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Integumentary system

  2. 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.
  3. Structure Of Integumentary System The Skin dermis hypodermis epidermis Skin Derivative nails sebaceous gland sweat gland hair
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. Skin Function Skin function immune response protection excretion sensation temperature regulation synthesis of vitamin D fluid balance
  9. 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.
  10. 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.
  11. 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.
  12. Wound Etiology pressure‐induced wounds: usually located over bony prominences. diabetic ulcers: most commonly found on the feet.
  13. Wound Etiology arterial ulcers: usually present over the lateral malleolus. venous ulcers: commonly present over the medial malleolus or dorsum of the foot.
  14. 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.
  15. 1-History Of The Patient’s Skin Condition: long has the condition been present? often does it occur or recur? 3.are there any seasonal variations? 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?
  16. 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?
  17. 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.
  18. 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.
  19. 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.
  20. 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.
  21. 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.
  22. 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.
  23. 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
  24. 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).
  25. 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.
  26. Skin Cancer skin cancer is a disease in which cancer (malignant) cells are found in your skin.
  27. Types Of Skin Cancer 3 types of skin cancer: 1. Squamous cell carcinoma. 2. Basal cell carcinoma. 3. Malignant melanoma.
  28. 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.
  29. Causes Of Skin Cancer Causes of skin cancer Ultraviolet radiation is the main cause Artificially produced UV radiation (solarium) chemicals
  30. Treatment Of Skin Cancer treatment freezing excisional surgery mohs surgery cryo therapy radiation therapy chemo therapy photo dynamic therapy biological therapy
  31. 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.
  32. Melanoma  melanoma is a skin cancer that arises in a pigment producing cell; usually begins in a mole. normal
  33. ABCDE Of Melanoma Screening  A: for Asymmetrical.  B: for Borders.  C: for Color.  D: for Diameter.  E: for Evolving (Changes with time).
  34. Diagnosis diagnosis exams and doctor visit skin biopsy self- examination of skin
  35. 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.
  36. 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.
  37. Biopsy/ Post-procedure Nursing 1.prevent bleeding. 2. prevent infection after biopsy. 3. apply antibacterial ointment. 4. keep incisional site clean & dry.