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Case Study: A mans chest, arms, and forehead are badly burned. It's…

- - - - The patients chest, arms, & forehead
        
        Chest & abdomen are pale white w/little swelling
        
        Blisters covering both arms
  - - - Caught fire & exploded
        
        Burning oil all over him
- - - - Forehead
        
        Red & tender but not blistered
        
        Burn evaluation
        
        Rule of nines = 1 1/2% for this region
        
        Not considered critically burned in this region
        
        First-degree burn
      - Chest & abdomen
        
        Pale gray-white with little edema
        
        Burn evaluation
        
        Rule of nines: 9% for chest region & 9% for abdomen totaling 18%
        
        Considered critically burned in this region
        
        Third-degree burn
      - Both arms
        
        From shoulder -> fingers covered in blisters
        
        Burn evaluation
        
        Rule of nines = 18% for this region
        
        Not considered critically burned in this region
        
        Second-degree burn
  - - - Burn of the forehead
        
        Pain symptoms
        
        Redness
        
        Edema
        
        Pain
      - Burns of the arms & hands
        
        Pain symptoms
        
        Redness
        
        More painful
      - Burns of the chest & abdomen
        
        Pain symptoms
        
        Gray-white, possibly cherry red, or blackened in color
        
        Little edema
        
        No pain
        
        Due to destroyed nerve endings
      - Problems the patient is likely to face
        
        The patient has a total of 37.5% of their body covered in burns causing some Major Concerns
        
        Water balance / dehydration
        
        Much fluid is lost during a severe burn
        
        Due to the reason that part of the skins function is to keep fluids in the body
        
        When this occurs fluid can seep out causing electrolyte imbalance & dehydration
        
        Temperature regulation
        
        Possibility the eccrine sweat glands are gone
        
        Which regulates temperature
        
        Further, the patient may be at risk for hypothermia
        
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        Infection
        
        Being that the chemical, physical, & biological barriers are possibly exposed
        
        -> Leaves the body vulnerable to infection
        
        Ex: The acid mantle from the chemical barrier helps to keep an acidic environment as to prevent the growth of bacteria
        
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        Eccrine sweat glands are possibly gone
        
        Which carries antibacterial properties
        
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        Other possible outcomes
        
        The kidneys & GI tract could be affected also
        
        From the burns, the body can go into shock
        
        Making the blood vessels more permeable
        
        Leading to plasma leaking out of vessels into interstitial fluid
        
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- - - - Superficial Region: Epidermis
        
        Characteristics
        
        Composed of
        
        Epithelial cells
        
        Tissue type
        
        Stratified squamous epithelium
        
        Function
        
        To protect
        
        Layers of the epidermis
        
        Deepest strata basale (basal layer)
        
        Characteristics
        
        Attached to the the underlying dermis
        
        Along a wavy borderline
        
        Cell types
        
        Single row of stem cells
        
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        Keratinocytes
        
        10-15% Melanocytes
        
        Tactile epithelial cells
        
        Continual mitosis occurring
        
        When each divides, they get pushed up & fall off
        
        1) Outermost strata corneum (horny layer)
        
        Characteristics
        
        20-30 cells thick
        
        Accounts for 3 quarters of the epidermal thickness
        
        Function
        
        Glycolipid between cells -> Waterproof
        
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        Keratin & proteins outside the membrane protect the skin
        
        Maintain body temp
        
        Cell types
        
        Corneocytes
        
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        4) deeper strata spinosum (prickly layer)
        
        Characteristics
        
        Spiky in appearance -> spinelike extensions of its keratinocytes
        
        Cell types
        
        Several layers of keratinocytes
        
        Dendritic cells
        
        This layer begins to produce keratin (pre-keratin)
        
        3) strata granulosum (granular layer)
        
        Characteristics
        
        Cell types
        
        Consists of 1-5 layers of cells
        
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        Protein w/ keratinocytes & lipids
        
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        Keratin forms granules
        
        Keratohyaline granules
        
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        Lamellar granules
        
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        Grainy in appearance due to build up of proteins
        
        2) strata Lucidum (clear layer)
        
        Characteristics
        
        Function
        
        To serve as an extra layer of thick skin
        
        Cells types
        
        Dead & flattened keratinocytes
        
        Cells of the epidermis
        
        Melanocytes
        
        Function
        
        Spiter shaped cells that synthesize pigment
        
        Protects the nucleus from UV radiation
        
        Found: Deepest layer of epidermis
        
        Dendritic cells
        
        Function
        
        Star shaped cells that arise from bone marrow & migrate to the epidermis
        
        They are macrophages
        
        Ingest foreign substances
        
        Key activators in immune system
        
        Found: Extend among surrounding keratinocytes
        
        Keratinocytes
        
        Function
        
        Keep the water in
        
        A protein in cells that make them water proof
        
        Undergo continuous mitosis
        
        To produce keratin
        
        Found: Stratum basale
        
        Tactile epithelial cells
        
        Function
        
        Touch receptors
        
        Allows you to sense touch, pressure, temp, texture ect.
        
