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Patient with major burns on both arms and chest (Physiology (Rule of Nines…
Patient with major burns on both arms and chest
Physiology
Integumentary system functions
How the integumentary helps keep homeostasis
Cutaneous sensation
Metabolic functions
Vitamin D3 and melanin are produced, giving skin a more tanned look
Body temperature regulation
Sweat glands release fluid onto skin, b body cools off by evaporation of sweat
Dilating blood vessels in dermis release heat
Constricting vessels conserve heat
When the body is hot
Sweat glands secrete water to cool the body
Tine blood vessels in the skin enlarged, permitting internal heat to escape
When the body is cold
Arterioles constrict to minimize heat loss
Blood reservoir
Protection of internal body structures
Main barrier to protect between internal organs and the outside world
Excretion of wastes
Sensory reception
Detect and relay pain, heat, cold, touch, pressure, vibration
Skin is a major sense organ
Serves as a communicator with the outside environment
Water balance
Water holding capacity, helps maintain the body's balance of fluid and electrolytes
Function of Nails
Fingerprints purpose
Provide your grip
Have many nerve endings in it to allow us to revive volumes of information about objects we touch
Use for protection and as a tool for precise activities
Function of Hair
Protection
Hair on the scalp guards the head
Guards against physical trauma, heat loss, and sunlight
Eyelashes shield the eyes
Nose hairs filter large particles like lint and insects from the air we inhale
Regulate body temperature
Facilitation of evaporation of perspiration
Hair also act as sense organs
Function of Skin
Functions of the 3 layers in the integumentary system
Function of Dermis
Temperature regulation
Dilating blood vessels release heat
Constricting vessels conserve heat
Sweat glands release fluid onto skin surface, body cools off by evocation of sweat
Sensory reception
Sensory receptors detect and relay pain, heat, cold, touch, pressure, vibration
Secretion and absorption
Sweat glands secrete sodium, watermand urea onto epidermal surface
Help maintain electrolyte homeostasis
Sebaceous glands secrete sebum, lubricates skin and hair
Helps make integument water resistant
Functions of epidemis
Immunity
Secretion and absorption
Metabolic regulation
Protection
Function of Subcutaneous (Hypodermis)
Provides thermal insulation
Pads and protects the body
Acts as energy reservoir
Extensive vascular network promotes rapid absorption so drugs are other injected into this layer
Function of sebaceous (oil) gland
Secretion of sebum
Keep skin supple and waterproof and hair soft
Forms part of the acid mantle to protect skin from microorganisms
Function of sweat (sudoriferous) glands
Eccrine (Merocrine) Sweat Gland Function
Work for thermoregulation
Regulated by sympathetic nervous system
Secrete sweat
99% water, salts, vitamin C, antibodies, dermcidin (microbe-killing peptide), metabolic wastes
Apocrine Sweat Glands
Begin functioning at puberty
Function unknot but may act as sexual scent gland
Rule of Nines
Arms (total of 9% for each arm)
Anterior part
Left arm
4.5%
Right arm
4.5%
Posterior part
Left arm
4.5%
Right arm
4.5%
Trunk (Toal of 36%)
Anterior par
18%
Posterior part
18%
Head and neck (total of 9%)
Anterior part
4.5%
Posterior part
4.5%
Legs (total of 18% for each leg)
Anterior part
Left Leg
9%
Right Leg
9%
Posterior part
Left Leg
9%
Right Leg
9%
Also used to help guid treatment decision such as fluid replacement
Perineum/genitals
Total of 1%
A method to calculate the percentage of the body that is burned
Divides the body into 11 areas, each accounting for 9%
The surrounding area of the genitals accounts for 1%
Burns are considered critical if
Over 10% of the body has third-degree burns
Over 25% of the body has second-degree burns
There are third-degree burns of the face, hands, or feet (facial burns introduce the possibility of burned respiratory passageways, which can swell and cause suffocation)
Upstream
Direct
Trauma
Indirect
Behavior
Not making proper decisions
Not wearing PPE (Personal protective equipment)
Not wearing a shirt
Upstream
Burned areas
Arms and hands
Second degree burn
Healing time
Skin regeneration occurs with little or no scarring within three to four weeks if care is taken to prevent infection
Signs/Symptoms
Swollen
Possibly white patches
Blistered
Extremely painful
Redness
Mimics the first-degree burns, but blisters also appears
Affects the dermis
Composed of connective tissue
Chest and abdomen
Third degree burn
Healing time
There isn't any set timeline for complete healing
Signs/Symptoms
Burned area is not painful
Due to lack of nerve ending have been destroyed
Little or no edema
Burned areas appear gray-white, cherry red, or blackened
Affects the subcutaneous tissue
Composed of adipose tissue
Cause additional complications to the body
Open wounds can lead to infection occurring
Without blood flow there isn't white blood cells
Without white blood cells it affects our immunity
Dehydration occurs
Causes electrolyte imbalance
Since the skin is affected it doesn't help keep water/fluids inside the body
Difficulty maintaining body temperature
