Med-Surg - Integumentary System, part 1: Anatomy & Physiology Review
by Cathy Parkes January 31, 2023 Updated: August 10, 2023 4 min read
Full transcript and video captions coming soon!
Hi, I'm Cathy with Level Up RN. In this video, I will begin my coverage of the integumentary system. I will be talking about the structure and functions of the integumentary system as well as wound healing. And at the end of the video, I'm going to give you guys a little quiz to test your knowledge of some of the key points I'll be covering, so definitely stay tuned for that. And if you have our Level Up RN Medical/ Surgical Nursing flashcards, you can find the integumentary system all the way here in the back, so go ahead and pull out your cards and follow along with me.
Key components of the integumentary system include the skin, the hair, the nails, as well as glands, such as sweat glands and sebaceous glands. Key functions of the integumentary system include protection as well as temperature regulation, excretion, such as the excretion of sweat, sensory function, as well as vitamin D synthesis. It's important to understand the different layers of skin and tissue, particularly when we are talking about pressure injury staging as well as burns. So let's go over those layers now.
The top layer of skin is the epidermis. So epi means upon, so the epidermis is the layer that sits upon the dermis. The dermis is the next layer down. This layer contains connective tissue and appendages such as hair follicles, sweat glands, and sebaceous glands. And then under the dermis, we have the hypodermis or subcutaneous tissue. This layer contains adipose or fat tissue. Then under the hypodermis, we have muscle and tendon. And under that, we have bone.
Let's now do a review of wound healing. A wound can heal by primary intention, secondary intention, or tertiary intention. With primary intention, the wound is closed or approximated using staples, sutures, or possibly glue. With secondary intention, the wound is left open to heal through a process of granulation, contraction, and epithelialization. So an example where we might leave a wound open to heal by secondary intention includes a situation where we might have a lot of tissue loss such that we can not bring the edges of the wound together. And then with tertiary intention, we intentionally leave the wound open in order to debride necrotic tissue or to wait for inflammation to subside, and then we close it at a later time.
How fast a patient's wound will heal really depends on a number of factors. So things that can delay wound healing include older age, decreased immune function, impaired nutrition, particularly protein. So as a wound care nurse, when I am caring for a patient's wound, one of the first things I ask them is how they're eating, what is their nutrition like, are they getting enough protein. Protein is essential for wound healing. Other factors that can delay wound healing include impaired circulation, smoking, as well as diabetes.
In terms of the wound healing process, we have three phases. We have the inflammatory phase, the proliferative phase, and the maturation or remodeling phase. So during the inflammatory phase, we have hemostasis that occurs first. So we have vasoconstriction, the aggregation of platelets, and the formation of a clot. This is quickly followed by vasodilation, which allows white blood cells to come to the area to perform cleanup. Then we move into the proliferative phase. During this phase, we have three key processes that occur, which include epithelialization, granulation, and contraction. So for an open wound, the wound will fill up with granulation tissue, which consists of collagen. The wound edges will contract or get smaller. And with epithelialization, we will have the resurfacing of the wound with new skin cells. And then we have the maturation or remodeling phase. During this phase, the collagen that was produced during the proliferative phase is replaced with new, stronger collagen, and this can take over a year to occur.
All right, it's quiz time. I've got five questions for you this time. First question, what skin layer contains appendages such as hair follicles? The answer is the dermis. Question number two, what is the top layer of skin? The answer is the epidermis. Question number three, what type of tissue can be found in the hypodermis? The answer is adipose tissue. Question number four, with blank intention, a wound is left open to heal through the process of granulation, contraction, and epithelialization. The answer is secondary. And last question, what phase of wound healing includes the replacement of collagen with new stronger collagen? The answer is the remodeling or maturation phase.
All right, that's it for this video. I hope you have found it really helpful. Take care, and good luck with studying.
Let's now move on to a review of wound healing. So wounds can hear-- can hear? [laughter] They can hear everything you're doing at all times, so be careful.
And question number four, with blank intention, a wound is left open to heal through the process of granulation, contraction, and epithelialization. The answer is secondary. So that describes what [inaudible].
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