3.
IntegumentaryIntegumentary
Skin forms
protective barrier,
shielding body
from elements and
pathogens, as well
as performing
several other vital
functions
Skin forms
protective barrier,
shielding body
from elements and
pathogens, as well
as performing
several other vital
functions
4.
Skin’s AccessoriesSkin’s Accessories
Skin is essential to
well-being, helps to
regulate body
temperature, and
contains many
accessory
components such as
nail, hair, and
glands
Skin is essential to
well-being, helps to
regulate body
temperature, and
contains many
accessory
components such as
nail, hair, and
glands
6.
The PA/Instructor Asks
What skin rash is caused by a viral illness and is a
reaction to the body’s immune system trying to stop the
virus?
A.
B.
C.
D.
A.
B.
C.
D.
Tinea cruris
Cellulitis
Dermatitis
Measles
7.
Figure 8-1
The three layers of the skin.
Largest organ, weighing approximately 20 pounds and covering
area about 20.83 square feet on an adult
8.
First Layer-EpidermisFirst Layer-Epidermis
Layer of skin we see
on outside; made up
of several smaller
layers of stratified
squamous
epithelium
Do you remember
what shape and
arrangement this is?
Layer of skin we see
on outside; made up
of several smaller
layers of stratified
squamous
epithelium
Do you remember
what shape and
arrangement this is?
9.
First Layer-EpidermisFirst Layer-Epidermis
Avascular and contains
NO NERVE CELLS
Avascular and contains
NO NERVE CELLS
Cells on surface are
constantly
shedding, being replaced
with new
cells that grow and arise
from the stratum
basale EVERY 2 to 4
weeks
Cells on surface are
constantly
shedding, being replaced
with new
cells that grow and arise
from the stratum
basale EVERY 2 to 4
weeks
11.
First Layer-EpidermisFirst Layer-Epidermis
The body sloughs off
500 million cells every
day, or about one and
a half pounds of dead
skin a year, allowing
for rapid repair in
case of injuries
The body sloughs off
500 million cells every
day, or about one and
a half pounds of dead
skin a year, allowing
for rapid repair in
case of injuries
12.
Melanocytes in EpidermisMelanocytes in Epidermis
Specialized cells
(melanocytes) located
deep in epidermis;
responsible for skin
color
Melanocytes
produce melanin;
actual substance
that affects skin
color in different
people
Specialized cells
(melanocytes) located
deep in epidermis;
responsible for skin
color
Melanocytes
produce melanin;
actual substance
that affects skin
color in different
people
13.
Melanocytes in EpidermisMelanocytes in Epidermis
Variations of skin color
result of amount of
melanin produced and
how it is distributed
Carotene: gives
yellowish hue to
skin
Albinism: little
pigment in skin,
hair, eyes
Variations of skin color
result of amount of
melanin produced and
how it is distributed
Carotene: gives
yellowish hue to
skin
Albinism: little
pigment in skin,
hair, eyes
14.
The PA/Instructor Asks
A person who is an albino (very little pigment in their
skin) is at risk for two conditions: Skin cancer and
A.
B.
C.
D.
A.
B.
C.
D.
Photosensitivity
Loss of Hair
Dermatitis
Acne
15.
Second Layer-DermisSecond Layer-Dermis
Layer below, or
inferior to,
epidermis is
thicker dermis
layer (corium)
Layer below, or
inferior to,
epidermis is
thicker dermis
layer (corium)
18.
Second Layer-DermisSecond Layer-Dermis
Small dermal papillae
project from surface
and anchor this layer
to epidermal layer-
*page 174 diagram
Small dermal papillae
project from surface
and anchor this layer
to epidermal layer-
*page 174 diagram
19.
Second Layer-DermisSecond Layer-Dermis
Fingerprints and toe prints arise from
this layer
Nerve fibers allow you to sense what is
happening in your environment
Fingerprints and toe prints arise from
this layer
Nerve fibers allow you to sense what is
happening in your environment
21.
The PA/Instructor Asks
What other factor, besides aging, leads to change in the
skin’s firmness and decreases its ability to recoil to its
normal state when stretched?
A.
B.
C.
D.
A.
