Integumentary (Skin)

• Functions of Integumentary system: Protection, metabolism, temperature regulation, communication, elimination, and sensation.
• Purpose of integumentary system: comprises the skin and its appendages. e.g hair and nails.
• The aim of integumentary assessment is to differentiate between different skin problems and to identify patterns that may help with diagnosis, and assess the impact of any problem on a patient.
• Purpose of Neonatal Skin: Provides a barrier to prevent pathogens from entering the body. Thermoregulation, Fluid and electrolyte balance, Synthesis of Vitamin D, Fat storage and insulation, Excretion, Protection from microorganisms, Tactile stimulation for mother and babyattachment.
• Neonatal Skin is more thinner, fragile, less oily, produce less Melanin, less resistant to bacteria and reacts to environmental substances.
• Skin Changes Associated with Ageing: Problem = Decreased sensory perception, Increased dryness, The skin becomes thinner and less elastic, Decreased vitamin D synthesis, Reduction in immune response, Decrease in temperature control or thermoregulatory functioning, Vascularity or blood supply of the skin is diminished, Hormonal changes, Changes in hair colour and balding, The amount of subcutaneous tissue decreases.
• Extrinsic Ageing: The effects of external factors such as UV light, pollution, smoking, and stress
• Intrinsic Ageing: The process of ageing that occurs within the body and is not caused by external factors. e.g. Ethnicity
• Relevant data to gather:

  Recent physiological or psychological stress = Hair, nail and skin care habits = Skin self-examination = Problems with the skin
• Integumentary Assessment = Inspect and palpate skin, hair, and nails noting: (General odour, temperature, moisture and turgor) Capillaryrefill time. Inspect and palpate for signs of pressure injury or skin lesions,noting:(Non-blanchable redness; localised heat; oedema and induration)ØObserve any wounds, dressings, drains and invasive lines,noting: (Warmth; Redness; Swelling; Exudate or odour)Determine frequency of skin assessment based on patientscondition
• Why should we assess skin integrity?


  Often gives indications of other conditions, risk assessment for wound types, lack of mobility.
• Skin Inspection: Skin colour, Bleeding and Lesions.
• Inspect hair for: Hair distribution, colour and quantity (thick, thin, balding)
• Inspect nails for: Nail length, colour, configuration, symmetry and cleanliness.
• Skin Integrity Assessment: Palpation = Skin temperature, Skin moisture, Skin texture, Tenderness, Oedema, Skin changes and Skin turgor (resilience and Elasticity of tissue).
• Oedema - swelling of the body due to excess fluid build up in the tissues
• Observe any wounds, dressings, drains or invasive lines for: Warmth, Redness, Swelling and Exudate or odour.
• Issues relevant to older adult = Venous leg ulcer - a wound that develops on the lower leg or foot.
• Arterial ulcers - caused by atherosclerosis, which is a build-up of fatty material in the arteries.
• Diabetic foot ulcer - a wound that develops in the foot or lower leg of a diabetic patient.
• Moisture associated skin damage (MASD) - skin damage caused by moisture, such as sweat, that is not removed from the skin. (Older adult)
• Incontinence associated dermatitis (IAD) - a skin condition that occurs when the skin is exposed to chemicals that cause irritation. (Older Adult)
• Skin tears - the skin is torn or cut open by a sharp object. Can be partial-thickness or full-thickness
• Skin tear risk factors include: limited mobility and use of wheelchairs or other mobility aids, cognitive impairment, poor nutrition, polypharmacy and sensory loss.
• Pressure Injury - a wound that is caused by pressure. Localised injury to the skin and/or underlying tissue usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction.
• Pressure Injury Risk Factors: Immobility or reduced physical mobility, loss of sensation, impaired cognitive state or level or consciousness,urinary or faecal incontinence, poor nutrition or recent weightloss, dry skin and acute or severe illness.
• Pressure Injury Risk Assessment Tools: Braden, and Pressure Injury Risk Assessment Tool, Waterlow, Glamorgan Paediatric Scale.