Chapter 9
The Integumentary System
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Anatomy and Physiology
❖Provides a barrier
❖Regulates body temperature
❖Synthesizes vitamin D
❖Allows sensory perception
❖Provides nonverbal communication
❖Provides identity
❖Allows wound repair
❖Allows excretion of metabolic wastes
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The Skin #1
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The Skin #2
❖Layers
o Epidermis
▪ Superficial, thin, no blood vessels
o Dermis
▪ Blood vessels, connective tissue, sebaceous
glands, sweat glands, hair follicles
o Subcutaneous or adipose
▪ Connects to underlying structures
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The Skin #3
❖Pigments
o Melanin
o Carotene
o Oxyhemoglobin
o Deoxyhemoglobin
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The Skin #4
❖Abnormal colors
o Jaundice (yellowish color)
▪ Deposition of bilirubin
▪ Easier to observe in sclera, nails, palms, soles
o Cyanosis (bluish color)
▪ Lack of oxygen (central)
▪ Lack of blood flow (peripheral)
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Appendages #1
❖Hair
o Vellus: short, fine, inconspicuous, unpigmented
o Terminal: coarser, thicker, conspicuous, usually
pigmented
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Appendages #2
❖Nails
o Protect distal ends
of fingers and toes
o Nail plate
o Lunula
o Cuticle
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Glands
❖Sebaceous glands
o Produce sebum
o Lubricates hair and skin
o Reduces water loss through skin
❖Sweat glands
o Eccrine: widely distributed, open directly on
surface, help control body temperature
o Apocrine: in axillary and genital areas, open into
hair follicles, stimulated by emotional stress,
responsible for adult body odor
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The Health History #1
❖Purpose to identify the following:
o Diseases of the skin
o Systemic diseases that have skin manifestations
o Physical abuse
o Risk for pressure injuries
o Risk for skin cancer
o Need for health promotion education regarding
the skin
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The Health History #2
Common or Concerning Common or Concerning
Symptoms Symptoms
Rash Lesions
Nonhealing lesions Bruising (ecchymosis)
Moles Hair loss
Growths Nail changes
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The Health History #3
❖Past history
o Skin diseases
o Diabetes or peripheral vascular disease
o Allergies or food sensitivities
o Sunburns
o Corticosteroid medications
o Medication use
o Immunization record
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The Health History #4
❖Family history
o Same or similar symptoms
o Skin diseases
o Allergies
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The Health History #5
❖ Lifestyle and personal habits
o Bathing and shampooing routines
o Change of products
o Wear false nails, wigs, hair extensions, false
eyelashes
o Go to nail salon or gym
o Daily sun exposure
o Skin self-examination
o Exposure to chemicals or radiation
o Diet
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Question #1
The skin is recognized for performing which function?
A. Temperature control
B. Synthesizes vitamin K
C. Excretion of excessive electrolytes
D. Motor perception
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Answer to Question #1
A. Temperature control
The functions of the skin include synthesis of vitamin
D from sunlight, provide a barrier of protection,
regulate body temperature, sensory perception,
provide identity, allow wound repair, and allow
excretion of metabolic waste.
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Physical Examination #1
❖General survey
❖Use natural or artificial light that resembles it
❖Ensure patient is properly draped
❖Inspect and palpate
❖Color
o Look for increased pigmentation, loss of
pigmentation, or redness of skin
o Assess for cyanosis or pallor
o Assess for jaundice
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Skin Color Changes #1
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Skin Color Changes #2
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Skin Color Changes #3
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Skin Color Changes #4
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Skin Color Changes #5
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Physical Examination #2
❖Moisture
o Excessive dryness, sweating, oiliness
o Should be dry to touch without flaking or
cracking
o Carefully inspect skin folds
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Physical Examination #3
❖Temperature
o Use back of hand
o Note generalized warmth or coolness
o Note increased temperature with erythema
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Physical Examination #4
❖Texture
o Roughness or smoothness
❖Mobility and turgor
o Lift fold of skin
o Ease with which it lifts—mobility
o Speed with which it returns into place—turgor
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Physical Examination #6
❖Edema
o Excess fluid in interstitial spaces
▪ Localized: injury
▪ Systemic: most often in the dependent
portions of body, feet, legs, and sacral area
⮚Skin puffy and feels tight
▪ Pitting: interstitial water is mobile
▪ Nonpitting: serum proteins have accumulated
in the interstitial space with the water and
coagulated; brawny edema
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Physical Examination #7
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Question #2
During your physical examination of the patient, you
gently pinch the back of the hand. The skin remains in
a “tent” shape and slowly returns to its normal
position. This is a sign of:
A. Infection
B. Overhydration
C. Dehydration
D. Properly hydrated
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Answer to Question #2
C. Dehydration
“Tenting” is a sign of poor turgor and occurs when a
patient is dehydrated, often occurring with excessive
vomiting, diarrhea, or heat-related situations. The
patient should be further assessed for the need of
intravenous fluids.
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Physical Examination #8
❖Lesions
o Color
o Size
o Elevation
o Number
o Texture
o Type of skin lesions
o Shape and pattern
o Anatomic location and distribution
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Skin Lesions #1
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Skin Lesions #2
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Skin Lesions #3
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Skin Lesions #4
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Skin Lesions: Patterns and Shapes #1
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Skin Lesions: Patterns and Shapes #2
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Skin Lesions: Patterns and Shapes #3
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Primary Skin Lesions (Initial
Presentation) #1
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Primary Skin Lesions (Initial
Presentation) #2
Flat, Nonpalpable Lesions With Changes in Skin
Color— (cont.)
