Integumentary disorders

Question 1

5 layers of epidermis

Answer 1

Stratum corneum - Luciderm - granulosum - spinosum - basale

- Vit d produced in last 2, nutrients and fluid diffuse to epidermis via blood vessels in the dermis

Question 2

Dermis

Answer 2

• connective tissue (elastin and collagen)
• nerve endings, lymph and blood vessels
• receptors for pain, pressure, heat, & cold

Question 3

Functions of skin

Answer 3

First line of defense! innate immunity

• prevents excessive fluid loss
• controls body temp
• sensory info against environmental hazards
• synthesizes ad activates Vit d

Question 4

Older adults

Answer 4

• flattening of the basement membrane
• loss of elastic fibers
• weakened collagen
• decreased subcutaneous fate
• thinner stratum corneum

Question 5

Skin lesion treatment

Answer 5

• antihistamine (itching)
• local wound care
• systemic meds if severe
• surgical removal

Question 6

Descriptive information

Answer 6

Location of skin lesion

• length of time lesion has been present
• change that have occurred over time
• physical appearance: color, elevation, texture, type of exudate, presence of pain or pruritus

Question 7

Pressure injury

Answer 7

Prolonged pressure on bony prominence, friction, shearing, maceration, dehydration, malnutrition, poor circulation
- 2 hrs in bed, 15 min in chair, 35 degree S-L, head of bed < 30 degree

Question 8

Pressure injury stages

Answer 8

1. Alteration in intact skin temp, consistency, sensation, persistent redness
2. Loss of epidermis/dermis, blister abrasion, partial thickness
3. Full thickness / subcutaneous, deep crater
4. Full thickness, necrosis, muscle, bone, tendon, capsule
   - unstageable: Escher / necrotic tissue requires debridement
   - deep tissue injury

Question 9

Treatment of pressure injury

Answer 9

• pressure relief
• wound care: clean, debride, infection control, moisture balance, nutrition, address circulation
• exercise
• hi volt e stim

Question 10

Diabetic (neuropathic) wounds

Answer 10

• typically on the plantar surface
• callus common on wound edge
• tunneling common
• foot deformities contribute to excess pressure
• decreased “protective sensation” leads to lack of feeling irritants

Question 11

Diabetic wounds

Answer 11

1. Risk factors
   - poorly controlled blood sugars
   - poor nutrition
   - obesity
   - peripheral neuropathy
2. Testing: monofilament for protective sensation

Question 12

Treatment of diabetic wounds

Answer 12

1. Prevention of infection
2. Off loading
3. Surgical debridement
4. Growth factors
5. Manage blood glucose levels

Question 13

Venous wounds

Answer 13

• venous insufficiency
• gaiter area of leg
• edema
• superficial wound (no tunneling)
• lots of drainage
• common with severe lymphedema

Question 14

Treatment of venous wounds

Answer 14

• wound care
• compression
• treat underlying medical conditions (fluid control and infections)

Question 15

Arterial wounds

Answer 15

• caused by poor blood perfusion
• dry wound bed
• gangrene
• punched out wound edge
• DO NOT COMPRESS
• many require vascular surgery to restore blood flow
• high amputation risk

Question 16

Inflammatory skin disorders

Answer 16

A broad category that includes many conditions, ranging in severity from mild to itching to serious medical health complications

Question 17

Treatment of inflammatory skin disorders

Answer 17

• refer to physician (meds and phototherapy)
• identify and remove irritant
• apply emollients

Question 18

Auto-immune: psoriasis

Answer 18

• chronic inflammatory skin disorder of unknown origin
• onset usually occurs in the teen years
• has remissions and exacerbations
• lesions are commonly found on the face, scalp, elbows, and knees

Question 19

Auto-immune: scleroderma

Answer 19

• a group of rare, progressive diseases that involve the hardening and fighting of the skin and connective tissues
• may occur as a skin disorder, or it may be systemic, affecting the viscera
• excess collagen
• unknown cause

Question 20

Eschar

Answer 20

• a slough or dead tissue that sheds from healthy skin

- eschar may be shed naturally or with debridement to prevent infection

Question 21

PT interventions

Answer 21

1. Debridement / wound care
   
   • remove eschar and non-viable tissue
   • sharp debridement, autolytic, enzymatic, mechanical, maggots
2. Techniques to increase ROM/function
   
   • stretching, splinting, positioning, compression
3. Techniques to increase muscle strength/function
   
   • exercise
   • assess for appropriate assistive devices

Question 22

Pressure garments

Answer 22

• control edem and the formation of hypertrophic scars by applying pressure to the wounded area
• aid in reducing the effects hypertrophic scarring there by reducing scarring and deformities

Question 23

Have you made these connections?

Answer 23

1. S&S = impairments
2. Healing is predictable (time and sequence)
3. Diagnosis does not equal acuity

Question 24

Cellulitis

Answer 24

• common, potentially serious bacterial skin infection
• swollen, red area of skin, feels hot and tender, may spread rapidly
• occurs when one or more types of bacteria enter through a break in the skin
• typically caused by staph or strep
• can occur at any location on the body, but is most common in the lower legs

Question 25

Impetigo

Answer 25

Highly contagious infection, spread by direct contact with hands, eating utensils, and towels

• usually caused by staph or strep
• commonly on the face
• presents as small vesicles that develop into yellowish-brown crusts that is red beneath they crust and exudes a honey colored liquid
• treatment includes topical antibiotics in the early stages