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#1 function of the skin
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#1 function of the skin
Integumentary system
skin, hair, scalp, nails and mucous membranes
Skin also
regulates body temp, function as sensory organ, helps maintains fluid/electrolyte balance, produce Vitamin D, excrete certain waste products from body
Layers of skin
epidermis, dermis, subcutaneous tissue
squamous epithelial cells produce keratin (keratinocytes) , melanin (melanocytes)
creates a barrier that repels bacteria and foreign matter and is impermeable to most substances; with increase friction areas (hands, feet) contain larger amounts of keratin creating thickened skin and callouses
pigment that gives skin its color; includes moles and birthmarks (nevi); exposure to uv rays causes increase in production
melanocytes are destroyed causing milk-white patches of depigmented skin surrounded by normal skin
dense, irregular connective tissue, made of collagen/elastic fiber, blood and lymph vessels, nerves, sweat/sebaceous glands and hair roots
oily substance secreted by sebaceous glands, lubricates skin to keep it soft and pliable
Subcutaneous tissue
anchors skin to muscle and bone; connective and adipose (fatty) tissue important factor in regulating body temperature
Maintaining skin integrity is
one of the most important independent functions of the nurse
is the primary means of heat loss
Skin damage
results in rapid loss of large quantities of fluid and electrolytes -- leads to shock, circulatory collapse, and death
Loss of subcutaneous tissue
causes skin sagging and wrinkling
core temp of 106 degrees or higher, hypothalamus no longer functions properly
core temp of 95 degrees or less; client can become confused and disoriented
Seven parameters should be examined while performing assessment
integrity, color, temp/moisture, texture, tugor/mobility, sensation, vascularity
Any skin lesion should be identified
according to type and description regarding color, size and location
disruption in the integrity of body tissue
Wound healing stages
Inflammatory, Proliferative, Maturation
Inflammatory (defense) phase
bleeding stops, platelet plug formed, fibrous meshwork provides initial wound closure; last 3-4 days; major events are hemostasis (cessation of bleeding) and inflammation (nonspecific cellular response to tissue injury)
Proliferative (reconstructive) phase
wound contraction is the final step of this phase; begins 3-4 day last 2-3 weeks;
formation of new blood vessels
Maturation phase
final stage of healing; scar tissue is remodeled by deposits of collegen; begins about 21st day and may continue for up to 2 years
Types of healing
Primary intention, secondary intention, tertiary intention
Primary intention
healing occurs in wounds that have minimal tissue loss and edges are well approximated (closed)
Secondary intention
seen in wounds with extensive tissue loss and wounds in which the edges cannot be approximated; wounds left open, repair time is longer
Tertiary intention
aka delayed/secondary closure; indicated when primary closure of a wound is undesirable due to poor circulation or infection
Wound drainage, types of
Serous exudate, purulent exudate, hemorrhagic exudate, serosanguineeous exudate
Serous exudate
fluid in blisters; composed primarily of serum, watery in appearance and has a low protein level
Purulent exudate
drainage which contains pus; yellow, green, brown; indicates infection
Hemorrhagic exudate
ranges in color from bright red to dark red; large component of RBCs; usually present with severe inflammation
Serosanguineous exudate
clear with some blood tinge and is seen with surgical incisions
Factors affecting wound healing
negative influences are age, smoking, oxygenation, drug therapy and diseases such as diabetes
Wounds are
measured in length (head to toe), width (side to side), and depth (in cm)
aka undermining
Skin cancer
is one of the most common malignant neoplasm in the US and is the most preventable cancer
Basal cell carcinoma
the most frequent type of skin cancer; metastasis are rare; surgical removal cures this type of cancer
Squamous cell carcinoma
appears as nodule lesions in the epidermis; can extend into the dermis and metastasize to other body tissues causing death; has crusted scaled appearance
can metastasize to every organ in the body through the bloodstream and lymphatic system; begins as a mole (nevus)
benign, fatty tumors
Sebaceous cysts
distended sebaceous glands filled with sebum
abnormal growth of scar tissue that is elevated, rounded and firm with irregular, clawlike margins
birthmarks (strawberry, port-wine angiomas)
contagious infectious bacterial skin disorder caused by staph; commonly affects children
Shingles (Herpes Zoster)
clusters of small vesicles over the course of a peripheral sensory nerve; unilateral TREATED WITH ZOVIRAX
infected hair folicles in the dermis; redness, swelling and pain; yellow cores of pus develop
Tinea (ringworm)
called becaused of it circumscribed appearance, typically round and reddened with slight scaling
Tinea capitis
ringworm of the scalp
Tinea corporis
ringworm of the body
Tinea cruris
Jock itch
Tinea pedis
athlete's foot
itch mite burrows under skin; lays eggs; deposits fecal material
Pediculosis (lice)
nits of pediculosis capitis attach themselves firmly to a hair shaft on the head or beard
antiviral drug used to treat herpes
atopic dermatitis often associated with allergic rhinitis and asthma; chronic superficial inflammation that evolves into pruritic, red, weeping crusted lesions
chronic inflammatory noninfectious disease of the skin which involves keratin synthesis
Pressure ulcers
are localized areas of tissue necrosis that tend to develop when soft tissue is compressed between a bony prominence and an external surface such as a mattress or chair seat for a prolonged period of time
Areas most likely to develop a pressure ulcer
bony prominences such as the occipital skull, pinna of ears, sacrum, ischial tuberosities, trochanter area of hip, ankles and heels
force exerted against the skin by movement or repositioning
force of two surfaces moving across one another
white color of skin due to reduced blood flow
Stage I pressure ulcer
nonblanchable erythema of intact skin
Stage II pressure ulcer
partial-thickness skin loss involving epidermis, dermis or both; ulcer superficial and presents clinically as an abrasion, blister or shallow crater
Stage III pressure ulcer
full-thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia; presents clinically as a deep crater with or without undermining of adjacent tissue
Stage IV pressure ulcer
full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone or supporting structures; undermining and sinus tracts may also be associated

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