INTEGUMENTARY SYSTEM

Structure Of Integumentary System
The skin is very flexible and resistant, it envelops the body:
 it constitutes the outer protective layer.
 its area in adults is 1.5 to 2 m2 and weights about 4 kg.
 the thickness of the skin = 0.5 to 2 mm. the thinner = eyelids, the
thicker = the soles of the feet and joints.
 The color of the skin depends on 3 factors: pigment (melanin),
oxygenation rate (by vascular route), bile pigment.

Structure Of Integumentary System
The Skin
dermis
hypodermis
epidermis
Skin
Derivative
nails
sebaceous
gland
sweat
gland
hair

The Skin
The skin is made up of 3 layers from top to
bottom:
 epidermis: The epidermis is a keratinized
epithelial tissue which constitutes the
surface layer of the skin.
 dermis: The dermis is a dense connective
tissue, containing the vessels and nerves.
 hypodermis: The hypodermis is an
adipose tissue which constitutes the
subcutaneous tissue.

Skin Derivative
1-Nails:
 the nail is a keratinized plate on
the dorsal side of the distal
phalanx of the fingers and toes.
 they protect the tips of the fingers
and toes.

Skin Derivative
2-Hair :
 hair is an epidermal derivative that
consists of keratinized cells tightly
bound together. Hair is not
permanent but is continuously being
replaced.
 hair Erector Muscles are tiny muscles
connected to each hair follicle and the
skin. When they contract they cause
the hair to stand erect.
 hair follicle ‐ Lies under the skin and
nourishes the hair.

Skin Derivative
3. the sebaceous glands secrete an oily
substance that protects the skin and
prevent excess water loss.
4.the sweat glands secrete a dilute,
saline solution that assists in thermal
regulation.

Skin Function
Skin
function
immune
response
protection
excretion
sensation
temperature
regulation
synthesis
of vitamin
D
fluid
balance

Skin Function
1. thermoregulation the skin acts to maintain temperature control by secreting sweat from
our sudoriferous (sweat) glands. This sweat helps to lower body temperature.
2. protection of the skin is the first layer of protection when it comes to invading organisms.
It also helps protect against excessive water loss, chemicals and other harmful substances,
and ultraviolet radiation.
3. sensation the skin has many nerve endings that send signals to the brain to convey
sensations such as touch, pain, pressure, and temperature.
4. excretion :The skin helps rid the body of wastes. It does this via perspiration. Perspiration
secretes water, salt, and a small amount of organic chemicals.
5. synthesis of vitamin D is required to allow the body to absorb calcium and phosphorus.
When the skin is exposed to ultraviolet light or sunlight, it converts a vitamin D precursor to
vitamin D via the liver and kidneys.

Risk Factors For Impaired Skin Integrity
1. incontinence.
2. excessive perspiration or diaphoresis.
3. wound drainage.
4. immobility.
5. inactivity.
6. paresthesia.
7. paralysis.
8. poor nutrition.
9. confusion.
10.agitation.
11.decreased level of consciousness.

Wound Assessment
1. identification of the etiology of the wound.
2. location, size, and depth of the wound.
3. type of tissue present.
4. quality and quantity of exudates.
5. presence of infection.
6. condition of the wound margins.

Wound Etiology
pressure‐induced
wounds: usually located
over bony prominences.
diabetic ulcers:
most commonly
found on the feet.

Wound Etiology
arterial ulcers: usually
present over the
lateral malleolus.
venous ulcers: commonly
present over the medial
malleolus or dorsum of the foot.

Skin Nursing Assessment
Assessment of the dermatology patient includes:
1. a history of the patient's skin condition.
2. a general assessment.
3. a specific skin assessment.
4. consideration of the skin as a sensory organ.
5. assessment of the patient's knowledge about his or her skin condition.

1-History Of The Patient’s Skin Condition:
1.how long has the condition been present?
2.how often does it occur or recur?
3.are there any seasonal variations?
4.is there a family history of skin disease?
5.what are the patient's occupation and hobbies?
6.what medication is the patient taking?
7.are there any known allergies?
8.previous and present treatments and their effectiveness?
9.are there any treatments, actions or behavioral changes which influence the
condition?

2-General &
3-Physical Skin Assessment
2-general assessment:
 the skin conveys a wealth of information about the person health status
3-physical assessment:
 characters: is there redness (erythema), scaling, crusting, exudate? Are there
excoriations, blisters, erosions, pustules, papules? Are the lesions all the same
(monomorphic), e.g. drug rash or variable (polymorphic) e.g. chickenpox?
 shape: are the lesions small, large, annular (ring shaped), linear?
 distribution: is it on hands, feet? extremities of ears and nose, in light exposed areas
or mainly confined to the trunk?

4-The Skin As A Sensory Organ
it is also important to establish the degree of pain, itching and soreness associated with the
skin condition.
itching (pruritus):
 it is the principal symptom of dermatological disease and also occurs in numerous systemic
disorders.
 it can be an extremely distressing complaint and is reported as the prime cause of 2.8% of
consultations in general practice.
 it is vital to attempt to identify and treat the underlying cause of pruritus.
 the most common cause of itching is a primary skin disease such as eczema, urticaria,
lichen planus, psoriasis, dermatitis herpetiformis, insect bites and scabies.
 systemic causes of itch include pregnancy, chronic renal failure, thyroid dysfunction,
hematological disorders, iron deficiency and malignancy.

