Deck 53: Integumentary System Function, Assessment, and Therapeutic Measures

Question 1

Evans
Mr. Evans comes to the doctor's office with atrophic skin (thin, shiny, pink, with visible vessels) at the area of psoriasis where he is applying his corticosteroid ointment. He says that he has been applying a thick layer of ointment four times a day.
1. What should you teach Mr. Evans about his treatment?
2. What should you include when you document his skin condition?

Answer 1

1)
The symptoms of Mr. Evans (pink, shiny skin with visible vessels) indicate the sensitivity of the skin towards the medication applied. The steroid medications cause thinning of the skin when applied in high doses or at more frequent intervals. Usually, the corticosteroid ointments are applied two times a day. So, Mr. Evans must be advised to apply a thin layer of ointment twice daily.
2)The size of lesion, location, colour and distribution of lesions are recorded, while describing what is exactly seen in the patient. Judgement by personal opinion must be avoided.

Question 2

Explain the normal structures and functions of the integumentary system.

Answer 2

Skin, in association with its accessory structures and subcutaneous tissue consists of the "integumentary system." This system protects the internal organs from the external environment and hazards. This system also helps to maintain the body temperature by resisting loss of temperature. The accessory structure of skin includes the receptors, glands, hair and nails.
The three layers of skin are,
1. Epidermis
2. Dermis
3. Hypodermis
Epidermis is the outermost layer of the skin made of stratified squamous epithelial tissue. It does not contain blood vessels, and the dermal layer supplies oxygen and nutrients by means of diffusion.
The layer of skin arranged in between the epidermis and hypodermis (subcutaneous tissue) is known as dermis. Dermis contains the roots of hair cells, sweat glands, sebaceous glands, blood vessels and receptors of mechanical stimuli. The dermis consists of two regions,
1. Papillary region (made of loose areolar connective tissue)2. Reticular region (made of dense irregular connective tissue)The major function of dermis is to cushion the body from mechanical stress and also provide elastic nature to the skin, the presence of sensory receptors also provide the sense of touch and heat.
Hypodermis is the connective tissue present beneath the skin and is made of adipose and areolar (loose connective tissue). This layer insulate the body to prevent the loss of heat an also act as an energy reservoir in the form of adipose tissue.
Hair found in the eyelashes, eyebrows and nostrils prevent the entry of dust into the eyes and nose. Hair on the head provides protection and thermal insulation for the head.
Nails undergo continuous mitosis, and they protect the finger tips from mechanical injury and are also helpful in picking up small objects.
Cutaneous receptors (of the skin) are a type of general sensory receptors that include the following.
• Naked nerve endings of the sensory neurons, which respond to pain and temperature.
• Meissener's corpuscles or tactile corpuscles are present in the dermal papillae of the hairless skin, they respond to the light touch.
• Ruffini's corpuscles respond to deep cutaneous pressure.
• Pacinian corpuscles or lamellated corpuscles are located deep in the dermis, and they respond to the deep pressure stimulus.
• Hair follicle receptors respond to the hair movement and light touch.
The dermis of the skin contains the exocrine glands, which release their secretions onto the skin surface. These glands include the eccrine and apocrine glands (sudoriferous glands), sebaceous glands, ciliary glands and ceruminous glands (secrete cerumen).

Question 3

When is the best time for the nurse to apply prescribed ointment to a patient with an inflamed skin rash?
1) In the morning before the patient dresses
2) When the patient will be resting for at least an hour
3) After the patient bathes
4) In the evening before bed

Answer 3

Many of the infectious diseases, allergic reactions, ulcers and traumatic lesions of the skin need the topical application of medications.
The dosage forms of topical medications include the ointments, gels, lotions, pasts, sprays, powders and creams. These topical medications (including ointments) are applied after cleaning the affected area, or after bath.
Thus, the options 1, 2, and 4 are incorrect.
Ointments are applied after cleaning the target area or after bath.
Thus, the correct option is .

Question 4

Identify the effects of aging on the integumentary system.

Question 5

Which nursing interventions are essential to achieve maximum benefit for the patient receiving balneotherapy for widespread dermatitis? Select all that apply.
1) Maintain the bath water at the hottest temperature tolerated by the patient.
2) Keep the patient in the water for 15 to 30 minutes.
3) Keep the tub room warm.
4) Dry the skin vigorously following the bath.
5) Use gentle or emollient soaps.

Question 6

List data to collect when caring for a patient with an integumentary system disorder.

Question 7

Which term should the nurse use to document a raised, fluid-filled lesion smaller than 1 cm?
1) Macule
2) Papule
3) Vesicle
4) Wheal

Question 8

Identify laboratory and diagnostic tests commonly performed to diagnose integumentary disorders.

Question 9

What equipment is most important to have readily available when a patient is undergoing skin testing for allergies?
1) Resuscitation equipment
2) Flashlight
3) Measuring device
4) Alcohol and cotton swabs

Question 10

Describe therapeutic measures that are used for patients with integumentary disorders.

Question 11

Which nursing intervention is essential to protecting the patient's skin integrity when applying occlusive dressings?
1) Make sure all skin surfaces are covered.
2) Remove the dressings for 12 of every 24 hours.
3) Apply a thick layer of prescribed ointment before applying the dressings.
4) Apply a gauze dressing next to the skin, underneath the plastic film.