1. Integumentary System
Med Surg Certification
Amy Dunbar RN, MSN, CWOCN
6-2-05

2. Objectives
Identify the functions of the skin
Identify the nursing assessment of the
skin
Identify common pathophysiologic
events associated with skin
Determine ostomy care

3. Layers of Skin
Epidermis
Dermis

6. Appendages
Hair
Sebaceous glands
Exocrine Glands
Aprocrine Glands
Nails

7. Changes with Aging
Epidermal turnover increases
Skin is drier
Decreased skin elasticity
Changes in thermoregulation
Decreased melanocytes

8. Skin Assessment
Itching
Pain
Rash
Dry, rough, scaly
Blisters
Hot/cold spots

9. Objectives
Inspection Palpation
*color *turgor
*hair *moisture
*lesions *temperature

10. Psoriasis
No cure
Treated with
topical steroids
and photo
therapy

11. Scleroderma
Usually treated
with steroids
and cholinergics

12. Shingles
Contagious
when exudate
from blisters is
present
May benefit
from antiviral

13. Skin Cancer
Malignant
melanoma can
metastasize
Prevention

14. Rule of 9’s
-Head = 9
-Each arm = 9
-Front of trunk = 18
-Back of trunk = 18
-Each leg = 18

15. Concerns
impaired gas exchange
fluid replacement

16. Interventions
Skin Grafts
-may be autologous
-additional wound will be present
Fasciotomy
-relieves pressure when edema is extreme

18. Stage I Pressure Ulcer

19. Stage II Pressure Ulcer

20. Stage III Pressure Ulcer

21. Stage IV Pressure Ulcer

22. Unstageable Pressure Ulcer

23. Post Operative considerations
Stoma appearance
Pouch maintenance
Releasing gas
Pouch emptying

24. Stoma Appearance

25. Pouch Maintenance

26. Releasing Gas

27. Pouch Emptying

28. Summary
Skin/Wound is complex
Nursing assessment and intervention
crucial
Ostomy care is daily