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236 PHYSICAL EXAMINATION
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Interpret: Mr Shaw shows marked changes in his mood.
Hepresents with poor eye contact, helpless and hopeless
themes, feeling no pleasure in activities, increased worry about
his future plans, thoughts of suicide to end his life. He displays
UNIT 2
understanding about his symptoms and is willing to seek help for
his mental health. He has been nancially reliant on his parents
since deferring university and resigning from his casual position,
which Mr Shaw reports has been a signicant stressor. He reports
that he noticed a decline in his mood due to increased stress from
university studies and death of a close friend.
Substance use
Mr Shaw reports using cannabis, alcohol and smoking cigarettes
daily to help him feel relaxed. He states that he is unsure about
whether he is dependent on substances.
Suicidal thoughts
Mr Shaw reports that he has had plans of hanging himself
previously, stated that he is comfortable approaching his family
for support if required, although he is not close to his siblings.
Currently he denies any active plans, but states that he does not
see the point of living due to his current mental state.
Family history
Parents are very supportive and Mr Shaw reports having a close
relationship with his parents. Nil known history of mental illness
inhis family.
Mr Shaw reports decline in his mood for the past 12 months,
with panic attacks and suicidal ideation, sleep disturbance,
and substance use. There is lack of evidence about perceptual
disturbances. He denies psychotic symptoms and his family is in
agreeance that Mr Shaw does experience depression and anxiety.
His presenting symptoms point to a diagnosis of major depression
with anxiety features.
Putting it all together – synthesise information
The nurse in this case would document all these ndings and
refer this to the medical ofcer. The likely outcome would be that
MrShaw would be further referred to a psychiatrist for review of
his medications and further treatment.
Actions based on assessment ndings
The nurse should also provide additional education for
interventions that do not require a doctor’s order such as:
1 Using deep-breathing techniques when feeling highly anxious.
2 Use of mindfulness, relaxation techniques to help
manageanxiety.
3 Establishing a daily routine at home to assist with structuring.
4 Education about the impact of substance use on his mood
andanxiety.
5 Monitor consumer closely due to suicidal thoughts; establish
therapeutic relationship to ensure that consumer feels
comfortable to discuss his concerns.
6 Referral to social worker for assistance with nancial support,
linking in with assistance at university.
The nal step in the process is accurate documentation. The
nurse must document ndings, referrals, interventions, advice
and education given. The consumer would continue to have
ongoing management and follow-up by specialist medical staff in
collaboration with general practitioner.
CHAPTER RESOURCES
REVIEW QUESTIONS
For answers to these questions, see Answer section at the end
ofthis book.
1. You are assessing a consumer who has reported feeling ‘low’
for suicide risk factors. Which of the following increases the
risk for suicide attempts? Select all that apply.
a. Suicidal thoughts without a specic plan
b. Verbal expression of increasing self-worth
c. Male sex
d. Previous non-fatal suicide behaviours
e. Does not take illicit substances
f. Increased alcohol use
g. Renewed interest in school or work
2. When assessing your consumer’s mental status, you note that
she is alert but talks with a monotone and little expression.
This indicates:
a. Flat affect
b. Aphasia
c. Altered level of consciousness
d. Acute confusion
3. Janet, a 40-year-old female, has presented with severe
depression and suicidal ideation. She reports that she is not
responding to antidepressant medication prescribed by her
GP. What are the common symptoms of depression? Select
allthat apply.
a. Perceptual disturbance
b. Low mood
c. Sleep disturbance
d. Anhedonia
e. Thought disorder
f. Weight changes
MENTAL STATUS AND NEUROLOGICAL TECHNIQUES 237
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4. What is the objective assessment for emotion in a mental
status examination?
a. Mood
b. Thought form
c. Affect
d. Thought content
5. Your consumer presents for a check-up reporting a sudden
collapse that lasted 15 seconds. The consumer is now awake
but feels nauseas and has a headache. He has a history of
diabetes mellitus type 1, and his current blood glucose level
is2.9mmol/L. You suspect he has which condition?
a. Syncope
b. Concussion
c. Vertigo
d. Seizure
6. Which of the following conditions are risk factors for stroke?
Select all that apply.
