TimbySmith Introductory MedicalSurgical Nursing 11e Chapter 64 Introduction

Skin • Two layers – Epidermis: replaced ≈ every 35 to 45 days – Dermis: ridges: create a unique pattern of finger, palm, and footprints; facilitate the ability to grip and hold objects • Subcutaneous tissue: skin attached to muscle, bone; connective tissue, fat cells • Melanin gives the skin its color. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? The epidermis is replaced with new cells every 35 to 45 days. The next layer, the dermis, contains the ridges that comprise the fingerprints. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer False The epidermis contains the ridges that comprise the fingerprints. Copyright © 2014

Skin Functions • Protection • Temperature regulation – Radiation; conduction – Evaporation; convection • Sensory processing • Chemical synthesis Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? One of the primary functions of the skin is to protect the underlying structures. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Answer True Rationale: One of the primary functions of the skin is to protect the underlying structures, protection from pathogens and also from dehydration. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Hair • Originates in hair follicle in dermis • Vellus hair; terminal hair • Keratin + amino acids = hair • Scalp hair grows most rapidly. • Hair growth slows by midlife. • Decreased melanin production causes graying hair. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Sebaceous and Sweat Glands • Connected to each hair follicle • Secrete sebum (oily substance) • More active during puberty • Sweat glands – Eccrine glands – Apocrine glands Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? Apocrine glands secrete fluid during perspiration.

Answer True Apocrine glands secrete fluid during perspiration. They also secrete a substance in the external ear canals called cerumen. In animals, apocrine glands secrete pheromones. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Integumentary Assessments • Scalp and Hair Assessment – Skin: smooth, intact, free of lesions – Assess: color, texture, and distribution – Abnormal findings: nits or lice; scales, flaking skin • Nail Assessment – Check for normal structure. – Assess change in shape or thickness; color of nail bed; capillary refill time Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Pressure Sore Staging • Pressure Sore Staging – Stage I: redness – Stage II: blistering or skin tear – Stage III: shallow crater with drainage – Stage IV: deeply ulcerated tissue; exposed muscle and bone; sepsis Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Fingernails and Toenails • Nails – Hard keratin; protective function; nail root – Abundant

Integumentary Diagnostic Tests • Visual inspection • Culture and sensitivity tests • Allergy tests • Wood’s light examination • Potassium hydroxide test • Fungal culture • Skin biopsy Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Medical and Surgical Treatment of Skin Disorders • Drug Therapy – Corticosteroids; antihistamines – Antibiotics; antiseptics – Scabicides; pediculicides – Antiseborrheic agents – Keratolytics – Standard precautions in application of topical medication over impaired skin Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Medical and Surgical Treatment of Skin Disorders—(cont. ) • Wet Dressings – Cooling, soothing effect – Sterile procedure for broken skin – Dry gauze placed on area is saturated with prescribed solution. – Dressing anchored – Left in place until dry as a method of debridement Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Medical and Surgical Treatment of Skin Disorders—(cont. ) • Therapeutic Baths – No soaps; warm water – Gentle application of solution to submerged parts – Inflammation and itching relief – Aid in removal of crusts and scales – Products used: oatmeal, cornstarch, baking soda, mineral oil Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Medical and Surgical Treatment of Skin Disorders—(cont. ) • Surgical Excision – Laser Therapy • Acronym for LASER • Precautions – Cryosurgery – Electrodessication • Radiation Therapy: treatment of malignant skin lesions Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Medical and Surgical Treatment of Skin Disorders—(cont. ) • Photochemotherapy – Combination of psoralen methoxsalen and ultraviolet A light • Lifestyle Changes – Tiredness or emotional stress aggravates condition. – Rest, sleep, and diet are important factors in treatment. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins