Transcript AP-Chapter-8 - McLaren

ESSENTIALS OF A&P
FOR EMERGENCY CARE
CHAPTER
8
The Integumentary
System: The Protective
Covering
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
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Multimedia Asset Directory
Slide 26
Slide 38
Slide 39
Slide 69
Slide 70
Slide 71
Slide 72
Slide 73
Slide 74
Wound Repair Animation
Degrees of Burn Animation
Chemical Burns Animation
Pressure Sores Animation
Eczema Video
Skin Cancer Video
Decubitus Ulcers Video
Emergency Medical Technicians Video
Nursing Video
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Introduction
• The integumentary system protects the
body from environmental damage.
• The skin forms a protective barrier
shielding the body from the elements and
pathogens, as well as performing several
other vital functions.
• Skin is essential to well-being, helps to
regulate body temperature, and contains
many accessory organs such as nails,
hair, and glands.
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Learning Objectives
• Discuss the functions of the integumentary
system.
• List and describe the layers of the skin.
• Explain the healing process of skin.
• Describe the structure and growth of hair
and nails.
• Explain how the body regulates
temperature through the integumentary
system.
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Pronunciation Guide
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apocrine (APP oh krine)
carotene (CARE oh teen)
corium (CORE ee um)
eccrine (EKK rin)
epidermis (ep ih DER miss)
epithelial cells (ep ih THEE lee al)
keratin (KAIR eh tin)
keratinization (KAIR eh tin eye ZAY shun)
lesion (LEE zhun)
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Pronunciation Guide
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lunula (LOO nyoo lah)
melanin (MELL an in)
melanocytes (MELL an oh sights)
pustule (PUS tyool)
sebaceous gland (see BAY shus)
sebum (SEE bum)
squamous cells (SKWAY mus)
stratum corneum (STRAY tum core NEE um)
subcutaneous fascia (sub cue TAY nee us FASH
ee uh)
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System Overview
• The integumentary system is comprised of
the skin and its accessory components
including hair, nails, and associated
glands.
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System Overview
• The integumentary system performs
several vital functions.
– Protection from pathogens
– Balances fluid levels
– Stores fatty tissue for energy supply
– Produces vitamin D (with help from the sun)
– Provides sensory input
– Helps to regulate body temperature
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The Skin
• The skin is the largest organ, weighing
approximately 20 pounds and covering an
area about 20.83 square feet on an adult.
• A cross section of skin reveals three
layers.
– Epidermis
– Dermis
– Subcutaneous fascia
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Figure 8-1 The three layers of the skin.
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Epidermis
• The epidermis is the layer of skin that we
see on the outside. It is made up of five
even smaller layers of tissue.
• There are no blood vessels in this layer.
• The cells on the surface of the epidermis
are constantly shedding, being replaced
with new cells that grow and arise from the
deeper region called the stratum basale
every 2–4 weeks.
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Epidermis
• The outermost layer is a layer of dead
cells, called the stratum corneum, which
are flat, scaly, keratinized epithelial cells.
• You slough off 500 million cells every day,
or about 1½ pounds of dead skin a year,
allowing for rapid repair in case of injuries.
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Skin Color
• Specialized cells called melanocytes are located
deep in the epidermis and are responsible for
skin color.
• Melanocytes produce melanin, a substance that
causes skin color.
• Variation in skin color is the result of the amount
of melanin produced and how it is distributed,
not the number of melanocytes.
• Carotene, another form of pigment, gives a
yellowish hue to skin while a pinkish hue is
derived from the hemoglobin in the blood.
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Effects of Disease on Skin Color
• Color of skin can indicate disease.
• When liver disease occurs, the body can’t
break down bilirubin. The buildup of
bilirubin gives the skin a deeper, yellow
color.
• A malfunctioning adrenal gland can cause
the skin to turn bronze due to excessive
melanin.
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Effects of Disease on Skin Color
• Excessive bruising could indicate skin,
blood, or circulatory problems.
• Cyanosis, or a blue coloring, results from a
drop in oxygenation.
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From the Streets:
Skin Color
• Normal skin color in light-skinned people is
pink.
• In dark-skinned people, inspect the
mucous membranes (such as lips) to
detect skin color changes.
• Paleness indicates decreased blood flow
through skin and can result from anemia,
hypothermia or hypovolemia.
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Dermis
• The layer below, or inferior, to the epidermis
is the thicker dermis layer.