a. Atrial brillation
b. Physical inactivity
c. Liver disease
d. Hypertension
e. Use of codeine
f. Obesity
7. The son of your 80-year-old female consumer expresses
concern about his mother’s cognitive mental status. You tell
the consumer a list of three items and have the consumer
repeat them to check initial understanding. By having the
consumer recall the three items 5 minutes later, you are
assessing what cognitive function?
a. Judgement
b. Attention
c. Memory
d. Abstract reasoning
8. Consumers with delirium may show which of the
following symptoms?
a. Perception is mostly affected and has a sudden onset,
hallucinations, emotional disturbance, and may be
volatileand impulsive
b. All cognitive processes are affected, onset is gradual,
andmay have intact long-term memory
c. Emotional state is mostly affected, could have gradual
or sudden onset, may be in response to a situation or
inherited neurochemical abnormalities. Attention, memory
and judgement are all intact
d. Show signs of slowed speech, lack of mental clarity and
coherence, with variable onset, short-term and long-term
memory may be impaired, spatial perception is impaired
and may be incoherent
9. You are assessing a consumer who has arrived to the
emergency department with a headache and difculty
speaking. The treating team are suspecting a stroke may
be the cause. A student nurse asks you what the term is for
the impaired laryngeal speech you are witnessing with the
consumer. This is an example of:
a. Hyperaesthesia
b. Hypophonia
c. Dysphonia
d. Dysaesthesia
10. The consumer you are seeing has a shingles outbreak
on the C4–C5 dermatomes. Where would you observe an
erythematous, vesicular rash? Select all that apply.
a. Chin
b. Clavicular area
c. Neck
d. Trapezius muscle area
e. Biceps muscle area
f. Scalp
11. With your consumer sitting relaxed and facing you, have
them perform the following sequence of activities: With arms
outstretched, alternately bring in each hand and touch the
tip of each index nger to his nose. Next, have the consumer
rapidly alternate patting his knees with the palmar, then the
dorsal, aspects of his hands. Finally, have the consumer
rapidly extend and tap his foot. Which component of the
neurological exam are you assessing?
a. Sensory function
b. Cerebellar function
c. Cranial nerves
d. Mental status
12. A 25-year-old female reports a history of anxiety and nervousness.
She comes in due to recent panic attacks. You know the ‘ght or
ight’ response is controlled by the sympathetic nervous system.
What characteristic symptoms might this consumer experience
with acute anxiety or panic? Select all that apply.
a. Heightened awareness
b. Increased gastric secretions
c. Decreased gastric motility
d. Bronchial constriction
e. Increased heart rate
f. Increased urine output
CLINICAL SKILLS
The following Clinical Skills are relevant to this chapter and
can be found in Tollefson & Hillman, Clinical Psychomotor
Skills, 8th edition:
> 16 Mental status assessment
> 20 Focused neurological health history and
physical assessment
> 27 Healthcare teaching
> 73 Seclusion management
> 74 Electroconvulsive therapy care.
CHAPTER 7
238 PHYSICAL EXAMINATION
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FURTHER RESOURCES
> Alzheimer’s New Zealand: http://www.alzheimers.org.nz/
UNIT 2
> Brain Injury Australia: https://www.braininjuryaustralia.org.au/
> Brain Injury New Zealand: http://www.brain-injury.org.nz/
> Community and Public Health New Zealand: https://www.cph.
co.nz/your-health/youth-mental-health/
> Dementia Australia: https://www.dementia.org.au/
> Headspace National Youth Mental Health Foundation
(Australia): https://headspace.org.au/
> Mental Health Australia: https://mhaustralia.org/
> Mental Health Foundation of New Zealand: https://www.
mentalhealth.org.nz/
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2022 from: https://alzheimers.org.nz/explore/facts-and-gures/
Australian Bureau of Statistics. (2021). Causes of death, Australia. ABS.
https://www.abs.gov.au/statistics/health/causes-death/causes-deathaustralia/latest-release.