        Found: Epidermal-dermal junction
      - Deepest Region: AKA Subcutaneous Fascia
        
        AKA Hypodermis
        
        Tissues
        
        Subcutaneous tissue
        
        Not part of the skin
        
        But does shares skin's protective function
        
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        Stores fat
        
        Adipose tissue
        
        Areolar connective
        
        Characteristics
        
        Superficial to the connective tissue wrapping
        
        The subcutaneous tissue it contains
        
        Acts as a shock absorber & insulator
        
        Reducing heat loss
      - Deeper Region: Dermis
        
        Characteristics
        
        Composed of
        
        Mostly dense connective tissue
        
        Cell types
        
        Mast cells
        
        White blood cells
        
        Macrophages
        
        Fibroblasts
        
        Comprised of 2 layers
        
        Reticular dermis -> Underlying layer
        
        Major tissues
        
        Dense irregular connective
        
        Major structures
        
        Main layers of dermis
        
        Sweat glands
        
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        Nervous structures
        
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        Sebaceous glands
        
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        Dermal vascular plexus
        
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        Hair roots
        
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        Characteristics
        
        Cleavage lines
        
        Lines that run longitudinally in skin of the limbs
        
        Circular patterns around neck & trunk
        
        Flexure lines
        
        Permanent wrinkles on the palms
        
        Papillary dermis -> Uppermost layer
        
        Structure
        
        Dermal pailllae
        
        Finger-like projections
        
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        Other characteristics
        
        Dermal ridges
        
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        Major tissues
        
        Areolar connective
      - Functions of the integumentary system
        
        Blood reservoir
        
        Dermal vascular supply can hold 5% of the body's blood volume
        
        Ex: When the muscles need more blood
        
        The nervous system constricts the dermal vessels
        
        Constriction shunts more blood into the circulation making it available
        
        Metabolic functions
        
        "Skin is a chemical factory"
        
        Example
        
        1) Sunlight hits hits skin
        
        2) Cholesterol molecules -> converted into Vit D precursor
        
        3) Transported via blood to other areas -> converted into Vit D
        
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        Excretion
        
        N2 containing wastes (ammonia, urea, & uric acid) are eliminated in sweat, although most are excreted as urine
        
        Profuse sweating can lead to H2O & salt loss
        
        Body Temperature
        
        External temp
        
        Less than body temp
        
        Skin surface loses heat to air & cooler objects
        
        Dermal blood vessels constrict
        
        Allows skin temp to drop -> external environment
        
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        Below 31-32C (88-90F)
        
        Sweat glands secrete ~ 500mL of sweat per day
        
        Normal resting condition
        
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        When body temp rises
        
        Nervous system stimulates dermal blood vessels to dilate
        
        & sweat glands into vigorous activity
        
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        Protection
        
        Protects the internal from the external environment
        
        Consists of 3 types of barriers
        
        Chemical
        
        barriers
        
        Skin secretions
        
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        Melanin
        
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        Physical
        
        barriers
        
        Hardness of skins keratinized cells
        
        Structure of strata corneum
        
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        Biological
        
        barriers
        
        Dermal macrophages
        
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        Dendritic cells of epidermis
        
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        Cutaneous sensation
        
        Function: Classified as exteroceptors b/c they respond to stimuli outside body
        
        Examples
        
        Lamellar corpuscles
        
        Alert us to bumps or contacts involving pressure
        
        Hair follicle receptors
        
        Send report on wind blowing our hair
        
        Tactile corpuscles
        
        How we feel clothing against skin
        
        Free nerve endings
        
        Allow us to sense painful stimuli, extreme cold/heat, chemical ect.
      - Integumentary challenges that bring the body away from homeostasis
        
        Burns
        
        Def: tissue damage inflicted by
        
        Extreme heat
        
        Kill cells in affected area
        
        Results in
        
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        Radiation
        
        Electricity
        
        Chemicals
        
        Evaluating burns
        
        Second-degree burns (partial thickness burns)
        
        Area affected
        
        Epidermis
        
        Upper region of dermis
        
        Symptoms
        
        Mimic those of first-degree
        
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        Area red in color
        
        Painful
        
        Recovery time
        
        Skin regeneration occurs w/little or no scaring
        
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        Third-degree burns (full thickness burns)
        
        Area affected
        
        Entire thickness of skin
        
        Symptoms
        
        Burned area appears gray-white, cherry red, or blackened
        
        Initially there is little to no edema (swelling)
        
        Destroyed nerve endings
        
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        Fluid loss
        
        Infection
        
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        Recovery time
        
        Depends on severity
        
        First-degree burns (partial thickness burns)
        
        Area affected
        
        Only epidermis
        
        Symptoms
        
        Localized redness
        
        Swelling
        
        Pain
        
        Recovery time
        
        2-3 days w/out attention
        
        Ex: Sunburn
        
        Considered critically burned
        
        Over 10% of body has third-degree burns
        
        There are third-degree burns on
        
        Face
        
        Hands
        
        Feet
        
        Over 25% of body has second-degree burns
        
        Rule of nines
        
        Divides body into 11 areas
        
        Totals
        
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        These rules are approximate so special tables are often used
- - - - To replace lost proteins & allow for tissue repair
        
        Antibiotics play a role in treatment
        
        Possible skin graft is needed