B.
C.
D.
Bathing
Too much oil
Sun Exposure
Acne
22.
Part of the Dermis-Part of the Dermis-
Sweat GlandsSweat Glands
Two main types of
sudoriferous or sweat
glands:
Apocrine sweat glands
secrete at hair follicles in
groin, anal region, and
armpits; become active
around puberty and are
believed to act as sexual
attractants
Two main types of
sudoriferous or sweat
glands:
Apocrine sweat glands
secrete at hair follicles in
groin, anal region, and
armpits; become active
around puberty and are
believed to act as sexual
attractants
23.
Part of the Dermis-Part of the Dermis-
Sweat GlandsSweat Glands
Eccrine glands are
found in greater
numbers on palms,
feet, forehead, and
upper lip;
important in
regulation of body
temperature
Eccrine glands are
found in greater
numbers on palms,
feet, forehead, and
upper lip;
important in
regulation of body
temperature
25.
Part of the Dermis-Part of the Dermis-
Sweat & Oil GlandsSweat & Oil Glands
26.
Part of the Dermis-Part of the Dermis-
Sebaceous GlandsSebaceous Glands
27.
Figure 8-2
Sweat and sebaceous glands.
Sebaceous glands
usually found in
hair covered areas
and deposit sebum
on hair shaft
where it is brought
to the surface
28.
Figure 8-2
Sweat and sebaceous glands.
Sebaceous glands
also found on non
hair covered areas
such as eyelids,
penis, labia minora
and nipples in
ducts that end at
the sweat gland
31.
How Skin HealsHow Skin Heals
Watch video “Wound
Healing- Integumentary
System”
http://www.youtube.com/watch?v=IYL6vg89uds
32.
HOW SKIN HEALS
If skin punctured and
wound damages blood
vessels, 1) wound fills
with blood
Blood contains
substances that cause
clotting
If skin punctured and
wound damages blood
vessels, 1) wound fills
with blood
Blood contains
substances that cause
clotting
33.
HOW SKIN HEALS
2) Top part of clot
exposed to air
hardens to form a
scab (nature's
bandage) forming
barrier and
preventing
pathogens from
entering
2) Top part of clot
exposed to air
hardens to form a
scab (nature's
bandage) forming
barrier and
preventing
pathogens from
entering
34.
HOW SKIN HEALS
Next, 3) inflammatory
response occurs, with
migration of white blood
cells (WBCs) to damaged
area to destroy any
pathogens that may have
entered
Next, 3) inflammatory
response occurs, with
migration of white blood
cells (WBCs) to damaged
area to destroy any
pathogens that may have
entered
36.
HOW SKIN HEALS
At same time, 4) cells
(fibroblasts) come in and
begin pulling edges of
wound together
5)Basal layer of epidermis
begins to hyperproduce
new cells for repair of
wound
At same time, 4) cells
(fibroblasts) come in and
begin pulling edges of
wound together
5)Basal layer of epidermis
begins to hyperproduce
new cells for repair of
wound
38.
How Skin HealsHow Skin Heals
Ideally wound starts
to heal from inside
out; aids in
preventing
pathogens from
becoming trapped
between healed
surface and deeper
layers of skin,
where they could
develop into a major
pocket of infection
Ideally wound starts
to heal from inside
out; aids in
preventing
pathogens from
becoming trapped
between healed
surface and deeper
layers of skin,
where they could
develop into a major
pocket of infection
40.
The PA/Instructor Asks
What factor, in addition to decrease in blood
flow, contributes to problems with wound
healing in diabetic patients?
A.
B.
C.
D.
A.
B.
C.
D.
Decreased clotting
Increased bleeding
Decreased WBC activity
Poor scab formation
41.
Figure 8-8
Keloids
Keloid is a “scar
gone wild” due
to an
overproduction
of connective
tissue
Keloid is a “scar
gone wild” due
to an
overproduction
of connective
tissue
Formation more
prominent in
African Americans
Formation more
prominent in
African Americans
Treatment is steroid injection or cryotherapyTreatment is steroid injection or cryotherapy
42.