Australian Institute of Health and Welfare (AIHW). (2022a). Dementia in
Australia. Retrieved 5 December 2022 from: https://www.aihw.gov.au/
reports/dementia/dementia-in-aus/contents/summary
Australian Institute of Health and Welfare (AIHW). (2022b). Mental health:
prevalence and impact. Retrieved 5 December 2022 from: https://
www.aihw.gov.au/reports/mental-health-services/mental-health
Bentley, M., Singhal, P., Christey, G., & Amey, J. (2022). Characteristics of
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Brain Foundation. (2022). Motor neurone disease. Retrieved 5 December
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Brain Injury Australia. (n.d.). What is TBI? Retrieved 5 December 2022 from:
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Connectivity: Traumatic Brain Injury Australia. (n.d.). Have you suffered a
traumatic brain injury? Retrieved 5 December 2022 from: https://www.
connectivity.org.au
Dementia Australia. (2023). Key facts and statistics. Retrieved 05 December
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Dharmadasa, T., Henderson, R. D., Talman, P. S., Macdonell, R. A. L.,
Mathers, S., Schultz, D. W., … Kiernan, M. C. (2017). Motor neurone
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Everymind. (2022). Midframe. Suicide: communicating about suicide.
An Everymind product, funded by the Australian government under
the National Suicide Prevention Leadership and Support Program.
Retrieved 31 October 2022 from https://mindframe.org.au/suicide/
communicating-about-suicide/language
Healthdirect. (2022). Stroke. Australian Government Retrieved 31 October
2022 https://www.healthdirect.gov.au/stroke#prevention
> MS Australia: http://www.msaustralia.org.au/
> MS Society of New Zealand: http://www.msnz.org.nz/
> Neurological Foundation of New Zealand: http://www.
neurological.org.nz/
> Royal Australian and New Zealand College of Psychiatrists:
http://www.ranzcp.org/
> Stroke Foundation (Australia): https://strokefoundation.org.au/
> Stroke Foundation of New Zealand: http://www.stroke.org.nz/
Health Promotion Agency (HPA). (2020). Mental Health in Aotearoa.
Retrieved 5 December 2022 from: https://www.hpa.org.nz/sites/default/
les/Mental_Health_Aotearoa_Insight_2020.pdf
Leske, S., Adam, G., Catakovic, A., Weir, B., & Kolves, K. (2022). Suicide
in Queensland: annual report 2022. Australian Institute for Suicide
Research and Prevention, World Health Organization collaborating
centre for research and training in Suicide Prevention, School of
Applied Psychology, Grifth University, Brisbane, Queensland, Australia.
Madsen, T. E., Howard, V. J., Jimenez, M., Rexrode, K. M., Acelajado, M. C.,
Kleindorfer, D., & Chaturvendi, S. (2018). Impact of convention stroke
risk factors in women. An update. Stroke, 49, 536–42. doi: 10.1161/
STROKEAHA.117.018418
Mindframe. (2022). Mental ill-health − Data and statistics. Retrieved
5 December 2022 from: https://mindframe.org.au/mental-health/
data-statistics
Motor Neurone Disease (MND) Australia. (2020). MND research statistics.
Retrieved 5 December 2022 from: https://www.mndaustralia.org.au/
research/for-researchers/mnd-research-statistics
Motor Neurone Disease New Zealand. (2020). Basic facts about MND.
Retrieved 5 December 2022 from: https://mnd.org.nz/about-mnd/
what-is-mnd/basic-facts-about-mnd/
New Zealand Brain Institute. (n.d.). Prevalence and incidence of
Parkinson’s in New Zealand. Retrieved 5 December 2022 from:
https://www.nzbri.org/Labs/parkinsons/Epidemiology/
New Zealand Government. (2018). Mental Health and Addiction Inquiry,
1.4.1 Mental health and addiction in New Zealand. Retrieved
5December 2022 from: https://mentalhealth.inquiry.govt.nz/inquiryreport/he-ara-oranga/chapter-1-the-inquiry/1-4-context/
O’Reilly, G., Curtis, K., Kim, Y., Mitra, B., Hunter, K., Ryder, C., …
Fitzgerald,M. C. (2022). The Australian Traumatic Brain Injury
National Data(ATBIND) project: a mixed methods study protocol.
