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The skeleton is covered by the skin, by the layer of subcutaneous tissue and fat, and by the muscles.

The skin consists of two layers: an outer layer termed the epidermis, and an inner layer termed the dermis.

The epidermis is composed of a number of layers of cells which vary in shape from above downward. The cells in the surface layers are flat. Those in the layers lower down are round or many-sided; the cells in the deeper layers are column-shaped, and possess great vitality and power of reproduction.

The dermis is composed of a mass of loosely connected fibers which can be divided into two layers.

An outer layer is raised into a great number of conical or finger-like projections termed papillae. Each papilla contains blood vessels and nerve endings and also the rudiment of a hair. An inner layer consists of bands of connective tissue interlacing with each other and permeated by blood vessels, glands and fat.

The skin contains two sets of glands: the sweat glands and the sebaceous glands. The nails and hair are special structures developed from the epidermis.

The functions of the skin are of great importance and are as follows: to enclose contained parts, to act as a protective covering, to contain special nerve endings, which receive and convey certain waste products in the form of perspiration which consists of water with a proportion of mineral matter dissolved in it and a small quantity of carbonic acid.

Observation of the skin can tell you much: what does its color indicate? Are there any lesions: wounds, or local damage, or trauma, or eruption?

A general term referring to any skin disease is dermatitis. Inflammation of the skin is called dermatitis. Sunlight may cause chemical and biological changes in the skin, and it may lead to skin cancer. Eczema is a very unpleasant disease that may be found in all age groups of people, and eczema may affect any and all parts of the skin surface. It is noncontagious disease.

There are many other skin diseases, such as furuncles, carbuncles, psoriasis (a chronic disease with the skin covered by silvery scales), herpes, cancer of the skin, urticaria (an allergic reaction characterized by red patches (hives) often accompanied by severe itching), decubitus ulcers, or bedsores, or pressure ulcer - areas of dead skin and subcutaneous tissues. The nurse who cares for a bed patient must prevent the beginning of such a disease by frequent position change of this bed patient, because it is far easier than treatment of an established ulcer.

3. Look at Fig. 9-1 and describe the structure of the skin.

4. Name the skin glands and appendages.

5. Describe the structure of the epidermis and dermis.

6. Explain the main functions of the skin.

7. List skin diseases.

8. Answer the following questions.

1) What are the layers of the skin?

2) What is the difference between the cells of the surface layer and the deeper layer?

3) What does each papilla contain?

4) What does perspiration consist of?

5) What is the role of observation of the skin?

6) What is the difference in the terms dermatosis and dermatitis?

7) What disease may sunburn cause?

8) Is eczema a contagious disease?

9) What is urticaria?

10) What is the duty of the nurse who cares for bed patients?

Fig. 9-1. Skin structure

III. Independent Work: