At the end of the presentation, the students will be able to: 1.

Explain the implications of abnormal findings in relation to the functions of the integumentary system and its appendages 2. Identify different conditions that affect the skin and its appendages

The integumentary system is made up of the skin, hair and nails, making it the largest system within the human body. These features work to protect and maintain the body's internal structures and processes.

ASSESSING THE SKIN

The skin is an easily observed indicator of the peripheral circulation and perfusion, blood oxygen levels, and body temperature. Skin is assessed for: 1. Color - normal skin color is consistent with genetic background
In lightly pigmented individuals, skin normally has a pink color. In patients with deeply pigmented skin, changes in skin color may only be apparent in certain areas, such as the fingernail beds, the lips, the mucous membranes in the mouth, the underside of the arm and hand, and the conjunctiva of the eye.

2. Temperature - The normal temperature of skin is about 33 C or 91 F. Depends on air temperature and time spent in that environment.

3. Moisture - in general the skin neither feels too oily or too dry 4.Texture - skin texture is even, soft, smooth, and plump 5. Turgor - the resilience of the normal skin when subjected to physical distortion, such as by pinching or pressing. The relative speed with which the skin resumes its normal appearance after stretching or compression is an indicator of skin hydration. Turgor is slower in older people.

NORMAL FINDINGS AGAINST ABNORMAL FINDINGS

PARAMETERS SKIN NORMAL Depending on genetic background. Normally flesh toned ABNORMAL Jaundice RATIONALE can indicate biliary tract disease or a liver problem pale yellow skin can indicate a renal problem Can indicate excessive ETOH intake, fever, localized inflammation, or even embarrassment.

Pale yellow skin

A flushed, red face

Temperature

Warm

Generalized coolness Generalized warmth Localized coolness

Hypothermia or shock Fever or increased metabolic rate Poor circulation in the area (cast)

lesions PARAMETERS NORMAL ABNORMAL Localized warmth Moisture Neither too oily or too dry Diaphoresis Dryness RATIONALE Infection or small wound Anxiety, fever, chest pain may present as dehydrated lips, or as dry and cracked mucous membranes May cause acne  dehydration, edema, connective tissue disorder

oiliness Turgor-pinch a fold rises easily and returns of skin under the to place immediately clavicle or on the forearm so the top skin separates from the underlying structure. Texture
Lesions

skin does not immediately return to place but exhibits tenting

Skin may be very smooth, thin, and moist rough, scaly, dry, or thick

Red, scaly patches  smooth warm moist thin Thick, itchy, rough, scaly & pale

Indicate eczema Hyperthyroidism Hypothyroidism

Is formed from keratin and produce by matrix cells in the dermal layer. At the lower end of the hair shaft is the hair bulb that contains melanocytes which determines hair color. The hair on the head,
surrounded by a sheath of connective tissue, is anchored 4 mm down in the hypodermis.

Color - Hair color is the pigmentation of hair follicles due to

two types of melanin, eumelanin and pheomelanin. Generally, if more melanin is present, the color of the hair is darker; if less melanin is present, the hair is lighter. Pheomelanin colors hair red. Eumelanin, which has two subtypes of black or brown, determines the darkness of the hair color

Texture - hair maybe kinky, curly, wavy or straight. Within these groups there are three types of texture, course, medium and fine. Many of us fall under several or a combination of these three categories. Distribution - Hair grows everywhere on the body except for glaborous skin, such as that found on the soles of the hands and feet, lips, etc. Lesions are injuries on the scalp. Some forms which lesions can take include: Bumps, scabs, cuts, ulcerations, blisters, flakes or scales, sores, growths, or areas of discoloration on the scalp Abnormalities of the hair Hair Split Ends Trichoptlosis or split ends is a problem commonly faced by people with dry or very brittle hair. Split ends occur, when the protective layer of cuticle is removed from the tip of the strands. As a result, the hair splits into two or three strands, each two to three centimeters long, at its tips.

HAIR TRIVIA Average number of hairs on the head: 100,000 Red hair: 90,000 Black hair: 110,000 Blond hair: 140,000 Maximum length of hair: 70 to 90 cm Annual growth: 12 cm

. The nail covers and protects the last phalanges of the fingers and toes. Hard, flexible, translucent, smooth and shiny, continually growing, an average by 0.1 mm/day (4 times slower than the hair).

Shape, color and contour - The nail plate is normally

colorless and a convex curve . The angle between the nail and the nail bed is normally 160 degrees.

Consistency - The nail is a hard horny layer formed from flat

keratinized cells which are stuck together

Capillary refill is a quick test performed on the nail beds to

monitor dehydration and the amount of blood flow to tissue.

ABNORMAL CONDITIONS Nail abnormalities are problems with the color, shape, texture, or thickness of the fingernails or toenails

Clubbing is a condition in which the angle between the nail and the nail bed is 180 degrees or greater. Clubbing may be caused by a long-term lack of oxygen.
SCHAMROTHS TEST is a popular test for clubbing. When the distal phalanges (bones nearest the fingertips) of corresponding fingers of opposite hands are directly apposed (place fingernails of same finger on opposite hands against each other, nail to nail), a small diamond-shaped "window" is normally apparent between the nail beds. If this window is obliterated, the test is positive and clubbing is present

1. Beau's lines are depressions across the fingernail. These lines can occur after illness, injury to the nail, and when you are malnourished. 2. Brittle nails are often a normal result of aging. However, they also may be due to low levels of zinc and iron as well as thyroid problems. 3. Koilonychia is an abnormal shape of the fingernail. The nail has raised ridges and is thin and curved inward. This disorder is associated with iron deficiency anemia. 4. Leukonychia is white streaks or spots on the nails. Leukonychia can occur with arsenic poisoning, heart disease, renal failure, pneumonia, or hypoalbuminemia. 5. Fungus or yeast cause changes in the color, texture, and shape of the nails. A paronychia is an infection around the nail 6. Yellow nail syndrome is characterized by yellow nails that lack a cuticle, grow slowly, and are loose or detached (onycholysis). Yellow nail syndrome is most commonly associated with lung disorders, and with lymphedema.