Medical Journal of Australia, 217(7): 361−5. doi: 10.5694/mja2.51674.
Retrieved5December 2022 from: https://www.nzbri.org/Labs/
parkinsons/Epidemiology/
Parekh, T., Pemmasani, S., & Desai, R. (2020). Marijuana use among
young adults (18-44 years of age) and risk of stroke. A behavioural
risk factor surveillance system survey analysis. Stroke, 51, 308–10.
doi: 10.1161/STROKEAHA.119.027828
Pitcher, T. L., Myall, D. J., Pearson, J. F., Lacey, C. J., Dalrymple-Alford,
J. C., Anderson, T. J., & MacAskill, M. R. (2018). Parkinson’s disease
across ethnicities: A nationwide study in New Zealand. Movement
Disorders. doi: 10.1002/mds.27389
MENTAL STATUS AND NEUROLOGICAL TECHNIQUES 239
Copyright 2024 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. WCN 02-300
https://t.me/medicina_free
Shake It Up Australia Foundation. (n.d.) About Parkinson’s. Retrieved
5 December 2022 from: https://shakeitup.org.au/understandingparkinsons/
Stark, B. A., Roth, G. A., Adebayo, O. M., Akbarpour, S., Aljunid, S. M.,
Alvis-Guzman, N., … Castañeda-Orjuela, C. A. (2021). Global, regional,
and national burden of stroke and its risk factors, 1990–2019:
a systematic analysis for the Global Burden of Disease Study 2019.
Lancet Neurology,20(10), 795–820. https://doi.org/10.1016/S14744422(21)00252-0
Stroke Foundation. (2018). About Stroke. Retrieved 29 August 2018 from
https://strokefoundation.org.au/About-Stroke
Stroke Foundation. (2020). Top 10 facts about stroke. Retrieved 5 December
2022 from: https://strokefoundation.org.au/about-stroke/learn/factsand-gures
Stroke Foundation. (2022). Learn about stroke. Retrieved 5 December 2022
from: https://strokefoundation.org.au
Stroke Foundation New Zealand. (n.d.). Facts and FAQs. Retrieved
5 December 2022 from: https://www.stroke.org.nz/facts-and-faqs
CHAPTER 7
240
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CHAPTER
8
INTEGUMENTARY
LEARNING OUTCOMES
By the end of this chapter you should be able to:
1 describe the anatomy and physiology of the integumentary system
2 demonstrate a physical assessment of the skin, hair and nails
3 identify pathophysiological changes to hair and nails, and explain possible aetiologies
4 explain the warning signs of carcinoma in pigmented lesions
5 identify health education opportunities for clients in regard to specic conditions
6 discuss the clinical reasoning to evaluate outcomes of health assessment and physical
examination including documentation requirements for recording information, health
education given and relevant health referral.
BACKGROUND
In Australia and New Zealand, hair, skin and nail conditions experienced by people
are largely affected by location, socioeconomic status and physical environment
(more specically the work environment). Examples of common skin conditions are
outlined according to these three factors.
> Location: Australia and New Zealand have the highest and second-highest
rates of melanoma in the world, likely due to mostly fair-skinned populations
and high ultraviolet (UV) radiation (Verma et al., 2022). Tropical diseases and
infections are a signicant health concern in northern Australia, particularly
bacterial and fungal infections resulting from the humid environment or contact
with vegetation, infected soils, coral reefs and sh (Australian Government
Department of Health, 2018). Skin conditions such as eczema are aggravated
by, and thus more prominent in, the colder mountainous regions of southern
Australia and New Zealand. Poor access to timely health care is also associated
with living in a rural or remote area (AIHW, 2022).
> Socioeconomic status: Aboriginal and Torres Strait Islander peoples in remote and
coastal communities in Australia struggle to control outbreaks of pediculosis (head
lice), impetigo (school sores) and scabies, all of which have signicant complications
(Davidson, Knight & Bowen, 2020). Although these conditions regularly occur and
are picked up in school environments (Mullane et al., 2019), they are not only found
in school environments, and the potential for epidemic outbreaks is prevalent in
both Australia and New Zealand. Poor socioeconomic status and the barriers facing
Indigenous peoples of Australia and New Zealand in accessing health care contribute
to poor knowledge about self-care practices in hygiene and nutrition. Such outcomes
are usually apparent in assessment ndings for hair, skin and nails.
