skin, hair, and nails.

• The integumentary system consists of the skin, hair, and nails, which are external structures that serve a variety of specialized functions.
• skin is the largest organ of the body
• skin is a physical barrier that protects the underlying tissues and organs from microorganisms, physical trauma, ultraviolet radiation (UVR), and dehydration.
• skin plays a vital role in temperature maintenance, fluid and electrolyte balance, absorption, excretion, sensation, immunity, and vitamin D synthesis
• epidermis: the outer layer of skin
• The innermost layer of the epidermis (stratum germinativum) is the only layer that undergoes cell division and contains melanin (brown pigment) and keratin-forming cells.
• The inner layer of skin is the dermis
• The dermis is a wellvascularized, connective tissue layer containing collagen, elastic fibers, nerve endings, and lymph vessels. It is also the origin of sebaceous glands, sweat glands, and hair follicles.
• The sebaceous glands are attached to hair follicles and, therefore, are present over most of the body, excluding the soles and palms. They secrete an oily substance called sebum that waterproofs the hair and skin.
• keratinocytes produce keratin, an insoluble protein that forms the structural framework of the epidermis
• hair is made up of dead cells called keratinocytes which form a hard protein called keratin
• hair is made up of dead cells called keratinocytes which form a hard protein called keratin. Hair grows outward from the root at an average rate of about half an inch per month.
• The apocrine glands are associated with hair follicles in the axillae, perineum, and areolae of the breasts
• The eccrine glands are located over the entire skin. Their primary function is secretion of sweat and thermoregulation, which is accomplished by evaporation of sweat from the skin surface.
• Apocrine glands are small and nonfunctional until puberty, at which time they are activated and secrete a milky sweat. The interaction of sweat with skin bacteria produces a characteristic body odor. In women, apocrine secretions are linked with the menstrual cycle.
• subcutaneous tissue, a loose connective tissue containing fat cells, blood vessels, nerves, and the remaining portions of sweat glands and hair follicles
• subcutaneous tissue stores fat as an energy reserve, provides insulation to conserve internal body heat, serves as a cushion to protect bones and internal organs, and contains vascular pathways for the supply of nutrients and removal of waste products to and from the skin.
• Hair consists of layers of keratinized cells, found over much of the body except for the lips, nipples, soles of the feet, palms of the hands, labia minora, and penis.
• Hair develops within a sheath of epidermal cells called the hair follicle.
• dermis has sensory receptors (meissner's corpuscles) that detect touch, pressure, vibration, temperature, pain, and other stimuli
• The hair shaft is visible above the skin
• hair root is surrounded by the hair follicle
• Attached to the follicle are the arrector pili muscles, which contract in response to cold or fright, decreasing skin surface area and causing the hair to stand erect.
• Vellus hair (peach fuzz) is short, pale, fine, and present over much of the body.
• Terminal hair (particularly scalp and eyebrows) is longer, generally darker, and coarser than vellus hair. Puberty initiates the growth of additional terminal hair in both sexes on the axillae, perineum, and legs
• hard, transparent plates of keratinized epidermal cells that grow from the cuticle
• The nail body extends over the entire nail bed and has a pink tinge as a result of blood vessels underneath.
• The lunula is a crescent-shaped area located at the base of the nail. It is the visible aspect of the nail matrix.
• The nails protect the distal ends of the fingers and toes, enhance precise movement of the digits, and allow for an extended precision grip.
• the free edge of the nail is called the distal margin
• The free edge is the portion of the nail extending beyond the fingertip.
• Patchy hair loss (alopecia) may accompany infections, stress, hairstyles that put stress on hair roots, and some types of chemotherapy.
• The proximal margin is the part of the nail closest to the finger or toe.
• The nurse educator is preparing an education module for the nursing staff on the epidermal layer of skin. Which of these statements would be included in the module? The epidermis is:

  
  

  a. Highly vascular.

  
  

  b. Thick and tough.

  
  

  c. Thin and nonstratified.

  
  

  d. Replaced every 4 weeks.

  d. Replaced every 4 weeks.

  
  

  The epidermis is thin yet tough, replaced every 4 weeks, avascular, and stratified into several zones.
• What layer of skin is thinner in older adults?

  Subcutaneous Tissue
• 5 Main Functions of the Skin

  1. Protection

  
  

  2. Sensation

  
  

  3. Regulation

  
  

  4. Secretion/Excretion

  
  

  5. Vitamin D Formation
• The nurse educator is preparing an education module for the nursing staff on the dermis layer of skin. Which of these statements would be included in the module? The dermis:

  
  

  a. Contains mostly fat cells.

  
  

  b. Consists mostly of keratin.

  
  

  c. Is replaced every 4 weeks.

  
  

  d. Contains sensory receptors.

  d. Contains sensory receptors.

  
  

  The dermis consists mostly of collagen, has resilient elastic tissue that allows the skin to stretch, and contains nerves, sensory receptors, blood vessels, and lymphatic vessels. It is not replaced every 4 weeks.
• Skin Assessment -- Subjective


  Ask Health History Questions to Address

  
  

  1. Allergies

  
  

  2. Skin conditions & diseases (past and present)

  
  

  3. New appearances on skin or changes on skin (rashes, lesions, moles)

  
  

  4. Pain or pruritus (itching)

  
  

  5. Medications

  
  

  6. Changes to hair or nails

  
  

  7. Recent exposure to environmental or occupational hazards (sun or chemicals)

  
  

  8. Self-care & hygiene
• The nurse is examining a patient who tells the nurse, I sure sweat a lot, especially on my face and feet but it doesnt have an odor. The nurse knows that this condition could be related to:

  
  

  a. Eccrine glands.

  
  

  b. Apocrine glands.

  
  

  c. Disorder of the stratum corneum.

  
  

  d. Disorder of the stratum germinativum.

  a. Eccrine glands.

  
  

  The eccrine glands are coiled tubules that directly open onto the skin surface and produce a dilute saline solution called sweat. Apocrine glands are primarily located in the axillae, anogenital area, nipples, and naval area and mix with bacterial flora to produce the characteristic musky body odor. The patients statement is not related to disorders of the stratum corneum or the stratum germinativum.See an expert-written answer!We have an expert-written solution to this problem!
• Special Subjective Questions for Patient with a Rash


  P: What were you doing when the rash presented? Have you tried a new food, or been outside gardening or camping? Do you have a new pet?

  
  

  Q: Can you describe what the rash looks like?

  
  

  R: Where is your rash? Has it spread?

  
  

  S: Does it itch? Is it painful? Has it gotten better or worse?

  
  

  T: When did you notice the rash? How long have you had it?

  
  

  U: Why do you think you have this? What do you think is causing it?