INTEGUMENTARY SYSTEM

By: Kelieraine U. Bon

ANATOMY AND PHYSIOLOGY
The integument is an organ, and is an
alternative name for skin.

Includes the skin and the skin
derivatives hair, nails, and glands.

The bodys largest organ and accounts
for 15% of body weight

THREE LAYERS:
Epidermis
is the thinner and more superficial layer of
the skin

The epidermis is made up of 4 cell types:

(A) Keratinocytes
(B) Melanocytes
(C) Langerhan Cells
(D) Merkel cells
Dermis
the deeper, thicker layer composed of
connective tissue, blood vessels, nerves,
glands and hair follicles


Hypodermis
subcutaneous
Adipose tissue which provides a
cushion between the skin layers,
muscles, and bones
FUNCTION:
Thermoregulation
Cutaneous sensation
Vitamin D production
Protection
Absorption & secretion
Wound healing
DEFINITION:
Burns are injuries to tissues
caused by heat, friction, electricity,
radiation, or chemicals.

Scalds from hot liquids and steam,
building fires and flammable
liquids and gases are the most
common causes of burns.
TYPES OF BURNS:
1.) Heat burns (thermal burns) are
caused by fire, steam, hot objects, or
hot liquids. Scald burns from hot
liquids are the most common burns to
children and older adults.

2.) Cold temperature burns are caused
by skin exposure to wet, windy, or cold
conditions.


3.) Electrical burns are caused by contact
with electrical sources or by lightning.

4.) Chemical burns are caused by contact
with household or industrial chemicals in
a liquid, solid, or gas form. Natural foods
such as chili peppers, which contain a
substance irritating to the skin, can cause
a burning sensation.

5.) Radiation burns are caused by the sun,
tanning booths, sunlamps, X-rays, or
radiation therapy for cancer treatment.


6.) Friction burns are caused by contact
with any hard surface such as roads
("road rash"), carpets, or gym floor
surfaces. They are usually both a
scrape (abrasion) and a heat burn.
HEAT BURN
COLD TEMPERATURE BURN
MANAGEMENT
Be sure to warm the whole body with blankets
as well as the cold injured parts.
Stay calm, find shelter, change to dry clothes,
keep moving, and drink warm fluids to prevent
further heat loss and slowly rewarm yourself.
If small areas of your body (ears, face, nose,
fingers, toes) are really cold or frozen,
try home treatment first aid to warm these
areas and prevent further injury to skin.
Warm small areas by blowing warm air on
them, tucking them inside your clothing, or
putting them in warm water.
MEDICINE:
Acetaminophen, such as Tylenol
Nonsteroidal anti-inflammatory drugs
(NSAIDs):
Ibuprofen, such as Advil or Motrin
Naproxen, such as Aleve or Naprosyn
Aspirin (also a nonsteroidal anti-
inflammatory drug), such as Bayer or
Bufferin

ELECTRICAL BURN
CHEMICAL BURN
MANAGEMENT
Prevent contaminated irrigation solution
from running onto unaffected skin.
Remove contaminated clothes.
Special situations:
-If contamination with metallic lithium,
sodium, potassium, or magnesium has
occurred, irrigation with water can result
in a chemical reaction that causes burns
to worsen. In these situations, the area
should be covered with mineral oil and the
metallic pieces should be removed with
forceps and placed in mineral oil. If forceps
are not available, soak the area with
mineral oil and cover it with gauze soaked
in mineral oil.

If contamination with white phosphorus
has occurred, thoroughly irrigate the
area with water then cover the area
with water-soaked gauze. Keep the area
moist at all times. The area can also be
covered with petroleum jelly.
If eye exposures have not been
irrigated, then this should be started
immediately. Immediate removal of
caustic substances in the eye is critical.

RADIATION BURNS
FRICTION BURNS
PHASE DURATION PRIORITIES
Emergent or
Immediate
Resuscitative
- From onset of injury to
completion
of fluid resuscitation
First aid
Prevention of shock
Prevention of
respiratory distress
Detection and
treatment of concomitant
injuries
Wound assessment and
initial care
Acute

- From beginning of
diuresis to near
completion of wound
closure
Wound care and
closure
Prevention or treatment
of complications,
including infection
Nutritional support
Rehabilitation

- From major wound
closure to return
to individuals optimal
level of physical
and psychosocial
adjustment
Prevention of scars and
contractures
Physical, occupational,
and vocational
rehabilitation
Functional and
cosmetic reconstruction
Psychosocial
counseling






EMERGENT/RESUSCITATIVE PHASE:
Cool the wound
Establish airway
Supply oxygen
Insert at least 1 large bore IV line
Assess pulse
Monitor blood pressure
Extinguish the flames
Remove restrictive objects
Cover the wound
Irrigate chemical burn

ACUTE OR INTERMEDIATE PHASE
Infection prevention
Wound cleaning
Wound dressing
Wound debridement

*Grafting
Autograft
Homograft
Heterograft

MANAGEMENT:
Circulation
The nurse assesses the graft area for
signs of adequate blood supply. She
inspects the color of the graft area,
which should be the same color as the
other skin on the patients body to see if
it has enough blood supply. The nurse
also checks to make sure the graft area
is warm as this indicates sufficient
blood supply to the area.

