Final Exam New Material Flashcards
Skin body weight %
15-20%
Skin function
-protection
-holding organs
-sensory
-fluid balance
-temp control
-absorb radiation
-vit D making
-synth. lipids
Primary Skin Lesion
-1st
-response to meds or radiation
-Macule, papule, tumor, wheal
Secondary Skin Lesion
-changes to primary lesion
-scale, crust, scar, ulver, atrophy
Factors Affecting Ability to Heal
-tobacco, psychological status, nutrition
Skin Lab Values
-Pre-albumin: nutritional status
-glucose
-hemoglobin
-hemocrit: wound healing
Aging in Integumentary Sys.
-changes in hair (color, thinning, balding, pattern)
-Changes in skin (hyperpigmentation, wrinkling, pain perception, thinning, temp regulation, less vit D production—> osteoporosis)
-Vascular changes (decreased healing, decreased vascularity, thinning)
-Decreased protection (statrum corneum, less langerhans cells (loss of immune surveillance)
Atopic Dermatitis
-chronic or relapsing inflammatory skin disease characterized by pruritus
-precursor to allergies
Contact Dermatitis
-acute or chronic skin inflammation caused by exposure to an external agent, that may act as an irritant or allergen
Eczema/Dermatitis
-superficial itchy inflammation of the skin caused by irritant exposure, allergies, or genetics
-ebbs and flows
Stasis Dermatitis
-development of erythematous itchy plaques that may open to form shallow ulcers on the lower legs
- underlying venous hypertension and resultant venous insufficiency
Rosacea
-chronic facial disorder of middle-aged and older people
-form of acne, vascular and allergen components
Incontinence-Associate Dermatitis
-skin damage resulting from chronic urine or feces exposure
Bacterial Skin infections
-impetigo
-cellulitus
Viral Skin infections
-Herpes Zoster
-Warts
Fungal Skin infections
-Ringworm
-Athelets foot
-Yeast
Parasitic Skin infections
-Scabies
-Pediculosis (lice)
Skin Cancer Benign lesions
-Seborrheic keratosis
-nevi (moles)
Skin Cancer Premalignant Lesions
-actinic keratosis
-bowen disese
Skin Cancer Malignant Nonmelanoma Carcinomas
-basal cell carcinoma
-Squamous cell carcinoma
Skin Disorders Associated with Immune Dysfunction
-Psoriasis
-Lupus
-System sclerosis
-Polymyositis
Burn Severity
-depth (determined by temperature, source, and duration) and total body surface involved
1st Degree Burn
-epidermis damage
-sun, UV, brief flame/water/flash
-mild, no blisters
-painful, tingling, eased by cool water
-3-7
2nd Degree Burn
-epidermis and dermis
-Scalding liquids or immersion of liquids
-blisters, edema, weaping
-pain, cold sensitive
-14-28 days
3rd Degree Burns
-epidermis, dermis, subcutaneous damage
-prolonged exposure
-fat exposed, dry surface
-no pain
-no healing w/o grafts, skin liquifies in 2-3 weeks, hypertrophic scarring
Wallace Rule of Nines
-9% on arms and head (3)
-18% on legs and both sides of torso (4)
-1% on genitals
Burn Admissions
-75% thermal (43% flame, 34% scalding)
-Chemical
-Electrical
-Radiation
Burn Mortality Determinants
-TBSA
-age
-inhalation injuries
Cardiovascular Sys. effects of Burns
-vasoactive substances from injured tissues
-decreased circulating blood volume
-increased HR
-CO: decreases in the beginning, returns to normal, then increases in 24 hrs
Renal and GI sys. effects of Burns
-shunting of blood from kidneys to intestines
-Oliguria: decreased urine output
-Paralytic ileus: intestinal dysfunction
Immune Sys. effects of Burns
-immunosuppression
-increased infections
Electrical Burns
-multi system injuries as it travels through the body