Accessory to Skin-NailsAccessory to Skin-Nails
Specialized
epithelial
cells
originating
from nail root
form nails
Specialized
epithelial
cells
originating
from nail root
form nails
43.
Accessory to Skin-NailsAccessory to Skin-Nails
As cells grow
out and over
nail bed, they
become
keratinized
forming
substance
similar to
horns on a
bull
As cells grow
out and over
nail bed, they
become
keratinized
forming
substance
similar to
horns on a
bull
44.
Accessory to Skin-NailsAccessory to Skin-Nails
Cuticle is fold of tissue
that covers nail root
Cuticle is fold of tissue
that covers nail root
Portion that
we see is
called nail
body
Portion that
we see is
called nail
body
Nails
normally
grow 1 mm
every week
Nails
normally
grow 1 mm
every week
45.
The PA/Instructor Asks
How long do you pinch the fingernail of a patient before
you release and check for return of the normal “pink”
color? How long does it normally take to return (i.e. the
capillary refill time)?
What is the name of the condition that consists of reduced
blood flow in patients with diabetes abbreviated PVD?
What else can decrease blood flow?
Page 185 Clinical Application
47.
Figure 8-10
Structures of the fingernail.
Pink color of nail comes from vascularization of
tissue under nails
White half-moon shaped area (lunula) is result of
thicker layer of cells at base
Pink color of nail comes from vascularization of
tissue under nails
White half-moon shaped area (lunula) is result of
thicker layer of cells at base
49.
Skin Accessory-HairSkin Accessory-Hair
Helps to regulate
body temperature
and functions as
sensor to help detect
things on skin, such
as bugs or cobwebs
Helps to regulate
body temperature
and functions as
sensor to help detect
things on skin, such
as bugs or cobwebs
50.
Skin Accessory-HairSkin Accessory-Hair
Eyelashes protect your eyes
from foreign objects, and hair
in the nose filters out
particulate matter
Eyelashes protect your eyes
from foreign objects, and hair
in the nose filters out
particulate matter
54.
Figure 8-12Figure 8-12
Diagram of a hair follicle.Diagram of a hair follicle.
Factoid:Flat hair
shafts produce curly
hair, while round
hair shafts produce
straight hair
Factoid:Flat hair
shafts produce curly
hair, while round
hair shafts produce
straight hair
56.
Skin and TemperatureSkin and Temperature
RegulationRegulation
Vasodilation: body's attempt to get as much “hot”
blood exposed to cooler environment
Vasoconstriction: forces blood away from skin and
back toward core of body where heat is
Vasodilation: body's attempt to get as much “hot”
blood exposed to cooler environment
Vasoconstriction: forces blood away from skin and
back toward core of body where heat is
Change in size of
blood vessels
Change in size of
blood vessels
57.
Skin and TemperatureSkin and Temperature
RegulationRegulation
Vasodilation: body's attempt to get as much “hot”
blood exposed to cooler environment
Vasoconstriction: forces blood away from skin and
back toward core of body where heat is
Vasodilation: body's attempt to get as much “hot”
blood exposed to cooler environment
Vasoconstriction: forces blood away from skin and
back toward core of body where heat is
A child’s lips are
blue when they
are cold getting
out of a pool due
to vasoconstriction
A child’s lips are
blue when they
are cold getting
out of a pool due
to vasoconstriction
58.
Skin and TemperatureSkin and Temperature
RegulationRegulation
Sweat glands
excrete water,
nitrogenous
wastes and
sodium chloride
(salt) to skin’s
surface
59.
Skin and TemperatureSkin and Temperature
RegulationRegulation
As long as you stay
hydrated and are
able to produce
sweat; thirst
indicates body has
reached level of
dehydration
60.
Skin and TemperatureSkin and Temperature
RegulationRegulation
Muscles in skin called
arrector pili attached to
hairs; when those muscles
contract, make your hairs
stand erect (gooseflesh or
goose bumps) when you
are chilled
Muscles in skin called
arrector pili attached to
hairs; when those muscles
contract, make your hairs
stand erect (gooseflesh or
goose bumps) when you
are chilled
61.
Figure 8-14Figure 8-14
Integumentary regulation ofIntegumentary regulation of
body temperature.body temperature.
