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            January 22, 2018                                                      The Integumentary SystemThe skin is the largest organ in the body, it accounts for 12-15 percent of total body weight.

The integumentary system consists of skin, nails, hair, glands, and nerves. The hair on our skin protects the skin from UV light, and regulation of body temperature. There are two different types of glands, sebaceous and sudoriferous glands. The sebaceous gland is a very small gland that produces a lubricating substance called sebum. The sudoriferous gland is a tiny tubular structure underneath the skin that excrete sweat by tiny openings. The sudoriferous gland also consists of two glands called apocrine and eccrine glands. There are sensory nerves ending that are found in the skin and they detect environmental changes, such as a cold, heat, pain pressure and touch, different nerves ending and detect different sensations. Sensory nerves endings send messages to our brain to let us know what we feel at that time.

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 The apocrine gland secretes fluid into hair follicles and does not become active until puberty. The apocrine glands are in the axilla area only. The eccrine gland are small sweat glands that produce an odorless water fluid onto the skins surfaces. This gland plays an important role in temperature regulation.

The eccrine glands are located all over the body. The nails on our skin protects our fingers from injuries and helps in touching and scratching. The integumentary system has six functions, the first function is protection which is our first defense against radiation, microorganisms, and physical injuries.

The second function is sensation, the skin is a receptor for touch, pressure and sensation of temperatures of hot and cold and for pain as well. The third function is regulating body temperature and releasing sweat to cool body down when the temperature goes up. The forth function stores and synthesizes vitamin D and vitamin B from sunlight. The fifth function is excretion which allows us to get rid of waste products through our skin such as water, urea, uric acid, and ammonia. The sixth function is absorption; the skin absorbs oxygen and nitrogen. (Functions of the Skin) (Chapter 4: The skin, hair and nails.

)    The Integumentary system has three layers of skin. The three layers of skin are the epidermis, dermis, and hypodermis. The epidermis is the top layer of skin and is only made up of epithelial cells. The epidermis has five layers; stratum basale, stratum spinosum, stratum granulosum, stratum lucidum, and stratum corneum.  The main functions of the epidermis are to protect, absorption of nutrients, and homeostasis.

The dermis is the middle layer and it is composed of dense irregular connective tissue and areolar connective tissue. The dermis is composed of two layers which are the papillary and reticular layers. The papillary layer is the superficial layer and is the tissue composed of the areolar connective tissue. The reticular layer is the deepest layer of the dermis and consists of the dense irregular connective tissue. The hypodermis layer is also known as the subcutaneous layer. It is composed of adipocytes and helps store fat.

These layers serve as elasticity to the skin.Common disorders within the integumentary system include a decubitus ulcer also known as pressure ulcer, pressure sore, or bedsore. It is an open wound on your skin and usually occurs near bony prominences such as the back, hips, ankle, and buttocks. The reason why the pressure ulcer occurs is due to someone who has stayed at the same spot for a long time, has not been turned, having poor eating habits, and diabetes can be a cause to having a pressure ulcer as well.

It is most commonly found in elderly people with decreased mobility. There are four stages of a pressure ulcer. The first stage is discoloration of the skin.

The skin may appear red and will not blanch when pressure is applied in a certain area and the skin is intact.  The second stage the skin is open with a shallow crater that shows some signs of tissue death. The tissue may be filled with  clear fluid. The third stage the ulcer is much deeper within the skin and can have tunneling into surrounding tissue. It affects fatty layers and looks like a crater. There will also be sloth in the sore. The fourth stage is full thickness loss of skin and tissue exposing muscles and bone.

The amount of pain a person can feel for a bedsore depends on the stage of the bedsore. The further into the stages the less likely the patient will feel the bedsore due to the bedsore affecting the nerves. When a dark substance (eschar) may appear over the sore it is considered  unstageable due to not being able to see under the eschar. This condition can be very hard to treat due to the inmobility of the resident and the amount of the care they receive but when treated properly, the outcomes can be good. The treatment depends on the stage of your pressure ulcer and treatments can include therapies, surgeries, and medications. (Can an ALF Resident Have a Stage 4 Bedsore?) (Pressure Injury Staging Illustrations.)            A blood blister is another common disorder within the integumentary system and it is considered as a deep tissue injury.

Blood blisters can occur from prolonged pressure in a short period of time and causes deep tissue injury. The reasons for getting a blood blister are from a patient falling, a bruise that has occurred, and a deep tissue injury. The prevention of a blood blister is by moving the patient frequently and putting pillows in bony areas and if possible making the patient move around and do activites.