-small entrance wounds, large exit wounds
-Alternating Current worse than Circulating Current
Chemical Burns
-continue to burn until neutralized
-alkaline burn deeper
Burn Locations/Effects
-Hand and joint burns can cause loss of use
-Circumferential burns can create a tourniquet
Inhalation Injuries
-respiratory failure, pneumonia, sepsis
Emergent phase of Burns
- fluid retention
-ventilatory magement
Acute Phase of Burns
-wound management
-infection prevention
-debridement
-skin grafting
-PT
Rehabilitative Phase of Burns
-return to max independence and function
Autografts
-full thickness burn to permanently close the burn
Allografts
-homografts
-cadaver skin
Xenografts
-heterografts
-pigskin
Biosynthetic Grafts
-collagen and synthetics
Integumentary Ulcers
-Diabetic Ulcers: neuropathic ulcers
-Wagner System:
0: preulcerative
1: superficial
2: Penetrate through subcutaneous
3: Osteitis, abscess
4: Gangrene of digit
5: Gangrene of foot
Pressure Injuries
-unrelieved pressure; Interface (externally) and Shearing forces
-Bony prominences: heels, sacrum, ishtub, greater troch, elbows, and scapula
-can’t be back staged, must be resolved
Pressure Injury Stages
1: Intact skin
2: Partial thickness; exposed dermis
3: Full thickness skin loss
4: Full thickness skin and tissue loss
Unstageable: Obscured full thickness and loss
Deep Tissue: Persistent deep red discoloration
Pressure Injury RF
Intrinsic Factors: decreased sensation, mobility, incontinence, activity levels, nutritional status
Extrinsic factors: pressure, shear, friction, moisture
Pressure Injury Lab values
Hemoglobin, hematocrit, prealbumin, total protein
CVD Signs & Symptoms & biomarkers
Biomarkers: BP, PVC, LDL
-edema, heart attack symptoms
Aging and CVS
Quiz: Cyanosis, decreased HR, increased cholesterol
-reduction in function, myocytes, capillary density
-Atheroscerlosis
-Arterial walls stiffen with age and become dilated, loss of elasticity
Gender Differences CVS
Women (more): mitral valve prolapse, fatal arrhythmias, increased bleeding episodes
Metabolic Syndrome
-3/5
1. Waist circumference
2. Reduced HDL <40 and 50
3. High BP
4. High BG >100
5. Elevated triglycerides >150
Ateriosclerosis
group of diseased of thickening and loss of elasticity of arterial walls
- Atherosclerosis: plaques of fat in inner layer
- Monckeberg Arteriosclerosis: middle layer destruction from calcium diposites
- Arteriolosclerosis: thickening of walls of small arteries
PCI
-Percutaneous coronary intervention
-balloon in LCA
CABG
-coronary artery bypass graft
-saphenous graft
Coronary Stent
-stent to open artery and move plaque
Adrenergic receptor agonist
orthostatic hyotension; hypertension
Adrenergic receptor antagonist
-hypertension
ACE inhibitor
-heart failure, hypertension
Angiotensin II blockers
-heart failure, hypertension
Beta blockers
-angina, arrhythmias, hypertension, heart failure
Antiarrhythmics
-arrhythmias and heart failure
Direct Renin Inhibitiors
hypertension
Calcium channel blockers
angina, hypertension, arrhythmias
Hemostatics
Excessive bleeding
Cholesterol-modifying agents
-CHD prevention, dyslipidemias, high cholesterol, arterosclerosis
Antidiuretics
-central diabetes
Diuretics
Heart failure, hypertension, edema
Phosphodiesterase inhibitors
-pulmonary arterial hyperension
Vasodilators
angina
Angina Pectoris
-workload exceeds o2 supply to heart and demand
-pain discomfort in chest
Hypertensive CVD
Primary (idiopathic), secondary (cause), Malignant (target organ damage)
