Transcript The Profession of Medical Assisting

CHAPTER
23
The Integumentary
System
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23-2
Learning Outcomes (cont.)
23.1 Describe the functions of skin.
23.2 Describe the layers of skin and the
characteristics of each layer.
23.3 Explain the factors that affect skin color.
23.4 Summarize types of common skin lesions.
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23-3
Learning Outcomes (cont.)
23.5 Describe the accessory organs of skin along
with their structures and functions.
23.6 Explain the process of skin healing,
including scar production.
23.7 Describe the common diseases and
disorders of the skin.
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23-4
Introduction
•
Integumentary system
–
Skin
•
•
–
Body’s outer covering
Largest organ
Accessory organs:
• Hair follicles
• Nails
• Skin glands
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23-5
Functions of the Integumentary System
• Protection
– First line of defense
• Bacteria
• Viruses
– Protects underlying structures
• UV radiation
• Dehydration
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23-6
Functions of the Integumentary System
(cont.)
•
Body temperature regulation
– If too hot
•
•
Dermal blood vessels dilate
More blood to surface so heat escapes
– If too cold
•
•
Dermal blood vessels constrict
Prevents heat from escaping
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23-7
Functions of the Integumentary System
(cont.)
• Vitamin D production
– Skin must have sunlight
– Needed for calcium absorption
• Sensation – receptors
• Excretion – perspiration
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23-8
Apply Your Knowledge
What are the functions of the integumentary
system?
ANSWER: The functions of the integumentary system
are protection, regulation of body temperature, vitamin D
production, sensation, and excretion.
Super!
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23-9
Skin Structure
• Epidermis
• Dermis
• Hypodermis
or subcutaneous
layer
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23-10
Epidermis
• Superficial layer of the skin
• Major layers
– Stratum corneum
• Outermost layer
• Mostly dead cells form an impermeable layer
– Stratum basale
• Deepest layer
• Cells constantly dividing and pushing older cells
outward
To Figure of Skin
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23-11
Epidermis (cont.)
• Cell types
– Keratinocyte
• Most common
• Makes and accumulates the protein keratin
– Melanocyte ~ makes the pigment melanin
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23-12
Dermis
• Deeper, more complex
• Contains all major tissues, plus
– Sudoriferous glands
– Sebaceous glands
– Hair follicles and arrector pili muscles
– Collagen, elastin, and nerve fibers
– Blood vessels
To Figure of Skin
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23-13
Subcutaneous Layer
• Hypodermis
• Composed of
– Adipose (fat) and loose connective tissue
– Blood vessels and nerves
To Figure of Skin
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23-15
Apply Your Knowledge
What are the layers of skin and what is their
function?
ANSWER:
Epidermis – superficial outer layer; cells produce keratin
which makes it waterproof and resistant to bacteria and
viruses; and melanin which absorbs UV radiation.
Dermis – most complex layer; contains all major tissue
types; binds epidermis to subcutaneous tissue
Subcutaneous layer – inner most layer of adipose and
loose connective tissue; the adipose cushions and
insulates underlying structures and organs.
Excellent!
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23-16
Skin Color
•
Determined by amount
of melanin and activity
of melanocytes
•
Genetic trait
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23-17
Skin Color (cont.)
• Oxygenated blood
– Oxygen dissolved in the hemoglobin of the
red blood cells
– Well-oxygenated blood ~ pink skin
– Poorly oxygenated blood ~ pale or bluish skin
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23-18
Apply Your Knowledge
What affects skin color?
ANSWER: The amount of melanin produced by the
melanocytes and the oxygenation of the blood.
Nice Job!
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23-19
Skin Lesions
• Any variation in the
skin
– As simple as a
freckle
– As serious as a
tumor
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23-20
Skin Lesions (cont.)
• Primary – originate from disease or body
changes
• Secondary – reaction to external trauma
• Vascular – anomalies of blood vessels
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23-21
Skin Lesions (cont.)
Lesion Name
Bulla
Description
A large blister or cluster of blisters
Cicatrix
Crust
A scar, usually inside a wound or
tissue
Dried blood or pus on the skin
Ecchymosis
A black-and-blue mark or bruise
Erosion
A shallow area of skin worn away
by friction or pressure
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23-22
Skin Lesions (cont.)
Lesion Name
Excoriation
Fissure
Keloid
Macule
Nodule
Description
A scratch; may be covered with
dried blood
A crack in the skin’s surface
An overgrowth of scar tissue
A flat skin discoloration, such as a
freckle or a flat mole
A large pimple or small node
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23-23
Skin Lesions (cont.)
Lesion Name
Papule
Petechiae
Plaque
Purpura
Pustule
Description
An elevated mass similar to but
smaller than a nodule
Pinpoint skin hemorrhages that
result from bleeding disorders
A small, flat, scaly area of skin
Purple-red bruises usually due to
clotting abnormalities
An elevated (infected) lesion
containing pus
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23-24
Skin Lesions (cont.)
