Skin and Pressure sores

Homeostasis
Chapter 14
Pages 393-404

Chapter 2
(34-38)
Learning Outcomes

❖ Describe the main structural features of skin

❖ Explain how the skin responds to injury and repairs itself.
❖ Understand the importance of skin integrity
❖ Explain pressure sores and stages of skin ulcers
❖ Understand the homeostasis and the mechanisms of homeostasis
 An Introduction to Skin
The Integument (skin)
• Is the largest system of the body
16% of body weight
1.5 to 2m2 in area
Has blood vessels in the dermis
The integument is made up of two parts
1. Cutaneous membrane (skin)
2. Accessory structures such as hair and
nails
 Function of Skin
• Protection of underlying tissues • Production of keratin
and organs by its waterproof layer
• Synthesis of vitamin D3
• Excretion of salts, water, and
(p.399)
organic wastes (glands)
• Maintenance of body temperature • Storage of lipids
(insulation and evaporation) via
• Detection of touch,
heat loss (p.397/8)
pressure, pain, and
• Production of melanin to protect temperature
against harmful UV rays in sunlight
The Epidermis
• No blood vessels or nerve endings
in this layer.
• Deeper layers bathed in interstitial
fluid providing oxygen and
nutrients and drain away as lymph.
• Hair, secretions from glands and
ducts from sweat glands pass
through the epidermis to the skin
surface
• Surface (epithelial) cells are
constantly rubbed off and replaced
by those beneath.
• Complete replacement of the
epidermis takes around 28 days
• Blisters develop when trauma
separates the dermis and
epidermis and serous fluid collects
between the two layers of skin
 The Dermis
Tough and elastic and made of
Structures found in the Dermis connective tissue and collagen
• Small blood vessels and lymph fibres which bind water and give
vessels the skin strength but this declines
with age and wrinkles develop.
• Sensory nerve endings
No topical surface creams can
• Sweat glands and their ducts reach this deeper level.
• Hairs and their associated arrector
pili muscles
• Sebaceous glands
Sensory receptors in the Skin
Sensory receptors are nerve endings
sensitive to touch, temperature,
pressure and pain

Nerve impulses generated in the sensor

receptors in the dermis are transmitted
to the spinal cord by sensory nerves and
from there to the cerebrum where
sensations are perceived.

Watch this video about skin layers:

https://medlineplus.gov/ency/anatomy
videos/000029.htm
 Primary wound healing
Need to have
• good diet and nutritional status
• Strong immunity
• Good circulation
Three stages (page 399)
• Inflammation
• Proliferation
• Maturation/remodelling
Explained in 2 minutes:
https://www.youtube.com/watch?v=1VBLm
yDjC0w
Stages of primary wound healing
Skin Ulcers - 2 most common types

Venous skin ulcers Pressure ulcers which

• affect the feet and the legs
• caused by a reduction of blood flow
• therefore feet and legs swell.
• Caused by excess pressure on the
skin on any part of the body.
• Pressure ulcers are classified into 4
stages depending on the stage of
tissue connection, or depth of the
sore- see next slide.

Both conditions can cause similar symptoms of itchy and/or painful

reddened or blistered skin and open crater-like sores
Pressure sores
A pressure sore (also called pressure ulcer, decubitus ulcer, decubiti (plural),
bedsore or skin breakdown) is an area of the skin or underlying tissue
(muscle, bone) that is damaged due to loss of blood flow to the area. Blood
Stage 1 flow to the skin keeps it alive and healthy. If the skin does not get blood, it
will die.

• In fair skinned people you get

redress of unbroken skin which is a
sign of lesion. In people with darker
skin tones there is a whitening
discoloration of the skin.
Stage 2
• Limited thickness skin loss
concerning dermis, epidermis, or
both. The lesion is shallow and
presents medically as a blister,
abrasion, or shallow centre.
Pressure sores
Stage 3
• Total thickness skin loss
concerning damage or necrosis
of subcutaneous tissue that can
expand down to but not through
to the underlying fascia. The
sore presents medically as a very
deep crater
Pressure sores
Stage 4
• Total thickness skin loss with far-
reaching destruction, tissue
necrosis or damage to bone,
muscle or supporting structures.
Risk zones for pressure sores
Homeostasis
Homeostasis is a core concept necessary for understanding the many regulatory
mechanisms in physiology.

In simple words, homeostasis is the state of steady internal, physical, and chemical
conditions maintained by living systems.
Physiological homeostasis
Physiological homeostasis is the
tendency of the body to maintain
critical physiological parameters (e.g.,
blood glucose level, blood pressure,
core body temperature etc.) of its
internal environment within specific
ranges of values.
Impact of homeostatic imbalance
● Many diseases are a result of homeostatic imbalance, an inability of the body to restore a functional, stable
internal environment.
● Aging is a general example of disease as a result of homeostatic imbalance. As an organism ages, results in an
unstable internal environment. This lack of homeostasis increases the risk for illness and is responsible for the
physical changes associated with aging.
● Diseases that result from a homeostatic imbalance include heart failure and diabetes, but many more examples
exist.
● Diabetes occurs when the control mechanism for insulin becomes imbalanced, either because there is a
deficiency of insulin or because cells have become resistant to insulin.
Quizizz
Spinal cord injury and pressure sores

● Individuals with SCI are at high risk for developing pressure sores.

● Pressure sores can be life threatening.

● Possible complications:
○ Infections can develop and spread to the blood, heart and bone.
○ Amputations
○ Prolonged bed rest necessary for healing can impact other activities
○ Due to lack of activity, risk of UTI and chest infections

Up to 80% of individuals with SCI will have a pressure sore during their lifetime,
and 30% will have more than one pressure sore.
● Most pressure sores are preventable.
Causes
Extrinsic:
○ Too much pressure on the skin for too long (see notes)
○ Shearing occurs when the skin moves one way and the bone underneath it
moves another way. This can result from slouching while sitting, sitting at a 45°
angle (as in bed), or sliding during a transfer instead of lifting your body.
Shearing can also happen during spasms.
○ Trauma of any kind (cuts, bumps, burns, scrapes, rubbing)
○ Abrasion or friction: Cut or scratch; sliding across sheets or transfer board with
bare skin.
○ Bump or fall: Bumping toes into doorways; bumping your buttocks off the tire
during transfers; bumping knees under desks.
○ Immobilisation and inappropriate equipment (bed, pressure relief mattress,
chair without cushions etc.)
Causes contd..
Intrinsic:

• Poor nutrition and hence exposed bony prominences

• Incontinence
• Infections: UTI etc. or due to prolonged incontinence
• Sensory impairment
• Poor circulation
• Medical conditions such as Diabetes
Prevention is better than cure!
● Do regular pressure reliefs (also called weight shifting, pressure redistribution and pressure
reduction).
● Padding, positioning and turning in bed
● Skin care: keep skin clean and dry, Check your skin, or have your attendant or caregiver check
your skin, a minimum of twice a day (morning and bedtime). Look for changes in skin color
(redness or darkening), blisters, bruises, or cracked, scraped or dry skin.
● Get a proper seating evaluation at least every two years or sooner if your health or skin
condition changes.
● Positioning and transferring, right equipment with pressure relief & M/H techniques
● Check clothing & shoes regularly
● Hydration (fluid intake)
● Nutrition: Eat a balanced diet that includes adequate protein, fruits and vegetables (fresh if
possible). Poor nutrition prevents the body tissue from rebuilding, staying healthy and fighting
infection.