Myocardial Infarction
Type 1: atherosclerotic plaque
Type 2: Mismatch between o2 supply and demand, no plaque
Orthostatic Hypotension
-decrease in BP 20 with pulse increase standing from sitting
Arrhythmias
-HR disturbance from SA node
Rheumatic Fever
-endocarditis from strep may lead to heart disease
Aneurysm
-stretching of BV 50% or more
-most common in abdominal aorta
-abdominal and low back pain
Thrombophlebitis
-deep vein thrombosis
-pulmonary embolism: DVT breaks lose and travels to heart, most common hospital readmission and death
-varicose veins: dilation of veins with incompetence of valves
-swelling of vein from clot
Lymphatic System
-one way system to cary filtrate, pressure driven
-absorb macros, maintain fluid balance, fight infection, removal of debris
Lymphedema
-accumulation of water and proteins in tissue leading to tissue fibrosis and swelling
-goal to put fluid back into ducts
-Primary (idiopathic) or Secondary (acquired: filariasis (most common in world) from parasitic worm, radiation, surgery, cancer(most common cause of secondary in US)
-Stage 0 to Stage III (elephantiasis)
RUE Lymphatics
-drain into right lymphatic duct
LUE Lymphatics
-drain into left subclavian vein
-3/4ths of flow
Superficial Lymphatic vessels
-rely on osmotic pressures
Deep lymphatic vessels
-venous pumps from muscles
Initial lymphatics
-lymphatic capillaries
-1 cell thick
Lymphatic valves
Lymphangion: segment of vessels btwn valves
-prevent backflow
Lymphatic trunks
-increase in size gradually
Lymph Vessel network
-contracts rhythmically
-embedded in fatty ttissue
-ANS innervation
-high pressure can deteriorate walls
-backflow of lymph causes lymphedema
Lymph Nodes
-filter, adjust fluid concentration, produce lymphocytes and macrophages
-100x the normal resistance
Lymphedema PT Implications
-consider effects on skin and structures
-check lymph nodes (immobile, increase in size, enlarged)
Lymphangitis
inflammation of lymphatic vessels
-usually due to strep
Lymphadentits
inflammation of lymph nodes
-infections in the body
Acute: LN enlarged
Chronic: scarred LN with fibrous CT
Lymphedenopathy
enlargement of lymph nodes
Normocytic Anemia
normal size
Macrocytic Anemia
abnormally large
Microcyic Anemia
abnormally small
Normochromic
normal amounts of hemoglobin
Hyperchromic
high hemoglobin
Hypochromic
low hemoglobin
Anisocytosis
various sizes
Poikilocytosis
various shapes
Destruction of RBC
-hemolysis
-congenital or acquired
Decreased Production of RBC
- Low erythropoietin
- Lack of response to EPO
- Nutrition deficiency: Fe, B12, folate
- Anemia of chronic disease (ACD): inflammation
- Chronic kidney disease
- Bone marrow disorders
- Radiation induced bone marrow failure
Anemia PT Implications
-less exercise tolerance
-fatigue
-vital signs
Primary Hemostasis
-platelet plug for blood clotting
- need platelets and von willebrand factor
-easy bruising and mucosal bleeding
Thrombocytopenia
-decreased platelets below 150,000
Secondary Hemostasis
-vascular damage exposes tissue factor
-necessitates the presence of clotting factors
-hemophilia A (80%, lack of CF 8) and B (15%, lack of CF 9)
-serious bleeding
Mild Hemophilia
-15%
-spontaneous hemorrhages
-need trauma
Moderate Hemophilia
-15%
-minor trauma
Severe Hemophilia
-60%
-spontaneous bleeding or slight trauma
-joints and muscles
UTI
-ecoli
-most common infection in hostpitals
-pain in suprapubic, lower abs, flank
-catheter care
Pyelonephritis
-urine backs up into renal pelvis