> Physical environment: Hot sun and high UV levels can cause issues such as
sunburn and skin cancer. Environmental factors, paired with individual factors,
INTEGUMENTARY 241
Nerve
Dermal papilla
Subcutaneous
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contribute to Australia and New Zealand having the highest incidence in the
world for melanoma skin cancers (Melanoma Institute Australia, 2022). Melanoma
is the third most common cancer in New Zealand and accounts for close to
80% of skin cancer deaths (Melanoma New Zealand, 2022). In Australia, new
melanoma diagnoses account for 11% of all cancers (Cancer Australia, 2022), and
approximately 17
000 Australians are diagnosed with invasive melanoma each
year (Melanoma Institute Australia, 2022). Men are more likely to develop and die
from a melanoma (Cancer Australia, 2022). Melanoma was the 10th most common
cause of cancer death in Australia in 2020 (Cancer Australia, 2022). However, more
common than melanoma are basal cell carcinomas (one of the non-melanoma skin
cancers), which affect a large proportion of Australians and New Zealanders. Skin
cancers kill more people in New Zealand than road trafc crashes (Health Promotion
Agency, New Zealand, 2018). Snow and ice conditions in New Zealand and parts of
the southern Australian Great Dividing Range can cause health problems such as
frostbite and xeroderma, which affect the person’s integumentary system.
This chapter provides a review of the skin and its appendages: hair and nails.
Techniques for examination of the integumentary system are addressed, as is an
approach to evaluating skin lesions.
ANATOMY AND PHYSIOLOGY
The skin, also known as the integumentary system or cutaneous tissue, is the
largest organ system of the body. It shelters most of the other organ systems and, if
assessed carefully, can provide a noninvasive window through which to observe the
body’s level of functioning.
The skin, hair and nails, along with their functions, are discussed.
CHAPTER 8
Skin
The surface area of the skin covers approximately 6 square metres in the average adult,
with a thickness varying from 0.2 to 1.5mm, depending on the region of the body and
the person’s age. Morphologically speaking, the skin is composed of three main layers:
the epidermis, the dermis and the subcutaneous tissue, or hypodermis (Figure 8.1).
Sweat gland
(eccrine)
Arrector pili muscle
Artery
Vein
Hair shaft
Sensory nerve
ending for touch
Papilla of hair
Sweat pore
Hair follicle
Sebaceous (oil) gland
Epidermis
Dermis
fatty tissue
(hypodermis)
FIGURE 8.1 Structures of the skin
242 PHYSICAL EXAMINATION
Epidermis
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UNIT 2
Epidermis
The epidermis is a multilayered outer covering consisting of four layers
throughout the body, except for the palms of the hands and soles of the feet, where
there are ve layers (see
in a continual state of
from the lower layers; a complete turnover of cells occurs every 3 to 4 weeks.
Figure 8.2). The top layer, called the stratum corneum, is
desquamation (shedding), as new skin cells are pushed up
Stratum corneum
Stratum lucidum
(only found on
soles and palms)
Stratum granulosum
Stratum spinosum
Stratum germinativum
Papillary layer
Dermis
Reticular layer
FIGURE 8.2 Part of the epidermal and dermal layers of the skin
The epidermis, with the exception of the palmar and plantar surfaces, is normally
smooth. All epidermal surfaces are devoid of blood vessels. Despite the absence of
vessels, blood pigments, such as oxyhaemoglobin and reduced haemoglobin in the
corium or dermis, are responsible for the vascular colour transmitted to the skin’s
surface. Other factors that affect the skin’s colour are various pigments such as
melanin and carotene. Epidermal thickness and the ability of the skin to reect light,
known as the Tyndall effect, also inuence integumentary colour.
