Integumentary System

• Psychosocial- display, body image
• Protection barrier
• Homeostasis: fluid & temperature
• Excretion
• Synthesis
• Sensory perception

• physical damage, trauma and infection

  immune function

  inflammation and repair

heat loss by radiation, conduction, convection and evaporation

• Pain: superficial (acute) pain, deep (chronic) pain
• Itch: mechanical (movement), chemical (histamine; kinins; bile salts)
• Touch and pressure

• Vit D. regulates calcium and phorporous levels
• 7-dehydrocholestrol (in skin cells) + sunlight = cholecalceiferol.
• Once in the liver and kidneys this is converted into Vit D.

• bonding
• touch
• body image

• changes in puberty
• changes due to arousal

• Protective barrier
• Homeostasis:
• fluid
• temperature
• Excretion
• Synthesis
• Sensory perception
• Communication/ relating
• Epidermis & dermis

• Microvasculature , extracellular spaces

• Vessels, sweat,hair

• Sweat glands

• Vit D Epidermis (UV)

• Sensory nerves, mechanoreceptors

• epidermis
• dermis
• hypodermis (superficial fascia/subcutaneous tissue)

No blood vessels

0.1 mm (eyelids) - 1mm (palms/soles)

4 - 5 sub-sections (from top to bottom)

stratum corneum (horny layer)

s. lucidum*

s.granulosum;

s. spinosum;

s.basale (germinative layer)

• Dermal papillae interlocks with epidermis
• Vascular
• Connective tissue
• Semifluid matrix
• Protein fibres: collagen; reticulin and elastin
• Ground substance

• Biological process: eg: microcirculation
• Genetic predisposition
• Hormones (e.g. menopause)
• Illness

• Photo damage (UV exposure)
• Smoking
• Pollutants
• Irritants and allergens
• Heating/low humidity
• Overwashing
• Therapeutic treatments (e.g. diuretics; radiotherapy; corticosteroids)
• Nutrition

• Nails: emerge from specialised epithelial cells from the nail root, growing out over the nail bed and become keratinised
• Nail cuticle: fold of tissue covering the nail root
• Nail body: the part we see
• Tissue is very vascularised under the nail
• Have a protective function

• Composed of the fibrous protein-keratin like nails) as they move away from the growth base (follicle)
• Key structures are the shaft (dead cells) - which extends down to the dermis to the follicle- from where the hair grows
• Sebaceous gland- sebum
• Key function: thermoregulation

Clinicians estimate the extent of the body area affected by a rash or burn

Rule of nines: percentage body area for different regions

Head and neck: 9%

Each upper limb 9%

Each lower limb 9%

Trunk-front 18%, back & buttocks 18%

Perineum 1%

Varies for children and infants (see Colbert et al fig 9.4)

Hand palm: 1%

due to inflammation (infection, immune response) and trauma

dryness due to disease, ageing, burns

due to pressure effects, poor nutrition, lymphoedema

due to chemicals and pathogens

• [Dry skin or xerosis]
• Chronic inflammatory dermatoses
• Rashes
• Acne and rosacea
• Infections
• Infestations & insect bites/strings
• Benign & malignant lesions (lumps & bumps)
• Hair/scalp disorders
• Nail disorders
• Leg ulcers
• Blistering diseases
• Urticaria
• Pressure ulcers

• Dry skin = xerosis: is common
• Disruption to skin barrier with loss of integrity
• Loss of skin moisture and oils (sebum)
• Sometimes easier to feel than see
• Observations that may be associated: scaling, erythema, soreness, roughness
• Disease: disruption to normal skin barrier
• Factors affecting: interior & climatic conditions
• Effective nursing can prevent or restore dry skin

• Atopic eczema
• Asteatotic eczema
• Ichthyoses (inherited)
• Psoriasis

In children it presents in 3 forms:

1. Infantile eczema - begins at 2-6 months

generally spontaneous remission by 3 years

2. Childhood - may follow infantile, occurs at

2 to 3 years old, and 90% will manifest by 5

years old

3. Preadolescent and adolescent - begins at 12

years old and may continue

• Relieve pruritis
• Hydrate the skin
• Reduce inflammation
• Prevent or control secondary infection

• Pressure ulcer localised injury to skin or underlying tissue usually over a bony prominence, due to pressure or pressure associated with shear (EPUPAP 2014)
• Severity may range from superficial affecting skin surface to deep, affecting muscle and exposing bone.

Intact skin, non-blanchable redness over a bony prominence. Darkly pigmented skin may not have visible blanching; colour may differ from surrounding area. May be painful, firm, soft, warmer or cooler as compared to adjacent tissue.

Partial thickness loss of dermis presenting as a shallow open ulcer with a red pink wound bed, without slough.

May also present as an intact or open blister.

Full thickness tissue loss, subcutaneous fat may be visible but bone, tendon or muscle are not exposed.

• Full thickness tissue loss with exposed bone, tendon or muscle. Slough or eschar may be present. Often includes undermining and tunnelling.
• At risk of osteomyelitis