The treatment for a blood blister is medications, therapies, and surgeries. Another common disorder is skin cancer. Skin cancer is abnormal growth of the skin cells. It affects people of all colors. People who have fair skin and who get easier burnt have a higher risk for skin cancer, and the reason for that is because fair skin people do not have as much pigmentation and have less protection from the sun. People with dark skin have more pigmentation and have more protection and have a less chance of developing skin cancer.  A kind of skin cancer is squamous cell carcinoma, this kind of cancer invades the sqaumous cells and epidermis and dermis which is the middle and outer layer of the skin.

 There are four stages of squamous cell carcinoma. Stage one is less than two centimeters and hasn’t spread to nearby lymph nodes or organs and has fewer high-risk features. Stage two is larger than two centimeters and has not spread to nearby organs or lymph nodes, or a tumor of any size with two or more higher risk features. Stage three cancer has spread to facial bones and or one nearby lymph nodes, but not to any other organs. Stage four cancer can be any size and has metastasized to one or more lymph nodes which are larger than three cm and may spread to bones or other organs in the body.

The treatment varies and may involve surgery and sometimes chemotherapy and radiation. The second kind of cancer is basal cell carcinoma is abnormal uncontrolled growth or lesions. The basal cell occurs in the deepest layer of the epidermis, they look like open sores, red patches, and pink growths. Basal cell carcinoma is form due to intense amount sun exposure and usually develops on the face, head, neck, but can potienally spread to other parts of the body.

 Sometimes the basal cell carcinoma can resembles noncancerous skin condtions such as psoriasis and eczema. There is four stages (0-4) to basal cell carinoma. The first stage is zero is present in the epidermis and has not spread to the dermis and less than two cm. Stage two is larger than 2cm across wherever the cancer is located and has not spread to any lymph nodes and organs. Stage three has spread into spread deeper into the skin, such as facial bones or lymph nodes but has not spread to other organ systems. Stage four has spread to any part of the body such as bones or other organ in the body and can be any size and could be the size 1cm to 3cm. Melanoma is one of the most dangerous type of skin cancer. These growths occur when unreparied DNA damage to the skin mutates.

These growths are often caused by ultaviolet radtion. There is four stages to melanoma. The first stage is zero is noninvasive and has not penetrated below the outer layer of the skin.

Stage one has invaded below the epidermis into the dermis, at this point metastasing is not a risk. Stage two is already localized, they are larger (one mm thick) at this point it may put them at risk for spreading. Stage three and four are more advanced and have metatasized to other parts of the body.

The treatment is to get the melanoma removed by a surgical incision and is the method normally done. (Basal and Squamous Cell Skin Cancer Stages.) (Skin Cancer Foundation) Normal aging changes of skin can potienally change colors over time, and hair stops growing as fast as we begin to age. Nails start to change and can appear yellow and dull after sometime.  Aging can cause many changes in your skin. Your skin will become thinner, drier, and more fragile.

Skin will start to lose elasticity over time and the hair becomes thin and turns gray. Even wrinkles and brown spots start to show up over time. Decreased circulation to the skin is another sign of aging and signs of skin turning blue or cold to the touch. CNA responsibilities for the integumentary system are to notice any changes in patients skin which consists of noticing discolorations, skin tears, and developing bed sores.

Skin tears are mainly caused when an elderly skin is very fragile and can occur due to friction forces or blunt trauma. There are three stages of a skin tear. Stage one is the tissue has a tear but without any tissue loss. Stage two consists of partial tissue loss.

Stage three is that the tissue is completely gone. The ways to treat the skin tears are by cleaning the wound and having the correct dressing for the skin tears. There is also many preventive measures for skin tears, such as using lotion, and making sure the patient is aware of their surrounding to avoid bumping into objects and causing skin tears. CNA’s can prevent bedsores from happening by changing positions often for the patients, keeping the patient clean and dry from any moisture, and using the pillows in bony areas to stop from bedsores occurring. Another consideration is to look for any changes in the patient’s skin or if a certain mole looks abnormal. Also, CNA’s should also look for scratches and bruises and notice if the patient bruises easily so that will let the CNA know to be gentle with the patient when helping them with certain activities during the day or night. (Skin Tears: Common Treatment Approaches and Protocols)The Integumentary system is one of the most visible and complex organ systems.

The integumentary system protects us from any harmful substances.  The integumentary is very important and we should be aware of any differences in our skin. The integumentary system is also important when caring for the elderly and their skin being fragile. I hope you guys enjoyed learning about the integumentary system. Thank you!     


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