lOMoAR cPSD| 47061011
ASSESSMENT: INTEGUMENTARY SYSTEM
(CHAPTER 24)
LEARNING OUTCOMES
1. Describe the structures and functions of the integumentary system.
2. Link the age-related changes in the integumentary system to differences in assessment findings.
3. Obtain significant subjective and objective data related to the integumentary system from a patient.
4. Compare the components for describing primary and secondary lesions.
5. Perform a physical assessment of the integumentary system using appropriate techniques.
6. Specify the structural and assessment differences in light- and dark-skinned persons.
7. Distinguish normal from common abnormal findings of a physical assessment of the integumentary
system.
8. Describe the purpose, significance of results, and nursing responsibilities related to diagnostic studies
ofthe integumentary system.
Structures and Functions of Skin and Appendages
Structures
• Epidermis- outer layers of the skin o Eyelids
0.5mm to palms 1.5mm.
• 5 distinct but interrelated layers o 2 layers are
stratum corneum (surface) o Stratum
germinativum (deepest, basal layer)
• Epithelial cells are made up of o Keratinocytes
(90%)- form in basal layer.
o Melanocytes- deep in basal layer and contain melanin (give skin color). Damaged but UV
light.
o Langerhans’ cells- dendritic. Immunocompetent cells that recognize antigens o Merkel
cells- found in basal layer, involved in the sensation of light touch.
o Basement membrane zone is between the epidermis and the dermis. Provides support for
epidermis and fluid exchange between the 2 layers. Inflammation of this epidermis and
dermis causes blisters as seen from burns.
• Dermis- connective tissue below the epidermis.
o Thickness from 0.6mm on eyelid to 3.0mm on back, palms, hands and soles of feet.
o Very vascular
o Contains nerves, lymphatic vessels, o Hair follicles o Sebaceous glands o Mast cells and
macrophages that protect the body for external stimuli.
• Made of 3 different types of connective tissue o
Collagen- give skin strength.
o Elastic and Reticular- form fibroblast.
, lOMoAR cPSD| 47061011
• 2 layers: o Thin papillary layer- forms finger
prints.
o Thicker reticular layer
• Subcutaneous Tissue- lies below the dermis.
o Made of connective tissue and fat cells. o Provides insulation, cushioning, temp
regulation and energy storage. o Attaches to muscle and bone.
o Distribution pattern depends on gender, heredity, age and nutrition status.
• Skin Appendages- Hair, nails and glands.
o Hair and nails are formed from keratin.
o Alopecia- baldness with no replacement hair.
o Nail body is the part you can see, nail root is hidden by skin folds which is the cuticle. Part
of the nail root you can see is the lunula. A white, crescent-shape area (site of mitosis and
nail growth).
o Sebaceous glands- 2 types sebaceous and sweat (apocrine and eccrine).
Secrete sebum which empties into hair follicles. This waterproofs and lubricates
the skin to promote absorption of fat-soluble substances.
Present on all areas of skin except the palms and soles/dorsum of the feet.
Most abundant on face, scalp, upper chest and back.
Apocrine sweat gland found axillary, genital and breast.
Eccrine sweat glands found most of body except the lips, ear canals, nail bed,
labia minora, glans penis and prepuce. 1 sq in as 3000 sweat glands. Body can
produce 2 to 4 L to 12 L in 24 hours.
Functions of Integumentary System
• Main function of skin is to protect underlying tissues acting as a barrier to the external
environment like bacteria and viruses.
Gerontologic Considerations: Effects of Aging on the Integumentary System
• Chronic UV exposure= premature aging. Actinic complexion happens in light skin and eyes.
Premalignant skin lesions.
• Decrease of melanin causes hair color to fade with decrease in hair growth. Nail growth slows
and becomes brittle.
Assessment of Integumentary System
• Normal:
o Skin- even pigmentation, no petechiae, purpura lesions or excoriations Warm with good
turgor.
o Nails- Pink, oval, adhere to nail bed with 160- degree angle.
o Hair- shiny and full. Amount and distribution appropriate for age and gender. No flaking
of scalp, forehead or pinna.
Subjective Data
• Important health information to get from patient history o Medications- many can cause skin
side-effects. o Surgery or other treatments- like radiation therapy.