The skin can't sent if it's too cold or too hot
Forehead
First degree burn
Healing time
Last two to three days without special attention
Signs/Symptoms
Swelling
Painful
Redness; non blistered skin
Dry skin
Peeling
Itching
Affects the epidermis
Compose of epithelium tissue
Anatomy
3 Types of burns
2nd degree burn
Symptoms of 2nd degree burns
Swollen
Possibly white patches
Blistered
Extremely painful
Redness
Mimics the first-degree burns, but blisters also appears
Skin regeneration occurs with little or no scarring within 3 to 4 weeks
Only if care is taken to prevent infection
Dermis is damage
Making up the bulk of the skin, is a tough, leathery layer
Composed mostly of dense connective tissue
Cause of 2nd degree burns
By contact with flames, hot liquids or chemicals
Examples of 2nd degree burns
Steam Iron Burn
Candle Wax Burn
Potato Gun Burn
Chemical Heat Pack
Scald Burn
Scalding with hot water
Sloughing
Hot Oil Burn
Friction Burn
3rd degree burn
Symptoms of 3rd degree burns
Burned area is not painful
Due to lack of nerve ending have been destroyed
Little or no edema
Burned areas appear gray-white, cherry red, or blackened
Examples of 3rd degree burns
Scalds
Chemical exposure
Flame Burns
Contact with a hot liquid/object
Electrical burns
Subcutaneous tissue is damage
Deep to the skin aka hypodermis; it's superficial to the connective tissue
Composed mostly of adipose tissue w/ some areolar connective tissue
1st degree burns
Epidermis is damaged
Outermost protective shield of the body
Composed of epithelial cells
Contains stratified squamous tissue
Symptoms of 1st degree burns
Swelling
Pain
Redness; non blistered skin
Last two to 3 days
Dry skin
Peeling
Itching
Examples of 1st degree burns
Sunburn
Brief contact with dry or moist heat
Regions integumentart system
Hair
Consist of dead, keratinized cells
Location
Over entire skin surfaces
Hair isn't on plans, soles, lips, nipples, and parts of the eternal genitalia (such as the head of the penis)
Structure of hair
Root
The part of the hair contained within the follicle, below the surface of the scalp
Shaft
The portion of hair that projects beyond the skin
Follicle
Tube-like depression or pocket in skin or scalp that contains the hair root
Cuticle
Outermost layer of hair, consisting of a single, overlapping layer of transparent, scale-like cells
Medulla
Innermost layer of the hair, composed of round cells; often absent in fine hair
Cortex
Middle layer of the hair; a fibrous protein core formed by elongated cells containing melanin pigment
Nails
Lateral nail fold
Folds of skin along right and left margins of nail plate
Nail plate
Visible portion of the nail plate
Nail root
Positioned deep to the eponuchium, anchors the nail plate to the underlying bed
Nail matrix
Most proximal part of the nail plate
Region of actively dividing cells
Nail cells are produced and pushed distally
Sweat (sudoriferous) Glands
Coiled, tubelike strutted located in the dermal and subcutaneous layer
The tubes open into pores on the skin surface
Excrete sweat, which cools the body surface
Two main types
Eccrine (merocrine) sweat glands
Abundant on palms, soles, and forehead
Apocrine (sweat glands)
Contain myoepithelial cells
Contract upon nervous system stimulation to force sweat into ducts
Confined to axillary and anogenital areas
Secrete viscous milky or yellowish sweat that contains fatty substances and protein
Bacteria break down sweat, leading to body odor
Are larger than eccrine sweat glands with ducts emptying into hair follicles
Contains modified apocrine glands
Ceruminous glands
lining of external ear canal; secrete crewmen (earwax)
Mammary glands
secrete milk
All skin surface except nipples and parts of external genitalia contain sweat glands
About 3 million per person
Skin
Specific tissue layers of the integumentary system
Dermis
Make up the bulk of the skin, is a tough, leathery layer composed mostly of dense connective tissue
Layers of the Dermis
Papillary Dermis
Superficial layer of areolar connective tissue
Consist of loose, interlacing collagen and elastic fibers and blood vessels
Loose fibers allow phagocytes to patrol for microorganisms
Sends fingerlike projections up into epidermis
Contain capillary loops, free nerve endings, and touch receptors
Has collectively ridges (friction ridges/fingerprints)
Contribute to sense of touch
Sweat pores in ridges leave unique fingerprint pattern
Enhance gripping ability
Reticular Dermis
Consist of course, dense fibrous connective tissue
Many elastic fibers provide stretch-recoil properties
Collagen fibers provide strength and resiliency
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Cutaneous plexus: network of blood vessels between reticular layer and hypodermis
Makes up 80% of dermal thickness
Extracellular matrice contains pockets of adipose cells
Flexure line
Layer are dermal folds at or near joints
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Cleavage (tension) lines
Used by many collagen fibers running parallel to skin surface
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Cells include fibroblast, macrophages, and occasionally mast cells and white blood cells
Contains nerves, blood vessels, and lymphatic vessels
Contains epidermal hair follicles, oil glands, and sweat glands
