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 muscles to constrict, increasing blood flow to warm the surface of the skin.
C.When external temperature drops, enzyme levels also drop and the hypothalamus triggers the body to release epinephrine, which constricts blood vessels, increasing blood flow that warms the skin.
D.As temperatures drop, the body causes the hair on the scalp and arms to stand up, triggering nerves in the skin to constrict, creating a more solid barrier against the cold.
Answer: A. Constriction of blood vessels in the second skin layer reduces amount of blood that reaches the epidermis, serving to conserve body heat.
Learning Objective: 3
3.How does the dermis differ from the epidermis?
A.The dermis is composed of five layers that offer different functions in addition to protection against bacteria.
B.The epidermis consists of a reticular and papillary layer, while the dermis contains five distinct layers responsible for immunity.
C.The dermis is considered the second layer of skin beneath the epidermis and is where the keratinocytes and the melanocytes are manufactured.
D.The epidermis is defined as the uppermost layer of the skin and is composed of five layers, while the dermis is defined as the second layer of skin and is composed of two distinct layers.
Answer: D. The epidermis is composed of five layers; the Stratum corneum, the Stratum lucidum, the Stratum granulosum, the Stratum spinosum, and the Stratum basale. The dermis consists of two distinct layers; the reticular and the papillary layers.
Learning Objective: 2
4.In which basic ways does the integumentary system influence other body systems?
A.The skin aids in balance of electrolytes, provides barriers against infection, helps regulate body temperature, and conserves or evaporates body fluids.
B.Skin is involved in filtration of vitamins A and D, homeostasis, and serves as the foundation for hair growth, which helps the body stay warm and protects it from UV rays.
C.The basic role of the skin is to produce heat in order to maintain body temperature at 98.6°F. This function is regulated by the pituitary gland and ensures that regardless of environmental temperature changes, the body maintains optimal body heat.
D.All of the above.
Answer: A. The integumentary system, though constantly challenged by environmental and physical challenges, provides the body with its first line of defense that protects internal environment. This includes body temperature, fluid balances, immune system support, and more.
Learning Objective: 4
■References
| 1. | Elaine Marieb and Katja Hoehn, Human Anatomy and Physiology. 10th ed. (San Francisco, CA: Pearson, 2016), 150 p. | ||
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