5-Knowledge & Education
the nurse needs to establish patients' level of knowledge about :
 their skin in general.
 their condition and expectations.
 how it affects their life and plan the appropriate education and support for them.

Nursing Role In Dermatology
 educate patients about their skin condition management.
 help control the skin condition by providing physical care, and maintaining the integrity
of the through the administration of drugs, especially topical treatments.
 maintain comfort of the patient by tackling distressing symptoms and effects such as
itch, soreness, dryness, bleeding and pain.
 monitor and educate about specific medication, use and side effects.
 adapt skin care regimes to suit individual patients and their families.
 support patients: stress management, counseling, listening and talking.
 provide continuity of care.

Atopic Dermatitis (Eczema)
 atopic dermatitis (eczema) is a condition that
makes the skin red and itchy.
 it's common in children but can occur at any age.
 atopic dermatitis is chronic and tends to flare
periodically.
 no cure has been found for atopic dermatitis. But
treatments and self-care measures can relieve
itching and prevent new outbreaks.

Eczema
General Recommendations
avoid contact with animals, dust, spray, perfumes.
avoid cold & dry weathers.
avoid contact with wool.
wear cotton fabrics, washed with mild detergent.
keep the skin well hydrated (moisturizes, daily baths…) .
avoid skin secondary invasion by bacteria.
apply topical corticosteroids & antibiotics when indicated.

Parasitic Skin Infestation
Pediculosis Humans Capitis
definition:
 pediculosis Humans Capitis is an
infestation of the scalp by the head
louse.
 the female louse lays her eggs (nits)
close to the scalp.
 the transmission is strictly interhuman.

transmission:
 directly by physical contact with the hair of an infested person.
 by indirect contact with infested combs, brushes, wigs, hats and bedding.
Incubation:
 the reproduction time of lice is one week.
 the itching occurs about 3 weeks after the start of the infestation.
note:
the head lice may infest anyone and are not a sign of uncleanness.
Parasitic Skin Infestation
Pediculosis Humans Capitis

Parasitic Skin Infestation
Pediculosis Humans Capitis
clinical manifestations:
 visible presence of lice and nits in the hair
 itching and scratching lesions occipital with extension to the neck and behind the
ears.
 lesions and dermatitis.
complications:
 secondary bacterial infection due to scratching (Impetigo secondary to scratching
lesions).

Parasitic Skin Infestation
Pediculosis Humans Capitis
treatment:
 washing the hair with a special shampoo ( according to the product directions).
 it must repeated 1 time per week in order to all nits disappear.
 after the hair is rinsed thoroughly, it is combed with a fine-toothed comb dipped in
vinegar to remove any remained nits or nits’ shells.
hygiene measures:
 avoid contact with the patient's hair and those around him
 apply general hygiene measures and specific hygiene measures for diseases with direct
skin transmission.
 environmental treatment (wash clothes, combs, brushes with hot water and vacuum
and clean regularly).
 all family members and closed contacts must be treated and inspected for head lice
daily for at least 2 weeks.

Skin Cancer
skin cancer is a disease in which cancer (malignant) cells are found
in your skin.

Types Of Skin Cancer
3 types of skin cancer:
1. Squamous cell carcinoma.
2. Basal cell carcinoma.
3. Malignant melanoma.

Risk Factors
1.light skin color, hair color, eye color, freckles.
2. genetics.
3. certain types of moles.
4. long-term sun exposure.
5. history of childhood sunburns.
6. exposure to industrial chemicals.
7. immune compromised patients.
8. radiations.

Causes Of Skin Cancer
Causes of
skin cancer
Ultraviolet
radiation is
the main
cause
Artificially
produced UV
radiation
(solarium)
chemicals

Treatment Of Skin Cancer
treatment
freezing
excisional
surgery
mohs
surgery
cryo
therapy
radiation
therapy
chemo
therapy
photo
dynamic
therapy
biological
therapy

Preventing Skin Cancer
1.limit sun exposure and avoid peak exposure times (10 AM - 4 PM).
2.wear protective clothing.
3.use broad-spectrum sunscreen with appropriate SPF (>30) & regardless of weather.
4.avoid tanning specially if the skin burns easily.
5.avoid sunburn.
6. be aware of sun-sensitizing medications (if they increase your sensitivity to sunlight, stay
out of the sun).
7. check the skin regularly and report changes to the doctor.
8. avoid smoking.
9. diet and skin cancer:
 avoid high fat intake &void obesity
 consume leafy green vegetables and antioxidant nutrients.

Melanoma
 melanoma is a skin cancer that arises in a pigment producing cell; usually begins in
a mole.
normal

ABCDE Of Melanoma Screening
 A: for Asymmetrical.
 B: for Borders.
 C: for Color.
 D: for Diameter.
 E: for Evolving (Changes with time).

Diagnosis
diagnosis
exams and
doctor visit
skin biopsy
self-
examination
of skin

Skin Biopsy/ Definition
extraction of a very small amount of skin tissue by excision
or needle aspiration, to definitively diagnose cell type & to
confirm or rule out malignancy.

Biopsy/ Pre-procedure Nursing
1.verify clients have signed informed consent form.
2. explain procedure.
3. establish a sterile field.
4. prepare material:
 local anesthetic.
 specimen containers.
 dressings.

Biopsy/ Post-procedure Nursing
1.prevent bleeding.
2. prevent infection after biopsy.
3. apply antibacterial ointment.
4. keep incisional site clean & dry.