• This layer contains the following:
–
–
–
–
–
–
–
–
Capillaries
Collagenous/elastic fibers
Involuntary muscles
Nerve endings
Lymph vessels
Hair follicles
Sudoriferous glands (sweat)
Sebaceous glands (oil)
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Dermis
• Small “fingers” of tissue project from the
surface of the dermis and anchor this layer
to the epidermal layer.
• Nerve fibers allow you to sense what is
happening in your environment.
• Vasodilation of capillaries in this layer
causes blushing.
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Dermis
• Collagen and elastic fibers allow for the
elasticity of skin, preventing the tearing of
skin with movement. They allow skin to
return to normal shape during periods of
rest. Older people lose some of this
elasticity, leading to wrinkles.
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Sudiferous Glands
• Two main types of sudiferous, or sweat,
glands
– Apocrine sweat glands secrete at the hair
follicles in the groin and anal region as well as
the armpits and become active around
puberty and are believed to act as sexual
attractants.
– Eccrine glands are found in greater numbers
on your palms, feet, forehead, and upper lip
and are important in the regulation of
temperature.
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Sudiferous Glands
• The body has three million sweat glands.
• Sweat has no odor, but bacteria degrades
the substances in the sweat over time into
chemicals that give off strong smells
commonly known as body odors.
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Sebaceous Glands
• Sebaceous glands play an important role
by secreting oil, or sebum.
• Sebum keeps the skin from drying out and
(due to its acidic nature) helps destroy
some pathogens on the skin’s surface.
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Figure 8-2 Sweat and sebaceous glands.
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Subcutaneous Fascia
• The innermost layer of the skin is the
subcutaneous fascia, or hypodermis.
• The subcutaneous fascia is composed of
elastic and fibrous connective tissue and fatty
tissue.
• Lipocytes, or fat cells, produce the fat needed
to provide padding to protect the deeper
tissues of the body and act as insulation for
temperature regulation.
• Fascia attaches to the muscles of the body.
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How Skin Heals
• If skin is punctured and the wound
damages blood vessels, the wound fills
with blood. Blood contains substances that
cause clotting. The top part of the clot
exposed to air hardens to form a scab,
nature’s bandage, forming a barrier and
preventing pathogens from entering.
• In minor wounds, the dermis will
eventually regenerate. In severe wounds,
the dermis will be replaced by a scar.
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Burns to the Skin
• Burns can be caused by heat, chemicals,
electricity, or radiation.
• Two factors affect assessments of
damage:
– Depth
– Amount of area damaged
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First Degree Burns
• The depth of a burn relates to the layer or
layers of skin affected by the burn.
• First degree burns damage only the outer
layer, or epidermis.
• Symptoms include redness and pain, but
no blister.
• Pain subsides in 2-3 days and there is no
scarring.
• Complete healing takes about one week.
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Second Degree Burns
• Second degree burns involve the entire
depth of the epidermis and a portion of the
dermis.
• Symptoms include redness, pain, and
blistering.
• The extent of blistering is dependent on
the depth of the burn.
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Second Degree Burns
• Blistering extends after the initial burn.
• Blisters heal within 10-14 days if there are
no complications, with deeper second
degree burns taking 1-3½ months.
• Scarring in second degree burns is
common.
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Third Degree Burns
• Third degree burns affect all three layers
of the skin.
• The surface of the burn has a leathery feel
and will range in color from black, brown,
tan, red, or white.
• The victim feels no pain because the pain
receptors are destroyed.
• Also destroyed are sweat and sebaceous
glands, hair follicles, and blood vessels.
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Fourth Degree Burns
• Fourth degree burns are the worst burns.
• These burns penetrate the bone and
cause bone damage.
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Amount of Area Damaged
• The rule of nines is used to estimate the
extent of area damaged by burns.
• The body is divided into the following
regions, each given a percentage of body
surface area value:
– Head and neck – 9%
– Each upper limb – 9% (2 × 9 = 18%)
– Front of trunk – 18%
– Back of trunk and buttocks – 18%
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Amount of Area Damaged
• The body is divided into the following
regions, each given a percentage of body
surface area value:
– Front of legs – 18%
– Back of legs – 18%
– Perineum (including anus and urogenital
region) – 1%
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Figure 8-3 Assessing the degree of the burn.
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Figure 8-3 (continued) Assessing the degree of the burn.
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Figure 8-3 (continued) Assessing the degree of the burn. Bottom photos showing first
degree burn (sun burn) and third degree burn.
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Burns – Clinical Concerns
• The clinical concerns for burn victims
relate to the functions of the skin already
discussed, including:
– Bacterial infections
– Fluid loss
– Heat loss
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Burn Treatment
• Severe burns require healing steps at an
intensity level the body can’t manage on
its own.
