Wound management is one of the cornerstones for nursing care however, effective wound care extends far beyond the application of the wound itself. Nurses may be required to assess, plan, implement, and evaluate wound care; therefore, order to fill these roles it’s critical to have an understanding of the several different areas of wound care such as, integumentary system, classification of wounds, wound procedures, and documentation. Knowledge in each of these areas will allow nurses to make well informed decisions about wound care, and as a result play an active part in wound healing.
Integumentary System
The integumentary system or skin is our body’s largest organ, which weighs 20 pounds or more, accounting for about 16% of total body weight (Thibodeau, 2014, p.93). According to Thibodeau (2014 p. 145) the: number of structures fitting into 1 square inch of skin: 500 sweat glands; more than 1000 nerve endings; yards of tiny blood vessels; nearly 100 sebaceous glands; 150 sensors for pressure, 75 for hot, 10 for cold; and millions of cells.
The integumentary system can be broken down into three main categories the Epidermis, Dermis, and Subcutaneous layer each of which contain certain specialized skin derivatives including hair, nails, and several kinds of glands.
The outer most layer of the skin or Epidermis contains stratified squamous, keratinized, epithelial tissue; which lacks blood vessels, and the cells are packed closely together (Sloane, 1994, p.85)
The
The Dermis is separated by two main layers called the superficial layer and the deep layer. The superficial layer consists of looser areolar connective tissue and the deep layer consists of dense irregular connective tissue. Dermal cells have four main cells types called fibroblast cells, macrophage cells, adipocyte cells, and mast cells. The most interesting cell to me are the mast cells. Mast cells release two chemicals called Histamine and heparin. Histamine increases blood flow that relaxes smooth muscle. Heparin is a blood thinner that increases capillary diffusion. (Tabor)
Carville (2012, p 8) defined epidermis as ‘the outer layer of the skin and is comprised of stratified, squamous epithelial cells or keratinocytes’. Epidermis have also various layers that are divided into 4 or 5 layers, stratum germinativum, stratum spinosum, stratum granulosum, stratum lucidum and stratum corneum, respectively. The first layer of epidermis is the stratum corneum, which is also known as a horny layer. The other layer is stratum lucidum, however this is mostly found in a thicker part of epidermis, such as soles of the feet and palms. The middles layer is the stratum granulosum, which is also known as the granular layer. According to Carville (2012, p 9), it is comprised of one to five cells thick of granular cells that contain keratin and shrivelled nuclei’. The next layer after the stratum granulosum is the stratum spinosum, otherwise known as the prickly layer. ‘The stratum spinosum is made up of several layers of polyhedral shaped cells, which have large oval nuclei’ (Carville 2012, p 9). The last layer of epidermis is the stratum germinativum or commonly known as basal layer. This is a layer where basal cells or keratinocytes develop. In comparison to epidermis, dermis have also layers, these are papillary layer, which is composed of loose connective tissue, and reticular layer, which is mostly composed of dense connective
Wound care is a tough field to specialize in nursing for so many reasons. One, you cannot do treatments alone. So today, together with Apsara, the wound care nurse, we assisted the doctor while he was doing debridement to patients. The doctor explained the importance of wound debridement to remove necrotic tissue and allow the wound to heal and granulate. The doctor further explained to the nurses that to attain proper healing of the wounds, adequate circulation should be present and the right nutrition should be given. To do this, patients should be turned, their feet should be off loaded and they should be assisted during feeding to encourage good nutrition. These are the things I learned today that would help me as a nurse to be care for
The Integumentary system additionally referred to as the integument (The skin) is the biggest organ in the body. It has a surface territory of around two Square meters, varies in thickness and incorporates hair and nails. There are two parts to the integument the cutaneous membrane which is the skin and the accessory structures which all originate from within the dermis.(Anderson, 2012, p.3)The structure of the integumentary system is comprised of different layers the epidermis, dermis and subcutaneous layer. The epidermis is the external layer of the skin and is comprised of epithelial cells. The epidermis does not have vessels so it is called avascular. Inside the epidermis are four cell types, Keratinocytes cells give defensive
Tissues are defined as groups of cells with a common structure and function. However, there are four different main categories in the human body: epithelial tissue, connective tissue, muscle tissue, and nervous tissue. Even within the four main categories, there are different types of cells assembled in a different formation. For example, the cells in the epithelial tissue are joined closely together with little material in between them. There are different types of epithelium tissues, including the simple epithelium and stratified epithelium. A simple epithelium has a single layer of cells and a stratified epithelium has multiple layers of cells. Just within the epithetical tissue, the cells connect to each other in a different structure
The skin is the largest organ of the body; although, it is only a few millimeters thick. It helps to protect the body from chemicals, ultraviolent light, disease, and physical damage. The epidermis is the outer layer of skin that covers almost the entire body. This layer lies above, and protects the dermis, which is the inner layer of the skin. The epidermis does not contain blood or blood vessels; however, the dermis does. There
The skin is made up of two layers: the epidermis and the dermis. The epidermis consists of keratinocytes, melanocytes, dendritic cells, and tactile cells (Marieb & Hoehn 153). The epidermis consists of four to five layers, including stratum basale, stratum spinosum, stratum granulosum, stratum lucidum, and stratum corneum. The deepest layer, stratum basale lies on top of the dermis and contains mitotic cells that help repair the skin when it is damaged (Marieb & Koehn 153). Stratum spinosum is the house for Langerhan’s cells, and can be characterized as the “prickly layer” on top of the stratum basale (Poonawalla & Diven). Stratum granulosum is where keratinization begins, and the cells will flatten and the organelles will die (Marieb & Koehn 153). The next layer is the stratum lucidum, which is only in thick skin. The most superficial layer of the epidermis is the stratum corneum, and it is made up 20-30 dead cell layers that help give the skin its protective function (Marieb & Koehn 154). The epidermis is avascular, meaning this layer contains no blood vessels. Each epidermal layer has its function and they work together when repair is needed and they protects the underlying dermis structures.
