Transcript The Interesting (and often overlooked yet totally obvious

The Interesting
(often overlooked, yet totally obvious)
Integumentary System
Ms. Bjorge
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The Interesting Integumentary
System
• Inte = whole
• gument = body covering
• System consists of the skin, hair, nails
– Also includes some glands, muscles, nerves
and connective tissues
• Most visible body system
What does the Integumentary
System do?
• Creates a boundary between the outside and
our insides.
– Protects against bacterial infection.
– Protects against ultraviolet light.
• Helps maintain constant body temperature.
• Provides some sensory information about the
environment.
Layers of the Skin
Layers of the Skin - Epidermis
• 90% of cells are keratinocytes
(they make keratin)
• 8% of cells are melanocytes
(pigment)
• Langerhans cells
– Made from red bone marrow
– Aid in immune responses
against microbes
• Merkel cells
– Fewest number of cells, in
deepest layer (Stratum
basale)
– They contact nerve cells and
allow sense of touch
Layers of the Skin
• Dermis
– Superficial = papillary
region
• Dermal papillae connect to
epidermis, contain
capillaries
• Meissner corpuscles –
sense touch (pressure)
– Deeper = reticular region
• Collagen and other
connective cells
• Adipose cells, hair folicles,
sebaceous (oil) and
sudoriferous (sweat)
glands
How does the skin provide
protection?
• Against dehydration:
– Lipids are released from lamellar granules found in
keratinocytes.
– Sebaceous gland secretions are oily
How does the skin provide
protection?
• Against microbes:
– Keratinocytes are tightly interlocked, resist bacterial
entry into deeper layers.
– Sebaceous gland secretions can have antimicrobial
properties.
– Langerhans cells in epidermis can signal to immune
system
How does the skin thermoregulate?
• Skin releases sweat through the sudoriferous
glands
– Evaporation once at surface lowers body
temperature.
• Dermis contains network of blood vessels that
contain 8-10% of blood flow in resting adult.
– When blood vessels in dermis constrict, blood moves
away from skin.
• Skin temperature decreases.
• Internal body temperature tends to increase.
Common Skin Disorders
• Acne
– Affects teenagers and women in their thirties
– Exact cause unknown (involves sebaceous glands,
hair follicles and hormones)
• Eczema (Atopic Dermatitis)
– Itchy, dry, hypersensitive skin
– Exact cause unknown (hereditary, hay fever/asthma)
– Skin can thicken, turn into crusty rash
• Skin Cancer
Shingles
• Caused by virus that also
causes chickenpox
– Virus remains dormant in
nerve cells then reactivates.
– Reactivation enhanced by
depression of immune
system
Shingles
• Symptoms
– burning pain or tingling, extreme sensitivity in one
area of the skin
– 2-3 days later: red rash occurs
– Group of blisters with a red base (looks like chicken
pox); generally last two to three weeks
• Blisters accumulate pus, crust over, then disappear
– Pain
• May be long lasting.
• Doctors may prescribe painkillers.
Shingles
• Appearance
– Generally affects one side of the body
– Blisters common on trunk, buttocks, genitalia.
Shingles
• Complications
–
–
–
–
Post-herpetic neuralgia: constant/episodic pain
Infection of blisters (treat with antibiotics)
High fever and spread of disease over entire body
Blisters in eye area can cause permanent damage. A
specialist should be consulted.
Soft Tissue Injuries
Soft Tissue:
The top layers of skin, muscle, fat that
protect the underlying body structures.
All soft tissue injuries are called wounds
Includes: open/closed wounds and burns
Soft Tissue Injuries
Closed wounds
Bruises
Open wounds
Abrasion
Laceration
Avulsion
Puncture
Burn Victims
• Stop the burn, make sure that your patient can
breathe, has heartbeat.
• What affects burn severity?
–
–
–
–
–
Depth of burn
Type of burn (chemical, wet heat, dry heat)
If heat – temperature
Contact time
Thickness of skin
• Complication: children and elderly have thinner skin
Burn Victims – Initial Assessment
• Can the burn get worse?
– Contact with heat or chemical source
– Decrease in blood flow and shock
– Infection
• How deep is the burn?
– Depth defined by how
much of epidermis and
dermis is destroyed by
heat source.