Subcutaneous (hypodermis) not part of skin
Lies just deep to the skin.. consist mostly of adipose tissue with some areolar connective tissue
Thermoregulatory Role
Adipose tissue surrounds and insulates, causing thermal regulation
Regulation of temperature by evaporation of fluid from skin
Consists of both areolar connective tissue and adipose connective tissue
Advantages/Disadvantage of Areolar Connective tissue
Advantage
Connects to layers for stability
Disadvantage
Not as strong as most other connective tissue
Epidermis
Layers of the Epidermis
Stratum Lucidum (Clear Layer)
Only in thick skin
Consists of thin, translucent band of 2-3 rows of clear, flat, dead keratinocytes
Lies superficial to stratum granulosum
Stratum Corneum (Horny Layer)
Three-Quarter of epidermal thickness
Dead cells function
Prevent water loss
Protects from abrasion and penetration
Protect deeper cells from the environment
Act as a barrier against biological, chemical, and physical assaults
20-30 rows of flat, anucleated, keratinized dead cells
Stratum Granulosum (Granular Layer)
Cells appearance change
Keratinization begains
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Cells accumulate lamellar granules, a water-resistant glycolipid that slows water loss
Cells flatten, nuclei and organelles disintegrated
4-6 cells thick, but cells are flattened; layer is thin
Cells above this layer die
Too far from dermal capillaries to survive
Stratum Spinosum (Princkly Layer)
Cells contain weblike systems of intermediate prekeratin filaments attached to desosomeees
Allow them to resist tension and pulling
Keratinocytes appear spikey
Several cell layers thick
Scattered among keratinocytes are abundant melanosomes and dendritic cells
Stem Cells of Stratum Basale (Basal Layer)
10-25% of layer also composed of melanocytes
Consists of a single row of stem cells that actively divide (mitotic), producing two daughter cells each time
One daughter cells goes from basal layer to surface, taking 25-45 days to reach surface
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Other daughter cell remains in stratum basal as stem cell
Layer also known as stratum germinativum because of active mitosis
Layer that is firmly attached to dermis
Deepest of all epidermal layers (base layer)
Cells of the Epidermis
Dendritic (Langerhans) Cells
Immune cells that fight off infection in epidermis
Star-shaped macrophages that patrol deep epidermis
Discs
Keratin
Extracellular lipids
Keratinocytes
Synthesized from keratin which is a protein that strengthens epidermis
Makes epidermis almost waterproof
Tightly connected by desmosomes
Millions slough off every day
Melanocytes
Produce and store pigment melanin in response to ultraviolet light exposure
Melanin is packaged into melanosomes
Tactile (Merkel) Cells
When compressed, release chemicals that stimulate sensory nerve ending, proving information about objects touching the skin
Composed mod epithelial cells, is the outermost protective shield of the body
Cells change through apoptosis (controlled cell death)
Dead cells slough off as dandruff and dander
Humans can shed 50,000 cells every minute
Thick/Thin Skin
Thick
On palms of hands , soles of feet
All five epidermal strata occur in thick skin
Ranges between 0.4mm and 0.6 mm thick
Houses sweat glands
Thin
Covers most of the body
Lacks a stratum lucidum
Contains hair follicles, sebaceous glands, sweat glands
Ranges from 0.75mm to 0.150mm thick
Sebaceous (Oil) Glands
Most develop from hair follicles and secrete into hair follicles
Relatively inactive until puberty
Stimulated by hormones, especially androgens
Widely distributed, except for thick skin of palms and soles
Secrete sebum
Oily holocrine secretion
Bactericidal (bacteria-killing) properties
Softens hair and skin
Three Pigments
Melanin
Occurs in variety of black, brown, tan, and yellow-brown shades
Melanin transferred in melanosomes from melanocytes to keratinocytes in stratum basal
Keratinocytes are displaced toward the stratum corner
Melanocyte activity affect color of entire epidermis(depends on individuals and race)
Packaged into melanosomes that are sent to shield DNA of keratinocytes from damaging UV sunlight
The more sun, the more need for protective shield, the more melanin will be produced
Pigment produced and stored in melanocytes
Amount determined by heredity and light exposure
Made from amino acid tyrosin by tyrosinase
Skin color differences are due to amount and form of melanin
Freckles and pigmented moles are local accumulations of melanin
Carotene
Most obvious in palms and soles
Accumulates in stratum corner and hypodermis
Yellow to orange pigment
Accquired from various yellow-orange vegetables (carrots, corn, squashes)
Can be converted to vitamin A for vision and epidermal health
May improve immune cell number and activity
Hemoglobin
Exhibits bright red color upon branding oxygen, giving blood vessels in dermis a reddish tint that is seen in lightly pigmented individuals
More red if superficial layers' blood vessels vasodilator
Oxygen-binding protein present in red blood cells
Pinkish hue of fair skin is due to lower levels of melanin
Skin of Caucasians is more transparent, so color of hemoglobin shows through