The epidermis is the external layer of the skin, mainly composed of keratinized stratified squamous epithelial. Epidermis is made up of keratinocytes (90%); melanocytes (8%) and the other (2%) represent Langerhans cells, Merkel cells and immunologically active cells derived from bone marrow (Kolarsick et al., 2011). Next to the epidermis is the dermis, which is composed of connective tissues (collagen and elastic fibres), blood vessels, sensory nerve endings, sebaceous glands, sweat glands, extracellular matrix (ECM), hair follicles and cells like dermal dendritic cells, fibroblasts, mast cells and macrophages. The dermis provides nutrition and support to the epidermis (Burr and Penzer, 2005). The last layer that separate the skin from internal parts of the body is called subcutaneous layer which is primarily composed of adipose tissue that acts to regulate body temperature in addition to its involvement in sensory and protective functions (James et al., 2006;
Human skin has three layers: epidermis, dermis and hypodermis. Each layer has a unique role in protecting the body and maintaining the functions that are more than skin deep. Of the three layers, only the epidermis is usually seen. This is the outer layer of skin that protects the inner functions of the body from dirt, dust, damage and germs. The next level down, the dermis, is where hair follicles, sweat glands and very tough connective tissue are found. The hypodermis is where
The integument is the largest organ in the human body. It consists of the skin (epidermis and dermis) and associated appendages (hairs, nails, sweat and sebaceous glands) (Venus et al. 2011).
Wounds can be the result of a whole range of afflictions. Going in for a surgery, falling and scraping your leg, or even the accidental handling of a sheet of paper or a knife. (burns, cuts, scrapes?SPLINTER, pressure ulcers) They can be severe and result in an alteration of lifestyle, or they can be nominal and quickly forgotten. Walburn classifies four types of wounds those resulting from; “planned interventions, trauma, pathological changes in the body, and pressure wounds” Some wounds have different degrees of severity and require different interventions. Yang & Glaser describe the four well-known stages of wound healing “clot-formation, inflammation, proliferation, and
The integumentary system mainly uses two tissues of the skin, which are the dermis and epidermis.
Skin is the largest organ of the body. It is about 20 feet long when you talk about it covering the entire body. The function of the skin is to cover and protect us from microbes and elements it also helps regulate our body’s temperature, allows the sensation of touch when it comes to heat and cold. When it comes down to the skin, the skin is made up of three layers. The Epidermis layer is the outer layer of the skin that provides a waterproof barrier and creates our skin tone. Our skin’s color is made up by special cells called melanocytes, which produces the pigment of our skin and is located in the epidermis. The second layer which is the Dermis layer is underneath the epidermis layer which contains touch connective tissue
Skin cells then change shape, they start out fat and in a square shape and over time they flatten out and move to the epidermis, where they flake off. The body rids itself of around 35,000 old skin cells a day and the skin that you have now will be gone in about a month. The dermis is the second layer and the thickest. It consist of fibrous and electric tissue that allows for it to be flexibility. The dermis also contains nerve endings, sweat glands, hair follicles and blood vessels. In one square inch of your skins it has around seven hundred sweat glands, twenty blood vessels and over a thousand of nerve endings. The subcutaneous is the third layer and I located under the dermis. This layer is composed of areolar and adipose tissue that helps connect the skin to the underlying bone and organs. This layer is not consider an actual part of the skin itself, but help insulate, provides padding, and stores energy. The thickness of this layer depends on the location, for example it’s a fraction of an inch thick in the eyelids and several inches thick in the
The skin is the largest organ in the body and there are four primary tissues that make up the organs of our bodies are muscle, nervous, epithelial, and connective tissues. Of these four tissues, two are responsible for the formation of skin. Epithelial and connective tissues make up the layers of the skin. The epithelial and connective tissues have different functions, however they both make up the layers of the skin.The epidermis is the epithelial tissue layer of the skin while the dermis is the connective tissue layer.