side of the melanoma might be larger than the other.
•Border irregularities – a melanoma, unlike most freckles, is not round or rather consistent in shape. Its borders can look jagged or irregular.
•Color – a melanoma is a spot of pigmentation that can contain a variety of colors; dark brown, black, tan, and even a bluish or reddish tinge. Changes in color or tone are often noticeable.
•Diameter – most freckles and moles are not large, but the diameter of a melanoma is often measured by equating its diameter in millimeters to that of a pencil eraser. If the spot is larger than 6 mm, or larger than the average pencil, it may be a melanoma. Get it checked.
Another thing to watch for is changes in the size or shape of the spot. If it changes shape, grows, or seems to be evolving, this may also be a prime indication of melanoma.
The American Cancer Society recommends that we all take the time to regularly check our skin for any new appearance of moles, freckles, or spots, summer and winter.
Burns
Burns are another common skin threat that can leave the body vulnerable to multiple types of infection as well as limited mobility. Damage caused by burns is typically measured as:
•First – degree: Defining damage only to the epidermis. This is typical with sunburns that cause redness, tenderness, and some swelling. In most cases, a first-degree burn will heal within a few days.
•Second – degree: This type of burn damages not only the epidermis, but the upper layer of the dermis. Signs and symptoms are similar to that of first-degree burns (redness, pain, swelling), but also with the appearance of fluid-filled blisters. In most cases, the body heals from second-degree burns with little scarring within four weeks, as long as the individual takes care to protect the area from infection.
•Third – degree: The most severe degree of burn, a third-degree burn is also known as a full-thickness burn. It impacts all thicknesses of the skin. It can take a long while for such severe burns to heal, during which time the individual is vulnerable to infection as well as fluid loss. In such cases, skin grafting is a common option.
Figure 3-17 Burns measured in degrees.
Another common cause of declining skin condition is caused by general aging processes.
Aging skin
Another common skin threat is general aging.
As we age, replacement of epidermal cells slows down. Hormone levels decrease. The skin grows thinner and is more susceptible to injury, damage, or bruising.
Endogenous lubrication of the skin due to declining hormone levels or even nutrition often declines and the skin becomes less elastic. Levels of collagen fibers decline and the skin grows stiffer and sags. Even fibers of elastin tend to clump together. For many, a diminishing subcutaneous fat layer not only changes the volume of the skin, but can leave an older individual vulnerable to drastic changes in temperature.
Lack of elasticity and subcutaneous (adipose) tissue contributes to the appearance of wrinkles. Hair begins to thin because hair follicles don’t replenish as frequently as they did during our younger years, contributing not only to male pattern baldness, but graying hair.
The good news is that through proper nutrition, skin protection, and resisting over exposure to UVA and UVB sunrays promotes fewer wrinkles and those dreaded “liver spots” often associated with old age.
■Conclusion
Hundreds, if not thousands of skin conditions have been identified, some mild and easily treatable, others more serious and sometimes life-threatening. Nutrition, adequate sunlight, and environment plays a role in the health and wellness of the integumentary system. Patient education plays a vital role for all age groups when it comes to skin health and wellness, maintaining the integrity of the skin, and avoiding issues.
Figure 3-18 Aging skin process.
The integumentary system not only provides cushioning and acts as a first barrier of defense for the body, but plays an important role in the health and wellness of internal body organs and systemic activities. By understanding the structures of skin and their associated functions, healthcare professionals are more readily able to able to identify changes in the skin associated with a number of illnesses, disease processes, as well as physiological aging processes.
Case Study Conclusion
The elderly burn patient is carefully monitored during her first 24 hours in the burn unit, where the primary focus is to replace fluid and maintain blood volume and reduce edema. For the next 24 to 72 hours, nurses and ancillary support staff in the burn unit regularly assess her urine, electrolytes, and serum levels until blood volume has been stabilized. Nursing staff also monitors for indications of pulmonary edema or water intoxication.
At this stage of treatment, focus has been on maintaining adequate ventilation, reducing risk of infection, providing pain relief, and monitoring body temperature.
Within 48 hours, adequate fluid resuscitation has been achieved, as well as stabilization of PO2 and PCO2 levels. The patient has adequate urine output, electrolytes are within normal limits, and pH stabilized.
Tissue edema and fluid weight gain is minimal and the patient exhibits no signs of pulmonary edema.
Only after the patient has been fully stabilized will actual wound care begin. The patient’s burns are treated but the elderly woman’s journey toward recovery will be extensive. Collaborative care management is achieved via a multi-disciplinary team of surgeons, nurses, physical and occupational therapists, and psychologists, as well as other support personnel.
Within the next three days to three weeks, the patient will undergo skin grafting procedures to accelerate healing processes, to reduce potential for contracture, and shorten overall convalescent time.
■Questions
1.Identify the five layers of the epidermis.
A.Stratum corneum, Stratum lucidem, melanocytes, Langerhans cells, and the hypodermis.
B.Stratum corneum, Stratum granulosum, Stratum spinosum, Stratum basale, Stratum lucidem.
C.Corneul, gramulosa, Stratum lucido, keratinocytes, and Stratum reticula.
D.Stratum corneum, Stratum lucidem, Stratum granulosum, Stratum reticular, and Stratum lamellar.
Answer: B. In order from outermost to innermost; Stratum corneum, Stratum lucidum, Stratum granulosum, Stratum spinosum, and Stratum basale.
Learning Objective: 1
2.Describe how the skin reacts to colder temperatures and how that function warms the body.
A.When external temperature drops, blood vessels in the dermis contract. This keeps blood away from the skin’s surface and reduces passive heat loss and conserves body heat.
B.When temperature drops, the parasympathetic nervous system triggers the body’s