INTEGUMENTARY 243
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Dermis
The dermis, or corium, is the second layer of the skin. It is approximately 20 times
thicker than the epidermis in certain areas of the body and can be divided into
two layers: the papillary layer and the reticular layer (see
layer
, or upper layer, is composed primarily of loose connective tissue, small elastic
bres, and an extensive network of capillaries that serve to nourish the epidermis.
reticular layer, the lower layer of the dermis, is formed by a dense bed of
The
vascular connective tissue that also includes nerves and lymphatic tissue. This layer
also provides structural support for the skin. Intermeshed with the connective tissue
are hair follicles, sweat glands, sebaceous glands and adipose tissue.
The brous connective tissue in the dermis gives the skin its strength and
elasticity. The brous tissues provide structural support for the epidermis and form
dermal ‘ridges’ to which the epidermis conforms and anchors, creating ‘epidermal
ridges’ known as ngerprints. These ridges develop during the rst trimester of fetal
development and, although they enlarge with growth, their pattern remains the
same throughout life and enhances with age. In general, the dermis is thicker over
the dorsal and lateral surfaces such as the palmar and plantar surfaces. It is much
thinner over the ventral and medial surfaces, and is especially thin in areas such as
the eyelids, scrotum and penis.
Figure 8.2). The papillary
Subcutaneous tissue
Beneath the dermis is the subcutaneous tissue, or supercial fascia. It is
composed of either loose areola connective tissue or adipose tissue, depending on
its location in the body. The subcutaneous layers attach the skin to the underlying
bones. These layers act as a temperature insulator and help regulate body heat; they
also encompass fat stores for energy use and contain an extensive venous plexus
layer, which acts as a reservoir for the blood that warms the surface of the skin.
Distributed around the dermal blood vessels and the subcutaneous tissue are the
skin’s mast cells. These cells number from 7000 to 20000 per cubic centimetre of
Mast cells are the body’s major source of tissue histamine and they trigger the
skin.
body’s reaction to allergens.
CHAPTER 8
Glands of the skin
There are two main groups of glands in the skin: the sebaceous glands and the
sweat glands.
Sebaceous glands
The sebaceous glands are sebum-producing glands that are found almost
everywhere in the dermis except for the palmar and plantar surfaces. They are
also part of the apparatus that contains the hair follicle and the arrector pili
muscle, which causes contraction of the skin and hair, resulting in ‘goose bumps’.
The ducts of the sebaceous glands open into the upper part of the hair follicle and
are responsible for producing sebum, an oily secretion that is thought to retard
evaporation and water loss from the epidermal cells. Sebaceous glands are most
prevalent in the scalp, forehead, nose and chin.
Sweat glands
The two main types of sweat glands are apocrine glands, which are associated
with hair follicles, and eccrine glands, which are not associated with hair follicles.
The secretory apparatus of both types of sweat glands is located in the subcutaneous
tissue. Eccrine glands open directly onto the skin’s surface and are widely distributed
throughout the body. Apocrine glands are found primarily in the axillae, genital
and rectal areas, nipples and navel. These glands become functional during puberty,
and secretion occurs during emotional stress or sexual stimulation. After puberty,
apocrine glands are responsible for the characteristic body odour when sweat mixes
with the natural bacterial ora normally present on the skin surface.
244 PHYSICAL EXAMINATION
Periungual tissue
Nail root
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UNIT 2
Hair
With few exceptions (the palmar and plantar surfaces, lips, nipples and the glans
penis), hair is distributed over the entire body surface. Exceptions to ‘normal’ hair
distribution or too much hair or loss of hair are considered conditions that may
respond to treatment. Causes of these conditions may be linked as a side effect to
certain drugs, a genetic predisposition, high levels of physical or emotional stress,
endocrine abnormalities or as markers of other disease processes. The abundance
and texture of hair are dependent on an individual’s age, sex, race and heredity.
Vellus hair, or ne, faint hair, covers most of the body. In general, terminal hair
is the coarser, darker hair of the scalp, eyebrows and eyelashes. In the axillary and
pubic areas, terminal hair becomes increasingly evident in both males and females
with the onset of puberty. Males also tend to develop coarser, thicker chest and
facial hair.
Most hair shafts are composed of three layers: the cuticle, or outer layer;
the cortex, or middle layer; and the medulla, or innermost layer. Hair colour is
determined by the melanocytes produced in the cells at the base of each follicle;
an abundance of pigment produces darker hair colour, and smaller amounts
produce a lighter colour.