• Damaged skin must be removed as soon
as possible and skin grafting must be
started.
• Autografting is using the patient’s own
skin, while heterografting (from a donor) is
required if the patient suffered a large area
of burn and has little healthy skin to graft.
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Burn Treatment
• Grafting requires many trips to the OR
because large areas can’t be done all at
once and often the grafts don’t “take.”
• It is possible to grow sheets of skin tissue
in the laboratory from patient cells or
utilization of synthetic materials.
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Nails
• Specialized epithelial cells originating from
the nail root form your nails.
• As these cells grow out and over the nail
bed, they become keratinized forming a
substance similar to the horns on a bull.
• The cuticle is a fold of tissue that covers
the nail root.
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Nails
• The portion that we see is called the nail
body.
• Nails normally grow 1 mm every week.
• The pink color of the nail comes from the
vascularization of the tissue under the
nails, while the white half-moon shaped
area, or lunula is a result of the thicker
layer of cells at the base.
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Figure 8-5 Clinician performing capillary refill assessment.
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Figure 8-4 Structures of the fingernail.
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Hair
• Body hair is normal and serves important
purposes.
• Hair helps to regulate body temperature
and functions as a sensor to help detect
things on your skin such as bugs or
cobwebs.
• Eyelashes help to protect our eyes from
foreign objects while hair in the nose helps
filter out particulate matter.
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Hair Anatomy
• Visible hair is composed of fibrous protein called
keratin.
• The hair you see is called the shaft with the root
extending down into the dermis to the follicle.
• The follicle is formed by epithelial cells with a
rich source of blood provided by the dermal
blood vessels.
• Cells divide and grow in the base of the follicle,
older cells are pushed away and die, so the
shaft of the hair is comprised of dead cells.
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Hair Anatomy
• Shaving or cutting hair doesn’t make it grow
quicker or thicker.
• There is a sebaceous gland associated with
each hair follicle, secreting sebum that coats the
hair follicle and works its way to the skin’s
surface to prevent drying of the hair, acting as
an antibacterial, and lubricating the hair shaft.
• Sebum production decreases with age,
explaining why older people have drier skin and
more brittle hair.
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Hair Color and Texture
• Your hair color is dependent on the
amount and type of melanin you produce.
• The more melanin, the darker your hair.
• White hair occurs in the absence of
melanin.
• Red hair is the result of hair that has
melanin with iron in it.
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Hair Color and Texture
• Flat hair shafts produce curly hair, while
round hair shafts produce straight hair.
• The life span of hair is dependent on
location, with eyelashes lasting 3-4
months while the hair on your head lasts
3-4 years.
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Temperature Regulation
• The integumentary system plays a major
role in the regulation of the body’s
temperature.
• Part of the regulation of temperature is
accomplished by changes in the size of
the blood vessels. Vasodilation exposes
heated blood to external cooling air.
Vasoconstriction keeps cooling of blood to
a minimum when it’s cold outside.
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Temperature Regulation
• Sweat glands excrete water onto the skin’s
surface, allowing cooling through
evaporation. This requires adequate
hydration to continue to produce sweat. By
the time you feel thirsty you’re already
dehydrated. You can potentially secrete 12
liters of sweat in a 24 hour period.
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Shivering
• Shivering causes muscle activity that
produces heat to warm you when you’re
cold.
• Hairs on your skin stand erect when
arrector pili muscles contract; this is
known as goose bumps. These hairs
create a dead space insulating you from
cooler surroundings, like a goose down
jacket.
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Figure 8-6 Diagram of a hair follicle.
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Diseases of the Skin
• There are whole sections of medical
libraries dedicated to diseases of the skin.
• A lesion is a single affected patch of skin.
• There are many common pathological
conditions of the integumentary system.
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Figure 8-7 Integumentary regulation of body temperature.
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Figure 8-8 Various types of skin lesions.
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Figure 8-8 (continued) Various types of skin lesions.
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Table 8-1 Common Pathological Conditions of the Integumentary System.
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Table 8-1 (continued) Common Pathological Conditions of the Integumentary System.
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Table 8-1 (continued) Common Pathological Conditions of the Integumentary System.
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Figure 8-9 Various types of integumentary conditions. (a) Urticaria (hives).
(Courtesy of Jason L. Smith, MD.)
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Figure 8-9 (continued) Various types of integumentary conditions. (B) Erythema infectiosum
(fifth disease). (Courtesy of Jason L. Smith, MD.)
