Integumentary

Question 1

Anticipated deformities based on burn location

Answer 1

Neck: flexion, possible lateral flexion
Chest and axilla: shoulder ADD, extension, internal rotation
Elbow: flexion and pronation
Wrist: flexion
Hip: flexion and ADD
Knee: flexion
Ankle: PF

Question 2

Rule of Nines

Answer 2

Head and neck: 9
Anterior chest and trunk: 18
Posterior chest and trunk: 18
Anterior UE: 9
Posterior UE: 9
Genitals: 1
Anterior UE: 18
Posterior UE: 18

Question 3

Burns Classifications

Answer 3

Superficial: outer dermis, slight edema

Superficial partial thickness: epidermis and some dermis, blistering, painful

Deep partial thickness: epidermis and most of dermis, mod painful due to damaged nerve endings

Full thickness: epidermis, dermis, and some subcutaneous (requires skin grafting, pt at risk of infection)

Subdermal: epidermis, dermis, subcutaneous including bone and muscle (requires skin grafting and surgery)

Question 4

Wound Classification By Depth

Answer 4

Superficial: epidermis

Partial thickness: epidermis and some dermis

Full thickness: epidermis and dermis, some subcutaneous tissue such as fat

Subcutaneous: epidermis, dermis, and subcutaneous tissue including deep structures

Question 5

Pressure Classification

Answer 5

Stage 1: Non blanchable erythema (skin intact)

Stage 2: Superficial (blisters, painful)

Stage 3: Partial thickness (skin loss), exposed dermis, adipose not exposed

Stage 4: Full thickness skin loss (epibole, tunneling), adipose exposed, fascia and subcutaneous structures not exposed

Unstageable (eschar and slough covers depth)

Deep Tissue: deep red, maroon, or purple discoloration

Question 6

Dressings (Most/Least Occlusive)

Answer 6

Hydrocolloids
Hydrogel
Semipermeable foam
Semipermeable film
Impregnated gauze
Alginates
Traditional gauze

Question 7

Dressings (Most/Least Absorptive)

Answer 7

Alginates
Semipermeable foams
Hydrocolloids
Hydrogels
Semipermeable films

Question 8

Bandages

Answer 8

Long stretch:
- ACE wraps
- used for acute MSK sprains
- high extensibility
- high resting pressure, low working pressure
- use compression to while the pt is resting to move fluid back to the heart

Short stretch:
- used for venous disease and lymphedema
- assist muscle pump action of the calf muscles while pt is active
- high working pressure, low resting pressure

Question 9

Wagner Ulcer Grading Classification Scale

Answer 9

0: no open lesion (pre-ulcerative)
1: superficial
2: involves subcutaneous tissue, can see exposed tenon, bone, ligament, capsule
3: osteitis, abscess, osteomyelitis
4: gangrene of digit
5: gangrene requiring disarticulation

Question 10

Arterial Ulcers

Answer 10

lower 1/3 of leg, toes, web spaces, distal toes, dorsal foot, lateral malleolus
minimal exudate
very painful
decreased/absent pedal pulses
smooth edges
usually deep
normal (no edema)
decreased skin temp (cool)
shiny, thin skin, hair loss, yellow nails
*leg elevation increases pain

Question 11

Venous Ulcers

Answer 11

medial malleolus
mod-heavy exudate
min-mod painful
normal pulses
irregular edges
usually shallow
increased edema
normal skin temp
flaky, dry skin, brownish discoloration
*leg elevation decreases pain

Question 12

Neuropathic Ulcers

Answer 12

areas of the foot susceptible to pressure or shear forces during WB
low-mod exudate
well-defined oval/circle, callused rim with cracked periwound
diminished/absent pulses
no pain, but dysesthesia may be reported
little to no necrosis with good granulation
decreased skin temp
dry, inelastic, shiny skin; decreased or absent sweat and oil production
*loss of protective sensation

Question 13

Monofilament Grading

Answer 13

0: loss of sensation
1: loss of protective sensation/deep pressure sensation only
2:
3: loss of protective sensation
4: diminished protective sensation
5: diminished light touch (protective sensation preserved)
6: normal

*failure to perceive 10gm monofilament = loss of protective sensation
*failure to perceive 75gm monofilament = loss of sensation

Question 14

Cellulitis

Answer 14

fast-spreading inflammation that occurs as a result of a bacterial infection of the skin and connective tissues

localized redness that may spread quickly, warm/hot skin, local abscess or ulceration, TTP, fever/chills, malaise

Question 15

Contact Dermatitis

Answer 15

superficial irritation of skin resulting from localized irritation (poison ivy, soap, lotion, latex)

intense itching, burning, and red skin corresponding to the location of topical irritation; can potentially spread past point of exposure

Question 16

Eczema (dermatitis)

Answer 16

a group of disorders that cause chronic skin inflammation typically due to an immune system abnonrmality, allergic reaction, or external irritant

most common in children and the elderly

red/brown itchy skin plaques that may be exacerbated by some topical agents such as soaps or lotions, can ooze or crust (younger populations)

Question 17

Gangrene (dry and wet)

Answer 17

dry: loss of vascular supply that leads to local tissue death
- dark brown/black nonviable tissue that eventually becomes hardened/mummified, cold, numb, hardened skin not painful (may be painful at the line of demarcation), develops slowly, may autoamputate

wet: an associated bacteria in the affected tissues
- may also develop as a result of an infected untreated wound
- tends to spread quickly and become can become fatal
- swelling and pain at site of infection, red to brown to black skin color changes, blisters that produce pus, fever, malaise

Question 18

Tinea Pedis (athlete’s foot)

Answer 18

superficial fungal infection which causes epidermal thickening and a scaly skin appearance
- itching, redness, peeling skin between the toes, odor, breaks in skin continuity
- can rapidly multiply in a warm and moist env

Question 19

Onychomycosis

Answer 19

fungal infection that primarily affects toenails and nailbeds
- yellow or brown nail discoloration, hyperkeratosis and hypertrophy of nail causing it to partially detach from nail bed

Question 20

Psoriasis (Plaque)

Answer 20

chronic autoimmune disease of the skin and is the most common of the five types of psoriasis
- red raised blotches, bilateral, itchy and flaky
- complications: arthritis, pain, severe itching,, secondary skin infections, side effects to secondary pharmacological interventions