weakens the epidermal-dermal junction, thus increasing tearing of skin.
• Thin skin in older adults may become nearly translucent, revealing underlying veins and tendons.

Immunological Changes in Aging Skin

• The body's ability to mount a quick inflammatory response decreases as Langerhans and mast cells decrease.
• Reducing melanocytes increases the risk of sun-related skin damage.

Functional Changes in Aging Skin

• The loss of subcutaneous tissue, sweat glands, and vascularity reduces temperature regulation.
• The reduction sensory receptors make it difficult to detect injuries.
• Hair and nail growth rates decrease as individuals age.

Tissue Culturing for Skin Infections

• Swab cultures collect fluid from superficial tissue layers, identifying infecting organisms with roughly 60% accuracy.
• Needle aspiration cultures help pinpoint infective organisms in tissues surrounding wounds.
• Biopsies focus on deeper layers of the skin and are the gold standard when it comes to the culturing wounds.

Laboratory Studies for Skin Infections

• Complete blood count (CBC) can be used to evaluate infection and acute occurrences.
• Chemistry screenings examine protein levels (albumin) and toxic byproduct accumulation.
• Blood cultures identify organisms in the circulatory system.
• Doppler ultrasounds help evaluate blood flow through vessels affected by skin infections.
• Thermography assesses skin perfusion and temperature changes.

Nursing Implications for Skin Infections

• Healthcare providers specially prepare skin tissue samples for removal.
• Nurses monitor throughout and after procedures.
• Patients receive site care instructions post-procedure for biopsy sites.