ASSESSMENT: INTEGUMENTARY SYSTEM
(CHAPTER 24)
LEARNING OUTCOMES
1. Describe the structures and functions of the integumentary system.
2. Link the age-related changes in the integumentary system to differences in assessment findings.
3. Obtain significant subjective and objective data related to the integumentary system from a patient.
4. Compare the components for describing primary and secondary lesions.
5. Perform a physical assessment of the integumentary system using appropriate techniques.
6. Specify the structural and assessment differences in light- and dark-skinned persons.
7. Distinguish normal from common abnormal findings of a physical assessment of the integumentary
system.
8. Describe the purpose, significance of results, and nursing responsibilities related to diagnostic studies
ofthe integumentary system.
Structures and Functions of Skin and Appendages
Structures
• Epidermis- outer layers of the skin o Eyelids
0.5mm to palms 1.5mm.
• 5 distinct but interrelated layers o 2 layers are
stratum corneum (surface) o Stratum
germinativum (deepest, basal layer)
• Epithelial cells are made up of o Keratinocytes
(90%)- form in basal layer.
o Melanocytes- deep in basal layer and contain melanin (give skin color). Damaged but UV
light.
o Langerhans’ cells- dendritic. Immunocompetent cells that recognize antigens o Merkel
cells- found in basal layer, involved in the sensation of light touch.
o Basement membrane zone is between the epidermis and the dermis. Provides support for
epidermis and fluid exchange between the 2 layers. Inflammation of this epidermis and
dermis causes blisters as seen from burns.
• Dermis- connective tissue below the epidermis.
o Thickness from 0.6mm on eyelid to 3.0mm on back, palms, hands and soles of feet.
o Very vascular
o Contains nerves, lymphatic vessels, o Hair follicles o Sebaceous glands o Mast cells and
macrophages that protect the body for external stimuli.
• Made of 3 different types of connective tissue o
Collagen- give skin strength.
o Elastic and Reticular- form fibroblast.
, lOMoAR cPSD| 47061011
• 2 layers: o Thin papillary layer- forms finger
prints.
o Thicker reticular layer
• Subcutaneous Tissue- lies below the dermis.
o Made of connective tissue and fat cells. o Provides insulation, cushioning, temp
regulation and energy storage. o Attaches to muscle and bone.
o Distribution pattern depends on gender, heredity, age and nutrition status.
• Skin Appendages- Hair, nails and glands.
o Hair and nails are formed from keratin.
o Alopecia- baldness with no replacement hair.
o Nail body is the part you can see, nail root is hidden by skin folds which is the cuticle. Part
of the nail root you can see is the lunula. A white, crescent-shape area (site of mitosis and
nail growth).
o Sebaceous glands- 2 types sebaceous and sweat (apocrine and eccrine).
Secrete sebum which empties into hair follicles. This waterproofs and lubricates
the skin to promote absorption of fat-soluble substances.
Present on all areas of skin except the palms and soles/dorsum of the feet.
Most abundant on face, scalp, upper chest and back.
Apocrine sweat gland found axillary, genital and breast.
Eccrine sweat glands found most of body except the lips, ear canals, nail bed,
labia minora, glans penis and prepuce. 1 sq in as 3000 sweat glands. Body can
produce 2 to 4 L to 12 L in 24 hours.
Functions of Integumentary System
• Main function of skin is to protect underlying tissues acting as a barrier to the external
environment like bacteria and viruses.
Gerontologic Considerations: Effects of Aging on the Integumentary System
• Chronic UV exposure= premature aging. Actinic complexion happens in light skin and eyes.
Premalignant skin lesions.
• Decrease of melanin causes hair color to fade with decrease in hair growth. Nail growth slows
and becomes brittle.
Assessment of Integumentary System
• Normal:
o Skin- even pigmentation, no petechiae, purpura lesions or excoriations Warm with good
turgor.
o Nails- Pink, oval, adhere to nail bed with 160- degree angle.
o Hair- shiny and full. Amount and distribution appropriate for age and gender. No flaking
of scalp, forehead or pinna.
Subjective Data
• Important health information to get from patient history o Medications- many can cause skin
side-effects. o Surgery or other treatments- like radiation therapy.