Lesion Name
Scale
Description
Vesicle
Thin plaques of epithelial tissue
on skin’s surface
A swelling of abnormal tissue
growth
A wound that results from tissue
loss
A blister
Wheal
Another term for hive
Tumor
Ulcer
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23-25
Apply Your Knowledge
Match the following:
C Keloid
___
ANSWER:
A. A blister
A Vesicle B. A crack in the skin’s surface
___
E Crust
___
C. An overgrowth of scar tissue
B Fissure D. A small, flat scaly area of skin
___
F Ulcer
___
E. Dried blood or pus on the skin
D Plaque
___
F. A wound that results from tissue loss
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23-26
Accessory Organs
•
Hair follicles
– Tube-like depressions in the dermis of skin
– Generate hairs
– Alopecia – follicles die
– Arrector pili ~ muscles that pull on follicles
Diagram
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23-27
Accessory Organs (cont.)
•
Sudoriferous
glands
•
– Eccrine glands
• Watery sweat
• Activated by heat
– Apocrine glands
• Thicker sweat
• Armpit and groin areas
• Activated by
nervousness or stress
Sebaceous glands
– Produce sebum to
keep hair soft
– Prevent bacteria
from growing on
skin
Diagram
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23-28
Accessory Organs
• Nails
– Protect the ends of
fingers and toes
– Epithelial cells with
hard keratin
– Nail body
– Nail root
– Lunula
– Nail bed
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23-29
Apply Your Knowledge
ANSWER:
Matching:
A.Sudoriferous glands
B.Sebum
C.Apocrine glands
D.Hair follicles
E.Nails
F.Eccrine glands
G.Alopecia
H.Sebaceous glands
I.Arrector pili
Perfect!
D tube-like depressions in the skin’s
dermis; generate hairs
G baldness
F produce watery type of sweat
I muscles attached to hair follicles;
cause “goose bumps”
A produce sweat
H produce sebum
B keeps hair soft and pliable
E protect the ends of fingers and
toes
C become active during puberty
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23-30
Skin Healing
• Injury  inflammation
– Redness due to dilation of
nearby blood vessels
– Swelling because vessels
leak fluid into spaces
between cells
– Pain because excess fluid
activates pain receptors
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23-31
Skin Healing (cont.)
• Inflammation promotes healing
– Extra blood to area
– Extra nutrients
– Defensive cells
Scab replaces
blood clot
Collagen fibers
replace scab
Injury occurs
Blood clot
forms
Clotted blood and other
dried tissue
Binds the edges of wound; scar may
form
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23-32
Apply Your Knowledge
How does inflammation promote healing of the
skin?
ANSWER: Inflammation promotes healing by
bringing extra blood, nutrients for skin repair, and
defensive cells to the area of injury.
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23-33
Common Diseases and Disorders of the
Skin
•
Burns
– Extent of body surface area and degree of a
burn
– Rule of nines is used to determine extent of
burn
• Estimate body surface area
• 11 body areas
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23-34
Burns
Head and neck
9%
Anterior trunk
18%
4½%
Anterior legs
and feet
18%
Posterior trunk
and buttocks
18%
Arms, hands,
and shoulders
18%
4½%
Perineum
1%
4½%
4½%
Posterior legs
and feet
18%
Back
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23-35
Burns (cont.)
• Full-thickness
• Superficial
– Epidermis only
– Pain, redness,
swelling
• Partial-thickness
– Epidermis and dermis
– All layers of skin and
often underlying
structures
– Skin appears charred
– Always requires
medical attention
– Pain, redness,
swelling, blisters
Burns
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23-37
Burns (cont.)
•
General guidelines for treatment
–
Do not remove anything sticking to the burn
–
Do not apply butter, lotions, or ointments
–
Cool with large amounts of water
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23-38
Burns (cont.)
•
General guidelines for treatment
–
Cover with sterile sheet or plastic bag
–
Contact emergency services
–
Check airways for swelling
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23-39
Skin Cancer and Common Skin Disorders
• Skin – vulnerable due to exposure
• Skin cancer
– Epidermis
– Excessive exposure to sunlight
– Types
•
Basal cell and squamous cell carcinoma
•
Malignant melanoma
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23-40
Skin Cancer and Common Skin
Disorders (cont.)
• Basal Cell
– Signs / symptoms
• Growth or sore that will not heal
• Waxy, smooth, red, pale, flat, or lumpy
– Treatment
• Curettage and
electrodessication
• Mohs surgery
• Cryosurgery
• Laser therapy
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23-41
Skin Cancer and Common Skin
Disorders (cont.)
• Squamous Cell
– Less common than basal cell
– Flat cells of the epidermis
– Found on face, lips, ears,
and backs of hands
– Signs and symptoms and treatments are the
same as for basal cell carcinoma
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23-42
Skin Cancer and Common Skin
Disorders (cont.)