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Primary Skin Lesions (Initial
Presentation) #3
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Primary Skin Lesions (Initial
Presentation) #4
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Primary Skin Lesions (Initial
Presentation) #5
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Primary Skin Lesions (Initial
Presentation) #6
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Primary Skin Lesions (Initial
Presentation) #7
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Primary Skin Lesions (Initial
Presentation) #8
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Secondary Skin Lesions
Overtreatment, Excess Scratching, Infection
#1
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Secondary Skin Lesions
Overtreatment, Excess Scratching, Infection
#2
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Secondary Skin Lesions
Overtreatment, Excess Scratching, Infection
#3
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Secondary Skin Lesions Depressed #1
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Secondary Skin Lesions Depressed #2
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Acne Vulgaris Primary Lesions
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Acne Vulgaris Secondary Lesions
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Vascular Lesions
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Purpuric Lesions
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Skin Tumors #1
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Skin Tumors #2
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Benign Nevi
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Question #3
Vesicles in a unilateral dermatomal pattern are typical
of:
A. Herpes zoster
B. Herpes simplex
C. Tinea capitis
D. Acne vulgaris
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Answer to Question #3
A. Herpes zoster
Herpes zoster (also known as shingles) forms vesicles
that follow a dermatome of the body, usually trunk.
These usually occur on only one side of the body
(unilateral).
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Evaluating the Patient With Decreased
Mobility
❖Susceptible to skin damage and ulceration
❖Pressure injuries
o Sustained compression obliterates blood flow
o Shearing forces from bodily movements
o Easier to prevent than heal
o Assessment tool: Braden scale for predicting
pressure sore risk
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Pressure Injuries #1
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Pressure Injuries #2
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Pressure Injuries #3
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Hair
❖Note quantity, distribution, and texture
❖Inspect for lesions, flaking, and parasites
❖Inspect body, axillae, and pubic hair
❖Changes
o Loss of hair on legs: peripheral artery disease
o Changes in pubic or axilla: hormonal problems
❖Inquire about laser hair removal treatments
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Hair Loss #1
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Hair Loss #2
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Hair Loss #3
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Nails #1
❖Inspect and palpate fingernails and toenails
❖Note color, shape, and any lesions
o Should be pink with white lunulae
o Smooth and firm in texture
o Rounded in shape
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Nails #2
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Findings in or Near the Nails #1
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Findings in or Near the Nails #2
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Findings in or Near the Nails #3
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Findings in or Near the Nails #4
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Recording Your Findings
❖May use sentences
❖May use phrases
❖Carefully record your findings
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Health Promotion and Counseling
❖Important topics
o Skin cancer prevention
o Risk factors for skin cancers
o Avoidance of excessive sun exposure and
artificial tanning lamps
o Use of sunscreen
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Skin Cancer
❖Basal cell carcinoma
o Basal level of epidermis
o 80% of skin cancers, rarely metastasize
❖Squamous cell carcinoma
o Upper layer of epidermis
o 16% of skin cancers, can metastasize
❖Melanoma
o Arise from melanocytes in epidermis
o 4% of skin cancers, most lethal
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Skin Tumors #3
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Skin Tumors #4
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Malignant Melanoma
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Some Risk Factors for Melanoma #1
❖Personal or family history of previous melanoma
❖Atypical or dysplastic moles
❖Male gender
❖50 or more common moles
❖Red or light hair
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Some Risk Factors for Melanoma #2
❖Light eye or skin color
❖Actinic keratoses, solar lentigines
❖Ultraviolet radiation from heavy sun exposure,
sunlamps or tanning booths
❖Severe blistering sunburns as child
❖Immunosuppression from HIV or chemotherapy
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Preventing Skin Cancer
❖Avoiding ultraviolet radiation and tanning beds
o Intermittent sun exposure more harmful
o Best defense—avoidance
❖Regular use of sunscreen prevents skin cancer
o Recommend use of sun protective factor (SPF)
30 with broad spectrum protection
o Water exposure should use water-resistant
sunscreen
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Skin Cancer Screening
❖Clinician screening
o Remain alert during routine assessments
o Full‐body examinations recommended for
patients over the age of 50
o Take advantage of “opportunistic screening”
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Skin Self-Examination #1
❖Equipment
o Full-length mirror
o Hand-held mirror
o Well-lit room
o Privacy
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Skin Self-Examination #2
Examine body front and back in mirror, then right
and left sides with arms raised
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Skin Self-Examination #3
Bend elbows and look carefully at forearms,
upper underarms, and palms
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Skin Self-Examination #4
Look at back of legs and feet, the spaces between
toes and the sole of feet
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Skin Self-Examination #5
Examine back of neck and scalp with hand mirror.
Part hair for closer look
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Skin Self-Examination #6
Check back and buttocks with hand mirror
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ABCDE-EFGs of Examining Moles for
Possible Melanoma #1
❖A: Asymmetry of one side of mole compared to
other
❖B: Irregular borders, especially ragged, notched,
blurred
❖C: Variation or change in color, especially black or
blue
❖D: Diameter ≥6 mm or different from others,
especially if changing, itching, or bleeding
❖E: Evolving, a mole or skin lesion that looks
different from the rest or is changing in size, shape,
or color
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ABCDE-EFGs of Examining Moles for
Possible Melanoma #2
❖Suggested adding EFG to help detect aggressive
nodular melanomas
❖E: Elevated
❖F: Firm to palpation
❖G: Growing progressively over several weeks
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Question #4
To prevent skin cancer, a sunscreen with a “skin
protection factor” (SPF) of _____ is recommended.
A. 10
B. 20
C. 30
D. 40
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Answer to Question #4
C. 30
An SPF of at least 30 and broad spectrum protection is
recommended.
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