Drainage
The nurse checks the patency of drains
placed in the graft area. She makes
sure they are not blocked, so drainage
can flow out of the graft site instead of
accumulating in it and potentially
causing an infection.

Positioning
The nurse ensures blood circulation to
the graft area by positioning the patient
off the graft. Taking pressure off the
graft and skin surrounding it reduces
the risk of decreased blood supply to
the area.

Low Pressure

The nurse may place the patient on a
low pressure bed when lying down or
low pressure cushion for sitting down.
The less pressure exerted on the graft
area, the more likely that it will be
adequately perfused. Low pressure beds
and cushions exert low pressure on the
skin.

COMPLICATIONS:
Failure of the skin graft is often due to:
Inadequate excision of the wound bed.
Inadequate vascular supply to the
wound bed.
Hematomas and seromas. These form
a barrier between the bed and skin graft
and prevent the graft from taking.
Shearing or displacement of the
graft. This prevents revascularisation of
the graft as the capillaries cannot link
up.

Infection. This can lead to disintegration of
the graft or excessive exudate that prevents
the graft from adhering to the bed (Beldon,
2003).
Late complications relate to the appearance
and function of the graft. The colour and
texture of a healed graft will contrast with the
surrounding skin and, usually, there is some
depression of the wound. Hyperpigmentation
of the graft can also be a problem (Young and
Fowler, 1998).
Contraction is the main functional problem
and can result in joint contracture and
restriction of function in the surrounding
tissue.

CLASSIFICATION OF BURNS
First-Degree
(Minor)
The burned area is painful. The
outer skin is
reddened. Slight swelling is
present.
Second-Degree
(Moderate)
The burned area is painful. The
underskin is affected.
Blisters may form. The area may
have a wet, shiny
appearance because of exposed
tissue.
Third-Degree
(Critical)
The burned area is insensitive
due to the destruction
of nerve endings. Skin is
destroyed. Muscle tissues
and bone underneath may be
damaged. The area
may be charred, white, or
grayish in color.
RULE OF NINES
A method for rapidly assessing
the extent of burns on the skin
surface, which determines the
amount of fluid required as
replacement therapy

LUND AND BROWDER METHOD
- a method for estimating the
extent of burns that allows for the
varying proportion of body
surface in persons of different
ages.
RULE OF PALM
Quick prehospital assessment used to
estimate the extent of burns.
The patients palm not including the
surface area of the digits, is
approximately 1% of the TBSA.
The patients palm without the fingers
is equivalent to 0.5% TBSA and serves
aas a general measurement for all age
groups.
FLUID REPLACEMENT:
Formula:
2-4ml x kg body weight x % TBSA
burned

Half to be given in first 8 hours
remaining half to be given over next 16
hours
LOCAL AND SYSTEMIC
RESPONSES TO BURNS
Hypovolemia
Burn edema
Pulmonary injuries
Altered renal function
Altered immunologic defenses

EFFECTS ON FLUIDS AND
ELECTROLYTES
Results to:

Hyponatremia

Hyperkalemia

Anemia

MANAGEMENT FOR MINOR
BURNS
Cool the burn

Cover the burn with a sterile
gauze bandage

Take an over-the-counter pain
reliever

CAUTION:
Don't use ice.

Don't apply egg whites, butter or
ointments to the burn.

Don't break blisters.

FOR MAJOR BURNS:
Don't remove burned clothing.
Don't immerse large severe burns
in cold water.
Check for signs of circulation
(breathing, coughing or
movement).
Elevate the burned body part or
parts.
Cover the area of the burn.

MEDICAL MANAGEMENT:
Transfer to a burn center.

Manage fluid loss and shock.

Fluid replacement therapy.
NURSING MANAGEMENT:
Assess the patients burn injury.
Aseptic management of the burn
wounds.
Monitor vital signs.
Inserting of indwelling urinary
catheter.
Administering and monitoring
intravenous therapy.
Neurologic assessment

COMPLICATIONS OF BURNS
Shock
Heart attack
Formation of scars