Acute: ecoli, abrupt, flank pain over costovertebral angle
Chronic: vesicoureteral reflux
Renal Neoplasms
-Renal cell (most common): resistant to chemo
1. Clear cell
2. papillary
-urothelial carcinoma
-renal sarcoma
-wilms tumor
-renal lymphhoma
Metastasizes to sternum
Renal Calculi
-nephrolithiasis
-Calcium most common
-colicky pain from groin to flank
-hematauria
Chronic kidney disease
-decreased GFR <60 for 3 months
RF
-diabetes
-high BP
-neuropathy
Signs
-hyperglycemia
-angiotensin II (vasoconstriction)
-elevated BUN and creatine
Stages of CKD
G0 >90: reversible
G3a 45-59: increases albumin
G4 15-29: proteinuria
G5 <15: uremia
Hemodialysis
-arm
-requires BV merging (fistula)
Peritoneal Dialysis
-ambulatory or cycling
-peritoneum
Sensory and motor control of Detrusor
-parasympathetic
-pelvic nerve
Control of PV
-pudendal
-somatic motor
Most common Pelvic disorder in PT
-chronic pelvic pain syndrome
Acute Bacterial prostatitis
-infection of prostate
-bacterial, viral, std
-issues with voiding
Chronic Prostatitis
-recurrent infection
-sexual dysfunction
IIIA: dysfunction with inflammation, no infection
IIIB: dysfunction w/o inflammation or infection
Asymptomatic Prostatitis
-WBC in semen and prostate
Benign prostatic hyperplasia
-decreased cell death
-hyperplasia
-Rectal exam or PSA test
Prostate Cancer
-adenocarsinoma (most common)
Hypoxemia
-lack of o2 of arterial blood
-most common pulmonary condition
-hypoxia
Pneumonia
-aspiration, chemicals or infections
-most common hospital acquired infections
-mostly viral and non life threatening
-preceded by an infection
-rust colored spitum (bacterial)
-watery (viral)
Acute Bronchitis
-inflammation of trachea and bronchi
-viral
COPD
-preventable and treatable
-airflow limitation to airway and alveoli due to loss of competency or increased mucus
-environmental
- chronic bronchitis
- emphysema
Chronic Bronchitis
-productive cough lasting 3 months for 2 years
-scarring of bronchus, obstruct airways
Emphysema
-enlargement of air spaces and loss of elasticity
-centriacinar (most common)
Asthma
-inflammation and bronchoconstriction and airflow resistance
Extrinsic (allergic: t cells, IgE) intrinsic (nonallergic)
Sleep Apnea
-obesity related
-obstructed (most common): daytime symptoms too
Adverse Drug Event
-Injury due to meds
-Dose related (predictable)
-Non-dose related (unpredictable)
Drug-Drug interaction
- drugs react unfavorably
Drug-Disease
-worsen existing disease
Side effects
-occur within therapeutic dose ranges
Overdosage toxicity
-predictable toxic effect
Mild Overdose
-altered tasted, anxiety, dizziness, shakiness
Moderate Overdose
-cramps, dyspnea, hyper or hypotension, heart issues
Severe Overdose
-arrythmia, seizures, edema, hypotension, cardiac arrest
Rheumatoid Arthritis
-autoimmune of synovial tissue
-osteoporosis, nodules, heart issues, dry eyes, nerve neuropathy, weight loss
Sepsis
-organ dysfunction due to infection
-can also be caused from non-infection and immune response
-Septic shock: circulatory shut down with hypotension
-elevated lactate, acidosis, low WBC
Multiple organ dysfunction syndrome
-most often caused by sepsis
-complications of disease
-common cause of death
-Increased BUN, lactate, low WBC, low platelets, acidosis
pH maintenance
-7.35-7.45
- blood buffer systems
-excretion of carbonic acid from lungs
-excretion of bicarbonate by kidneys
Co2 increases/decreases = respiratory acidosis (hypoventilation and CO2 retention)/alkalosis (hyperventilation; pulmonary or non)