Regulating
temperature
through
vasoconstriction
and
vasodilitation
Regulating
temperature
through
vasoconstriction
and
vasodilitation
*Page 189
73.
S: A 27-year-old female presents to her doctor's office with
complaints of red, itching, and oozing skin on arms and
legs for the past two days. The patient states that she
returned from a primitive camping and hiking vacation in
Virginia two days ago.
Case Study-SOAP NoteCase Study-SOAP Note
74.
O: Physical exam and history reveal a well-
nourished, white female who is otherwise in good
health, has NKA (no known allergies).
Vital Signs: T: 98 P: 87 R: 12 BP: 110/60
EENT; pupils are normal and reactive, ENT negative
Lungs: normal breath sounds
Skin: liquid-filled vesicles, and scabbing on inside of
right arm and top of her sock lines to the bottom of
her shorts, and new vesicles have formed around her
eyes.
Case Study-SOAP NoteCase Study-SOAP Note
75.
Based on the case study information, what do you
think the diagnosis is?
What caused the vesicles to begin to form around her
eyes?
Case Study-SOAP NoteCase Study-SOAP Note
76.
DermatologyDermatology
Tic Tac ToeTic Tac Toe
• Also known as shingles
• Dormant, adult version of chickenpox
• Blisters/rashes found on trunk in midline fashion, following
course of sensory nerve
• Extremely painful lesions producing sharp, stabbing sensations;
may last from 10 days to several weeks
• Result of stress, disease, trauma, aging process
77.
Dermatology
Tic Tac Toe
• These are noncancerous skin growths on the soles of your feet caused by
the human papillomavirus (HPV), which enters your body through tiny
cuts, breaks or other vulnerable sites on the skin of your feet.
• They often develop beneath pressure points in your feet, such as the heels
or balls of your feet. This pressure also may cause one to grow inward
beneath a hard, thick layer of skin (callus).
78.
Dermatology
Tic Tac Toe
• Inflammation of the skin and subcutaneous tissue with redness, heat,
swelling and pain (4 characteristics of inflammation)
• This often develops in patients with diabetes or compromised healing
capacity. Usually caused by strep and staph bacteria. SERIOUS infection in
patients with MRSA (methicillin resistant staph aureas)
79.
Dermatology
Tic Tac Toe
• Inflammation in a LOCALIZED encapsulated lesion. One lesion is called a boil
but this collection of abscesses under the skin have another name. Lesions can
grow and fill with pus, until they become painful and burst.
• Can start as an infection of the hair follicle and are usually caused by Staph
aureus bacteria. Individuals with weakened immune systems, adolescents and
young adults are more susceptible to these than younger children or older
adults.
80.
Dermatology
Tic Tac Toe
• A metabolic condition, allergies, drug or endocrine disorders are
possible causative agents.
• Inflammation of hair follicles/sebaceous glands especially on the face,
neck, chest, upper back/shoulders. Can form blackheads, cysts, nodules,
pustules and pimples.
81.
Dermatology
Tic Tac Toe
• Red ring shaped patches (mimicking a worm), with red
inflamed skin, cracked and weeping areas with itch,
discoloration.
• Caused by a fungus; It can be spread on towels, clothing, or
sports equipment. Personal hygiene is important in
preventing the spread of ringworm. Dogs and cats can pass
it to people through direct contact.
82.
Dermatology
Tic Tac Toe
• Occurs in melanocytes, from excessive sun exposure
• May appear as a brown or black irregular patch that appears
suddenly . A color or size change in a pre-existing mole or
wart may also indicate a melanoma. These metastasize to
other areas quickly
83.
Dermatology
Tic Tac Toe
• Unknown agent(s) causing benign overgrowth of epithelial cells.
• This looks like a well defined warty-scaled lesion that can present in a
variety of colors from yellow to brown and can be removed with
scraping (curettage) or freezing
84.
EXAMEXAM
Chapters 4,5 and 8Chapters 4,5 and 8
Exam will be on
Oct 17 at 9:30 am
•Multiple Choice
•Fill in the Blanks
•Short Essays (taken
directly from the
Short Essays at end
of Chap 4 and 5)
•Diagram of skin
