Integumentary Flashcards
How long should pressure garments be worn for burn injuries (that take 2 weeks or more)
23 hours/day for several months to 2 years
Optimal temp/environment for wounds
NOT too cold or dry b/c want to have a somewhat moist wound bed. Find the balance
Alginate
Seaweed good for hemostasis,
Good for mod-high exudate, heavy drainage
Good for infection (b/c not occlusive), so gives “breathing room”
Autolytic debridement
Infected, pressure, venous wounds (wet)
Requires second dressing
Non adhering
Similar to hyrdofiber
Transparent film
Friction reduction
Not good for infection or
hemostasis
Good for visualization
Works for autolytic debridement of DRY wound
Hydrocoloid
Most OCCLUSIVE which is…
GOOD for moisture and autolytic debridement of necrotic tissue
BAD for infection because it traps bacteria
for partial and full thickness. Low to mod exudate
Good for dry wounds
Does not require second dressing
Foam dressing
For mod amounts of exudate and drainage AND it is occlusive
Also used as secondary over hyrdogels
enables debridement and moisture environment
Less capacity
ADHERING, traumatizing periwound
Hydrogel
Water and gel mix
Good for dry wounds
Only for SUPERFICIAL wounds (abrasion, blister, pressure ulcer)
Promotes moist wound bed (obviously cause water)
Used as coupling agent for ultrasound
OCCLUSIVE so NOT good for infections
Usually secondary for drainage because it is not moisture retentive
Low Wound irrigation
helps with infection
Sharp debridement.
- Sharps debridement is contraindicated for wounds with tunneling. 2. Sharps debridement is contraindicated for wounds with dry eschar. 3. Option 3 is the correct answer. Vascular wounds with necrotic tissue and eschar are appropriate for sharp debridement performed by a physical therapist. 4. Sharps debridement is contraindicated for arterial insufficiency wounds.
b/c too deep
Cold pressure lase therapy
and
Hyperbaric oxygen therapy
Diathermy
This treatment intervention would be more appropriate for neuropathic wounds
This treatment intervention would be more appropriate for pressure ulcers and neuropathic wounds.
Diathermy for chronic wounds
NPWT
Negative pressure wound therapy Based on the case description this treatment intervention would be most appropriate, in order to facilitate increased granulation and wound edge approximation.
SKin rashes diff dx
Lyme disease. Incorrect. A bull’s eye rash, pain, and malaise are signs and symptoms, which are more consistent with this condition.
- Psoriasis. Incorrect. The appearance of erythematous plaques covered with a silvery scale is more consistent with this condition.
- Tinea corporis. Correct. The characteristics of a ring-shaped rash is most consistent with Ringworm. Based on the patient case, transmission of this fungal infection most likely occurred from her dog.
- Tinea pedis. Incorrect. Itching and erythema would present on the foot, typically between the toes, not the shoulder.
Scleroderma
his includes a history of Raynaud’s, an elevated ESR, as well as decreased sensation, which are consistent with scleroderma and ofc hardened skin
Fadir
Faber
For impingement of hip and piriformis
For hip impingement, lower back, SI
Types of headaches
Cervicogenic Headache. Incorrect. Decreased range of motion, a forward head posture, pain which starts at the occipital region and spreads anteriorly are more consistent with this diagnosis.
- Cluster Headache. Incorrect. Pain behind the eye, with nasal congestion and facial sweating is more consistent with this diagnosis.
- Migraine. Correct. Visual changes with aura described as spots, balloons, lights and colors, are common in individuals who experience migraines. Common triggers include lack of sleep, stress, stress and medication changes.
- Tension Headache. Incorrect. Dull pressure, ‘band-like’ tightness around the head and upper cervical muscle tenderness are more consistent with this diagnosis.
Uncontrolled diabtes vs diabetic ketoacididosis
Unas boot
provides LE support and is a dressing
Pressure injury stages
Stage 1: Nonblanchable, Intact skin, localized erythema, changes in sensation, temp
Stage 2: Partial thickness skin loss with exposed dermis, Viable, pink, red wound bed, may have intact or not intact blistering. NO granulation, slough tissue, or eschar present
Stage 3: Full thickness skin loss. Adipose and granulation tissue, epibole (rolled edges), undermining and tunneling maybe. Still not soft tissue structures
Stage 4: Exposed or palpable fascia like muscle tendon or bone, slough and eschar, epibole. Cannot stage if covered in slough or eschar (necrotic tissue) D
Unstageable: stage 3 or 4 but cant stage due to eschar or slough.
IF STABLE ESCHAR ON HEEL, DO NOT REMOVE. may need afo and heel cusion
Deep tissue pressure injury. looks like what it sounds. Looks like stage 1 or may not be intact and have dark wound bed. Due to intense or prolonged shear forces at bone muscle interface.
Darker skin
May be purple instead of read if erythmea
If eschar
Cannot stage
Granulation tissue
New red, connective tissue,
happens in proliferation phase days 5-21
Epitheliazation
layers of skin cells begin also in proliferative phase
Arterial dry wound
Hydrogel, hydrocolloid
b/c not infected but dry
Impregnated gauze
has iodine or petrolatum
for “packing”
chronic wounds
Regular gauze
secondary
For venous Stasis/insufficiency wounds
Calcium alginate
Hydrofibers
Enzymes
CollagenASE
panafil (causes green tinge)
Growth factors
for tissue building
Maceration
skin too moist pruny
Primary intention
Surgeon stitches it up
Secondary intension
Natural healing
Tertiary
Delayed closure due to major issue
Tilt in space
Prevents pressure injuries
Shingles = herpes zoter
Narrow band along dermatome
Comes from chicken pox first
Dermis
Strong but low stiffness
Highly vascularized
Partial thickness vs full thickness wound healing
partial thickness: epithelization b/c skin regrowing superficially
Full thickness: b/c all of dermis is gone, granulation occurs and fills with collagen matrix, more scar tissue, fibroblasts fill in space. Bottom up healing cant let the top close
Rule of 9s
Arms= 9 total (4.5x2)
Legs = 18 total (9x2)
Trunk = 36 total (18x2)
Head = 9 total (4.5x2)
Genitals = 1 percent
Diff with child is head is 18 total
and LE is 14 total
Positioning
Avoid contractures
e.g ant surface of neck, stay in neutral so no flexion contracture
HEAL IN SKIN STRETCHED POSITION
Most painful burn
Superifical partial thickness
Blisters in
superficial partial-thickness and deep thickness
Painful but not as detecting
3rd degree burn is now
Painless (except surrounding areas)
Saline vs
- When a wound is suspected of being infected or having a bacterial colonization, irrigation with an antiseptic or antimicrobial is indicated. Saline is appropriate for a wound with NO signs of infection.
On the other hand
Iodine, Chloride like hydrogen peroxide and alcohol are better for infections
Total contact casting
- Body build is related to bone fragility, with thin patients having less cortical bone and a higher risk for fracture.
Dont forget nerve flossing
. The patient has symptoms consistent with a tibial nerve entrapment at the tarsal tunnel. A common intervention for a nerve entrapment is nerve gliding/flossing. Repeated passive ankle dorsiflexion with eversion is a nerve gliding/flossing technique that is appropriate for the tibial nerve. (
Utilize a moisture-retentive dressing
Explanation:
Moist wound healing:
Moisture-retentive dressings are the gold standard for promoting wound healing because they:
Create an optimal healing environment.
Facilitate cellular activity, such as fibroblast migration and angiogenesis.
Reduce the risk of desiccation and maintain adequate oxygen and nutrient flow.
Minimize pain by preventing the wound from drying out and forming painful scabs.
