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21.1 Structure and Functions of the Skin

The epidermis, dermis, and hypodermis are the three distinct layers of the skin. The epidermis is the outermost portion and is made up of stratified epithelial cells. The dermis is the second layer of skin that consists of elastic connective tissue made up of collagen. The bottom layer, the hypodermis or subcutaneous tissue, anchors the skin to the underlying tissues. The functions of the skin include protection, thermoregulation, sensation, absorption, elimination, and vitamin D production. These functions each play a major role in maintaining health and homeostasis of a person. The skin has psychosocial effects and serves to aid in identification. Assessment findings may vary among cultures and ethnicities, developmental levels, and age groups.

21.2 Factors Affecting Skin Integrity

Normal healthy skin is based on the age, ethnicity, genetics, and health condition of the patient. Patients are at risk of impaired skin integrity if they have risky lifestyle and behavioral factors (e.g., poor nutrition, activity levels, sexuality, illicit drug use, body piercings, tattoos). State of health (e.g., illnesses, medications, mobility status) and genetic (e.g., vitiligo, acne, melanoma, psoriasis, eczema) factors may also pose a risk. Common skin disorders include bacterial infections, viral infections, fungal infections, inflammatory reactions, and skin cancers. Common bacterial infections of the skin include impetigo, folliculitis, carbuncles, and cellulitis. Viral skin infections include herpes simples, herpes zoster, and verruca. Common fungal skin infections include tinea that affect the feet and toes, beard, body, groin, and scalp. Parasitic skin infections include pediculosis (affects the body, scalp, and groin) and scabies. Inflammatory skin reactions include eczema, seborrheic dermatitis, urticaria, acne vulgaris, psoriasis, and SLE. Skin cancer has three main types: basal cell carcinoma, squamous cell carcinoma, and malignant melanoma. People with impaired skin integrity may need to make lifestyle modifications to promote healing. Nurses must take age-related and cultural factors into consideration when developing a plan of care and educating patients, their family members, or their caregivers to promote skin health.

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