• Malignant Melanoma
– Signs / symptoms
• Mole that itches or
bleeds
• ABCDE rule
– Treatment
• Surgery
• Determination if
cancer has spread
• Chemotherapy and
radiation therapy
• Immunotherapy
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23-43
Skin Cancer and Common Skin
Disorders (cont.)
Asymmetry – a mole should not become
asymmetrical.
Border – a mole should not have irregular
borders and edges should not blur into
normal tissue.
Color – a mole should not change or
become mixture of colors.
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23-44
Skin Cancer and Common Skin
Disorders (cont.)
Diameter – a mole should not grow larger
than the diameter of a pencil eraser (6
mm.)
Evolving – a mole that has been changing in
size, color and appearance, or growing
in an area of previously normal skin
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23-45
Skin Cancer and Common Skin
Disorders (cont.)
Stages of Melanoma
Stage 0
Only found in epidermis
Stage I
Stage II
Spread to epidermis and dermis (1 to 2 mm
thick)
2 to 4 mm thick and may be ulcerated
Stage III
Spread to one or more nearby lymph nodes
Stage IV
Spread to other body organs or lymph nodes
far from original melanoma
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23-46
Common Skin and Hair Disorders
• Alopecia
• Dermatitis
– Inflammation of skin
or a rash
– Eczema ~ chronic
dermatitis
– Hair loss
– Heredity
• Cellulitis
– Inflammation of
connective tissue
in skin
– Red, tight, painful skin
• Folliculitis
– Swimmer’s rash
– Inflammation of hair
follicles
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23-47
Common Skin Disorders (cont.)
• Herpes simplex
– Type 1
– Shingles
• Cold sores
• Spread through saliva
– Type 2 – genital
• Genital
• Sexually transmitted
– No cure
• Herpes zoster
– Chicken pox virus lies
dormant
– Symptomatic
treatment
– Vaccine
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23-48
Common Skin Disorders (cont.)
• Impetigo
• Pediculosis
– Oozing skin lesions
that eventually crust
over
– Capitus ~ head lice
– Corporis ~ body lice
– Pubis ~ pubic lice
– Highly contagious
• Psoriasis – chronic,
inflammatory skin
condition
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23-49
Common Skin Disorders (cont.)
• Ringworm
• Rosacea
– Three types
• Tinea corporis
• Tinea capitis
• Tinea pedis
– Dilation of small
facial blood vessels
– Not curable
– Dermatophytes
– Antifungal agents
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23-50
Common Skin Disorders (cont.)
• Scabies
• Warts
– Contagious skin
condition caused
by mites
– Redness and
itching
– Harmless growths
caused by a virus
– Vary in appearance
– OTC medications
– Treat entire family
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23-51
Apply Your Knowledge
1. True or False:
ANSWER:
F Basal cell carcinoma is the most aggressive form of skin
___
cancer and can form anywhere.
Melanomas are more aggressive.
T Squamous cell carcinoma is more likely to spread to
___
surrounding tissues.
T Lesions of melanoma appear on trunk, head, neck of
___
men and on arms and legs of women.
F The borders of skin cancers are usually regular.
___
Borders are irregular.
T Basal cell carcinoma progresses slowly and rarely
___
spreads to other body parts.
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23-52
Apply Your Knowledge
2. Using Figure for Rule of Nines,
determine burn extent for a
patient who has burns to his
anterior face and both arms.
Click for Rule of Nines
ANSWER:
Face = 4.5%
Both arms, hands, and shoulders = 18%
4.5% + 18% = 22.5%
It all adds up to a
right answer!
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23-53
In Summary
23.1 The functions of skin include: protection, body
temperature regulation, vitamin D production,
sensation, and excretion.
23.2 The topmost layer of the skin is the epidermis. The
dermis is the complex middle layer. The innermost
layer attaching the skin to muscle is the subcutaneous
layer.
23.3 The amount of melanin affects and determines skin
color. The amount of oxygen-carrying hemoglobin in
the blood also affects skin color.
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23-54
In Summary (cont.)
23.4
Skin lesions are split among three main types:
primary lesions such as macules and vesicles;
secondary lesions, which include ulcers and keloids;
and vascular lesions, which involve blood vessels
and include telangiectasias and ecchymoses.
23.5
The accessory organs of skin include: hair follicles,
arrector pili muscles, sebaceous glands,
sudoriferous glands, and keratin-filled nails.
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23-55
In Summary (cont.)
23.6
Injured skin becomes inflamed from dilating blood
vessels that leak and cause swelling. A blood clot is
formed, which is replaced by a scab, which is then
replaced by collagen fibers that produce scar tissue.
23.7
Common diseases and disorders of the skin include
alopecia, cellulitis, dermatitis, eczema, folliculitis,
herpes simplex, herpes zoster, impetigo, pedicuosis,
psoriasis, ringworm, rosacea, scabies, and warts.
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23-56
End of Chapter 23
We may have different
religions, different
languages, different
colored skin, but we all
belong to one human
race.
~ Kofi Annan
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in any manner. This document may not be copied, scanned, duplicated, forwarded, distributed, or posted on a website, in whole or part.