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Figure 8-9 (continued) Various types of integumentary conditions. (C) Acne. (Courtesy of
Jason L. Smith, MD.)
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Figure 8-9 (continued) Various types of integumentary conditions. (D) Poison ivy (dermatitis). (Courtesy
of Jason L. Smith, MD.)
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Figure 8-9 (continued) Various types of integumentary conditions. (E) Herpes simplex.
(Courtesy of Jason L. Smith, MD.)
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Figure 8-9 (continued) Various types of integumentary conditions. (F) Burn, second degree.
(Courtesy of Jason L. Smith, MD.)
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Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
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Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
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Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Snapshots from the Journey
• Your skin is your largest organ; it acts as a
barrier to infection and injury; helps to
keep you from drying out; stores fat;
synthesizes and produces vitamin D;
regulates body temperature; provides a
minor excretory function in the elimination
of water, salts, and urea; and provides
sensory input.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Snapshots from the Journey
• The skin is composed of three layers:
epidermis, dermis, and subcutaneous
fascia. Glands secrete oil to moisturize,
waterproof, and control body temperature.
• The skin has several accessory structures
including various glands, hair, and nails.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Snapshots from the Journey
• Burns are assessed by depth of burn and
area covered. The severity of burns to the
skin is evaluated the depth of the burn and
the area that the burn covers.
• Nails are protective devices composed of
dead material.
• Hair (also dead material) aids in controlling
body temperature.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Case Study
A 27-year-old female presents to her
doctor’s office with complaints of red,
itching, and oozing skin for the past two
days.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Case Study
Physical exam and history reveal a wellnourished, white female who is otherwise in
good health, has no known allergies, normal
vital signs, pupils are normal and reactive,
has good reflexes, normal breath sounds,
liquid filled vesicles, and scabbing on both
legs from the top of her sock lines to the
bottom of her shorts, and new vesicles have
formed around her eyes.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
Case Study Questions
The patient states that she returned from a
primitive camping and hiking vacation in
Virginia two days ago.
• Based on the case study information, what
do you think the diagnosis is?
• What caused the vesicles to begin to form
around her eyes?
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
From the Streets
You are called to the scene of a 20-year-old
male involved in a fire in his garage. He has
sustained second-degree burns to his entire
chest and abdomen and the anterior of both
arms and legs.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
From the Streets Questions
• Calculate the percent body area burned.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
From the Streets Questions
• Calculate the percent body area burned.
– Each upper limb (4.5 X 2)= 9%
– Front of trunk= 18%
– Front of legs= 18%
Total = 45%
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
End of Chapter
Review Questions
1. The substance that is mainly responsible
for skin color is:
a. Melanin
b. Pigmentin
c. Carrots
d. Luna
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
End of Chapter
Review Questions
2. Whether you have naturally curly or
straight hair is dependent on the shape
of your:
a. Hair follicles
b. Hair shafts
c. Sebum
d. Melanin
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
End of Chapter
Review Questions
3. The fibrous protein that makes up your
hair and nails and fills your epidermal
cells is called:
a. Carotene
b. Myelin
c. Keratin
d. Dermasene
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
End of Chapter
Review Questions
4. In a cold environment, in order to
maintain a core body temperature,
peripheral blood vessels will:
a. Vasodilate
b. Venospasm
c. Shiver
d. Vasoconstrict
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
End of Chapter
Review Questions
5. Excess blood loss may cause this sign in
the integumentary system:
a. Decreased hair growth
b. Decreased capillary refill
c. Increased wound healing
d. Brittle nails
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
End of Chapter
Review Questions
1. The three main layers of skin are the
_______, ________, and ________.
2. This type of sweat gland is involved
mainly in temperature regulation _____
and the ___ glands are involved mainly
in nervous sweating.
3. Sebaceous glands secrete an oily
substance called____.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
End of Chapter
Review Questions
4. For some individuals, melanin locates in
small patches called _________.
5. Jaundice, a condition associated with
liver disease, occurs as a result of the
buildup of _________.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
End of Chapter
Review Questions
1. Discuss three functions of the
integumentary system.
2. Explain the organization of the
epidermis. What happens to epidermal
cells as they rise to the surface of the
skin?
3. Why is there an increased production of
melanin when there is an increased sun
exposure?
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.
End of Chapter
Review Questions
4. Explain the classifications of burn
severity.
5. List and briefly describe the major
accessory structures of skin.
Essentials of A&P for Emergency Care
Bruce J. Colbert • Jeff Ankney • Karen T. Lee • Bryan E. Bledsoe
Copyright ©2011 by Pearson Education, Inc.
All rights reserved.