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Chapter 4: Integumentary System

Annie Burke-Doe; Rolando Lazaro

CLINICAL APPLICATION OF FOUNDATIONAL SCIENCES

The integumentary system is the largest organ in the body and is important to our survival in many ways. The skin is a membranous barrier between our internal system and the environment, and responds to external and internal changes. Examination requires understanding of the structures and function of the system. Understanding of healthy and disease states of skin, hair, nails, mucous membranes, circulation, and sensory structures is essential to examination.

The integumentary system has two major components, the cutaneous membrane (skin), and accessory structures (Figure 4–1). The skin is divided into three layers: the epidermis, the dermis, and subcutaneous tissue. The accessory structures include the hair, nails, vascular supply, sweat glands, and sebaceous glands. The skin is the site of many complex and dynamic processes, which include being a protective barrier, having immunologic functions for first-line defenses, and functions of melanin production, vitamin D synthesis, sensation, temperature regulation, protection from trauma, and aesthetics.1

FIGURE 4–1

Anatomy of the skin. (From Hamm RL. Text and Atlas of Wound Diagnosis and Treatment. Copyright © McGraw-Hill Education. All rights reserved.)

An illustration shows the anatomy of the skin.
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High-Yield Terms to Learn
Capillary refill

Press down on one of the patient’s nails until it pales. Release the nail and observe for the pink color to return. The normal color should return in less than 3 seconds.

Note: Capillary refill can be affected by room and body temperature, vasoconstriction from smoking, or peripheral edema.
Clubbing

Normal concave nail bases will create a small, diamond-shaped space when the nails of the index fingers of each hand are placed together. Clubbed fingers are convex at the bases and will touch without leaving a space.

Note: Finger clubbing, a sign of chronic tissue hypoxia, occurs when the angle between the fingernail and where the nail enters the skin increases.
Cyanosis

Dark bluish or purplish discoloration of the integument and mucous membranes.

Note: May indicate hypoxia or hematologic pathology.
Hyperthermia

Increased temperature.

Note: May indicate localized or systemic infection, inflammation, thermal injury; hyperthyroidism or fever is generalized.
Hypothermia

Decreased temperature.

Note: May indicate arterial insufficiency or shock.
Jaundice

Yellowish discoloration of skin and sclera.

Note: May indicate liver disease or hemolytic pathology.
Tzanck smear Scraping of an ulcer base to look for Tzanck cells (acantholytic cells). It is sometimes also called the chickenpox skin test or the herpes skin test.
Dermatitis Inflammation of the skin.
Total body surface area Used to estimate the total fluid and caloric requirements, and is a predictor of mortality.
Hypertrophic scar A raised scar that stays within the boundaries of the burn wound; characteristically red, raised, firm.
Keloid scar A raised scar that extends beyond the boundaries of the original burn wound; red, raised, firm.
Pruritus Itching.
Exudate Also known as drainage, exudate is a ...

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