Skin Case

The skin is the largest vital organ in the human body

and the most visible. The main function of the skin

is to act as a barrier, protecting the warm moist

internal environment from the essentially hostile,

dry and cool external environment in which we

live. It is a common belief that the skin acts as a

total barrier to the penetration of external substances.

In fact, it is permeable to many substances,

including perfumes and dyes with which we may

be in frequent contact.

Apart from protection, the skin plays critical roles

in the control of body temperature and blood pressure.

It also has endocrine functions and contains

numerous sensory receptors (Box 1). The condition

of the skin often reflects underlying disease processes.

It is important that nurses observe and attend to

patients' skin. An understanding of the structure

and physiology of the skin enables nurses to assess

what might be causing changes in its texture,

appearance or integrity (Fig. 1). It is claimed that

healthcare professionals are poorly educated in the

management of skin problems and diseases (APGS

2000, APPGS 1998). Assessment of skin by nurses

frequently occurs as part of everyday care-giving.

When a patient is being washed and dressed, nurses

often take the opportunity to examine the skin informally,

particularly in relation to skin integrity and

pressure areas. However, with fewer registered staff

performing hands-on care, it is possible that this significant

aspect of skin care is being overlooked. When

this is the case, it becomes important that formal skin

care assessments are performed and documented.

An understanding of the structure and function of

the skin can assist in this process. In addition, an awareness

of how the skin can