Week 3 - integumentary system

Question 1

functions of the skin

Answer 1

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.

Question 2

layers of the skin

Answer 2

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.

Question 3

subjective data: health history

Answer 3

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

Question 4

LOTTARRPP

Answer 4

Location
Onset
Type
Timing
Aggravating
Alleviating
Radiating
Related symptoms
Personal perception
Precipitating event

Question 5

older adults

Answer 5

• 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.

Question 6

objective data: skin color

Answer 6

• general pigmentation: freckles, moles, birthmarks
• widespread color changes: pallor, erythema, cyanosis, jaundice

Question 7

objective data: skin-inspect and palpate

Answer 7

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

Question 8

objective data: hair

Answer 8

colour
texture
distribution
lesions

Question 9

objective data: nails

Answer 9

shape and contour
consistency
colour
cap refill time
- assess on hands and feet bilaterally. < 3 sec is normal, > 2 sec is delayed

Question 10

ABCDE rule

Answer 10

A: asymmetry
B: border irregularity
C: colour variation
D: diameter
E: elevation and enlargement

Question 11

pressure injury

Answer 11

assess high pressure areas: head, scapulae, ribs, elbows, coccyx, hips, ankles, heels

Question 12

pressure injury - stage 1

Answer 12

intact skin appears red, but unbroken
localized erythema, blanchable (turns light with pressure, then back to skin color)

Question 13

pressure injury - stage 2

Answer 13

partial thickness, loss of epidermis +/- dermis
looks like and abrasion or open blister

Question 14

pressure injury - stage 3

Answer 14

full thickness, extends to subQ tissue
looks like a crater, may see subQ tissue

Question 15

pressure injury - stage 4

Answer 15

full-thickness, involves all skin layers, and extends into supporting tissue; muscle, tendon, bone may be exposed, black or brown necrotic tissue (eschar)

Question 16

non-blanchable rashes

Answer 16

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.

Question 17

congenital dermal melanocytosis

Answer 17

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.

Question 18

Lyme disease

Answer 18

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.