• 1st Degree: epidermis only
• 2nd Degree: epidermis and part of dermis involved.
• 3rd Degree: epidermis AND dermis destroyed.
Burn Victims – Rule of Nines
•
•
•
•
•
•
Whole Head = 9 %
Front = 18%
Back = 18%
Each arm = 9%
Groin = 1%
Each Leg = 18 %
Treatment of First Degree Burn
Victims
• Patient Challenges
– They will be in PAIN!
– Can involve young children
• Appearance
– Red and dry
• Treatment
– Cool Burned skin
• Prognosis
– Burn should heal within 5 to 6 days without permanent scaring
Treatment of Second Degree Burn
Victims
• Patient Challenges
– They will be in PAIN!
– Can involve young children
• Appearance
– Pink to red appearance
– Blister formation
• CAUTION: Frequently, epidermis does not lift off the dermis for 12
to 24 hours and what appears initially to be a first degree is actually
a second-degree burn.
• Treatment
– Clean wound
– Apply neomycin or water-soluble topical antibiotic. Could instead
apply synthetic skin substitute.
• Antibiotics may slow healing, though.
– May need to apply soft gauze dressing.
• Prognosis
– If no infection, wound healed in 7-14 days.
– Minimal scarring
Treatment of Third Degree Burn
Victims
• Appearance
– Initial: tissue is a waxy white color
– If burn produces char or extends into fat:
leathery brown or black appearance,
surface coagulation veins.
– Wound has coarse non-pliable texture
to touch.
• Treatment
–
–
–
–
–
Transfer to Burn Center
Gentle washing with antibacterial soap.
Silver sulfadiazine using a closed dressing twice a day.
Or use of a silver impregnated dressing
Cold is not beneficial once the burning has stopped as pain is
minimal.
• Prognosis
– Except for a very small wound, the burn wound will require
excision and a skin graft.
Severity of Burn
Types of Burns:
1.
2.
3.
4.
Heat (Thermal)
Chemical
Electrical
Radiation
Thermal (Heat) Burns
Assess and monitor breathing
3 basic steps:
Cool the burned area
Cover burned area
Minimize shock
Other types of burns
Chemical
Flush with water
Electrical
Do not cool with water
Cover and minimize shock
Radiation
Solar or other type of radiation
Sunburn is the most common
Cellular Basis of Skin Color
• Melanocytes in epidermis produce melanin
– Number of melanocytes is the same for ALL races.
• Melanin is produced from tyrosine
– Enzyme = tyrosinase
– Tyrosinase activity increases with exposure to UV
light.
• Other skin pigments include carotene and
hemoglobin
Skin Color as a Diagnostic Tool
• Cyanosis
– Skin, nail beds and mucous membranes
appear blue.
– Blood lacks oxygen
Skin Color as a Diagnostic Tool
• Jaundice
– Skin and “whites” of
eyes appear yellow
– Caused by build up of
bilirubin, a pigment
– Breakdown of blood
cells produces bilirubin
– Could mean that too
many blood cells are
being destroyed or the
liver isn’t able to
remove from system.
Skin color as a Diagnostic Tool
• Erythema
– Redness of skin
– Caused by dialated capillaries
• Become engorged with blood
– Causes:
•
•
•
•
•
Injury
Heat exposure
Infection
Inflammation
Allergic reactions
Skin Color as a Diagnostic Tool
• Petichia (plural – petichiae)
– Tiny red spots in skin caused by broken
capillaries (hemorrhage)
– Can be a sign of low platelet counts in blood
Interesting Facts about the
Integumentary System
• Your skin is the largest organ of your
body.
• For the average adult, your skin:
– covers about 2 square meters.
– weighs about 10-11 pounds (this is 16% of
total body weight)
Homework and Review
Read in book pages 243 – 249 (Dressings,
Role of the First Responder, and Infection)
Complete Matching and Case Study 12.1
and 12.2
Quiz on Burns, Wounds, Dressings on
Wednesday
Body Systems Presentation
• System Order:
–
–
–
–
–
–
–
–
–
–
Integumentary System
Muscular System
Skeletal System
Nervous System
Endocrine System
Cardiovascular System
Lymphatic System
Respiratory System
Digestive System
Urinary System