Nails
Like hair, nails are composed of modied keratin and are layers of cells that arise
from undifferentiated epithelial tissue called the
that covers the distal portion of the digits and provides protection, is approximately
0.5 to 0.75mm thick. The nail consists of the
the cuticle and is attached to the matrix; the
located beneath the nail plate; and the
nail plate and the free edge of the nail (
is a white, crescent-shaped area known as the
the cuticle in some individuals.
periungual tissues, which surround the
Figure 8.3). At the proximal end of each nail
matrix. The nail plate, tissue
nail root, which lies posteriorly to
nail bed, which is the vascular bed
lunula. This structure is obscured by
FIGURE 8.3 Structures of the nail
vascular bed in light-skinned individuals and a brownish cast in dark-skinned
individuals. In many disease processes, the colour of the nail bed may vary. For
instance, a decrease in oxygen content of the blood will cause the nail beds to
appear cyanotic, or variations of colour from blue (in a fair-skinned person) to grey
or dark brown (in darker-skinned people). The nail plate is formed continuously
Nail plate
Nail bed
The normally translucent nail plate is given a pinkish cast by the underlying
Cuticle
Nail matrix
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as the plate is pushed forwards by new growth from the germinative layer of the
matrix. Fingernails take about ve months to grow and cover from base to tip, and
toenails can take up to 10 months to grow; however, growth varies with age, season,
nutrition, climate, health status and activity.
Function of skin
The skin has many functions, but perhaps the most important one is its ability
to serve as a protective barrier against invasion from environmental hazards and
pathogens. It provides boundaries against materials that might enter the body,
such as toxic chemicals, and provides boundaries for uids and mobile tissues,
such as blood, within the body. An intact integument is also responsible for the
protection of underlying organs, which would otherwise be vulnerable to injury
because of exposure.
Temperature regulation is carried out by the skin through the production of
perspiration. During states of increased body temperature, large quantities of sweat
are produced by the eccrine glands. As perspiration reaches the skin’s surface, rapid
evaporation takes place, and the body’s temperature begins to decrease. The skin’s
vascular system also plays a role in heat control. When vasodilation occurs, much of
the heat can be lost through radiation and conduction. Conversely, vasoconstriction
helps to maintain body heat.
The skin contains receptors for pain, touch, pressure and temperature. These
receptors originate in the dermis and terminate as either free nerve endings
throughout the skin’s surface or as special touch receptors that are encapsulated
and found predominantly in the ngertips and lips. Each hair found on the body
also contains a basal nerve bre that acts as a tactile receptor. Sensory signals that
help determine precise locations on the skin are transmitted along rapid sensory
pathways, and less distinct signals such as pressure or poorly localised touch are sent
via slower sensory pathways.
The skin acts as an organ of excretion for substances such as water, salts and
nitrogenous wastes. The skin produces cells for wound repair and is the site for the
production of vitamin D. The skin is also an indicator of nonverbal language and
emotions via blushing and facial expressions. The skin may further be used for the
purpose of identication via ngerprints and birthmarks. Skin colour is one of the
most visible variations between people across our diverse populations. Skin colour
can impact on melanin production, risks associated with sun or UV damage, and
can be a focus of health promotion, a barometer of health and wellness and plays a
large part in people’s self-identity and self-image.
CHAPTER 8
Function of hair
Hair provides warmth, protection and sensation to the underlying systems.
Terminal hair of the scalp and face provides warmth, shields against UV light, and
lters dust and particulate matter. Vellus hair enhances tactile sensation and sensory
perception. In some cultures, hair is a status symbol of beauty and wealth. Even
though physiological functions of hair have modied with changes to lifestyle
and evolution, psychologically and socially, hair serves a very important function
especially for self-image. Unwanted changes to hair location, quality and presence
can impact greatly on the individual’s sense of wellness and self.
Function of nails
Nails provide protection to the distal surface of the digits and can be used for
self-protection. In some cultures, nail length in both men and women is a qualier
of social and economic status and self-image.
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