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Integumentary System

Unit 11 Lesson 4

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Explain the function of the integumentary system
Describe care interventions for clients experiencing integumentary problems
Identify specific integumentary signs and symptoms that are reported to the nurse

Student Learning Outcomes

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The Integumentary System

Comprises skin, hair, nails, and glands
Main Functions

Protection against pathogens
Temperature regulation
Sensory reception
Vitamin D synthesis

Sandquist-Reuter, 2023

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Structure of the Skin

Epidermis

Outermost layer
Thin
Contains

Sweat gland openings
Hair shafts

Sandquist-Reuter, 2023

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Structure of the Skin continued…

Dermis

Middle layer
Thicker
Houses

Hair follicles
Sebaceous glands
Blood vessels
Sweat glands
Nerves

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Structure of the Skin continued…

Hypodermis

Deepest layer
Subcutaneous
Mainly adipose tissue
Provides insulation and cushioning

Sandquist-Reuter, 2023

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Role of Nursing Assistants

Daily observation during activities of daily living (ADLs)
Early detection of changes in skin condition
Impaired Skin Integrity

Examples: Pressure injuries, tears, ulcers
Impacts healing and increases infection risk

Sandquist-Reuter, 2023

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Critical Thinking Question

A resident has developed a small, red area on their lower back. What steps should the nurse's aide take to address this potential issue?

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Age-Related Changes in Skin

Adipose Tissue Reduction

Loss of insulation
Increased cold sensitivity

Decreased Gland Activity

Drier skin
Increased risk of cracking
Reduced sweat production affects temperature regulation

Sandquist-Reuter, 2023

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Age-Related Changes in Skin continued…

Increased Susceptibility

Higher risk for skin tears
Pressure injuries, bruising

Sandquist-Reuter, 2023

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Critical Thinking Question

Which of the following interventions would best help maintain skin integrity in an older adult resident?

A) Encouraging daily full body showers

B) Applying moisturizer regularly

C) Minimizing fluid intake to prevent swelling

D) Using powder to keep skin dry

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Skin Care Needs for Older Adults

Bathing Practices

Emphasize gentle, partial baths daily
Full body bathing weekly to preserve skin oils

Moisturizing and Repositioning

Regular moisturizing to prevent dryness
Reposition immobile clients every two hours to prevent pressure sores

Sandquist-Reuter, 2023

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Critical Thinking Question

An older adult resident with diabetes is experiencing dry skin, and a small cut is noticed on their foot. What actions should the nurse's aide take to ensure proper care?

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Chronic Conditions Affecting Skin Integrity

Impaired Circulation

Conditions like heart failure, diabetes, and high blood pressure
Reduced blood flow increases skin breakdown risk

Diabetes and Foot Care

Daily inspection for wounds, especially on feet
Nail care by Registered Nurses due to infection risk

Sandquist-Reuter, 2023

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Specific Care for Common Conditions continued…

Diabetic Foot Care

Inspect feet daily for wounds or changes
Report any concerns to the nurse for further evaluation

Managing Pressure Injuries

Use barrier creams to protect at-risk areas
Collaborate with the healthcare team for specialized wound care

Sandquist-Reuter, 2023

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Specific Care for Common Conditions continued…

Temperature Regulation

Assist residents in maintaining a comfortable room temperature
Dress residents appropriately for the weather to prevent heat-related issues

Sandquist-Reuter, 2023

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Preventing Pressure Injuries

Repositioning Techniques

Use of lift sheets to minimize friction and shear
Document repositioning schedules and skin assessments

Pressure Relieving Devices

Use pillows and foam wedges to relieve pressure on bony prominences

Sandquist-Reuter, 2023

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Critical Thinking Question

A resident is at risk for pressure injuries due to immobility. Which action should be prioritized to prevent these injuries?

A) Repositioning the resident every four hours

B) Placing a foam wedge under the knees

C) Using a lift sheet to reposition the resident

D) Massaging bony prominences to increase circulation

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Common Positions for Repositioning

Supine Position

Flat on the back
Use pillows for comfort
Float heels with a pillow under calves

Fowler’s Position

Head elevated
Used during feeding and respiratory distress
Prevent sliding with pillows under knees

Sandquist-Reuter, 2023

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Common Positions for Repositioning continued…

Lateral (Side-Lying) Position

Reduces pressure on coccyx
Supports blood flow
Use supports between knees and elbows

Sims’ Position

Left side only
Used for enemas and suppositories

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Common Positions for Repositioning continued…

Prone Position

Face down
Used less often
Supports respiratory function

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Repositioning Techniques

Use of Lift Sheets

Prevents friction and shear during movement
Ensure proper technique to protect the resident's skin

Regular Repositioning

Move immobile residents every two hours
Document repositioning and any observed skin changes

Sandquist-Reuter, 2023

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Repositioning Techniques continued…

Pressure Relieving Devices

Use pillows and foam wedges to alleviate pressure
Ensure devices are properly positioned to maximize comfort

Sandquist-Reuter, 2023

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Critical Thinking Question

During a routine check, the resident’s heels are red and warm. What is the best immediate intervention?

A) Apply ice to reduce the redness

B) Elevate the legs on a pillow

C) Apply a bandage to protect the area

D) Encourage the resident to walk frequently

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References

Sandquist-Reuter, M. (2023). Nursing Assistant. WisTech Open. https://wtcs.pressbooks.pub/nurseassist/

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