Integumentary disorders Flashcards
5 layers of epidermis
Stratum corneum - Luciderm - granulosum - spinosum - basale
- Vit d produced in last 2, nutrients and fluid diffuse to epidermis via blood vessels in the dermis
Dermis
- connective tissue (elastin and collagen)
- nerve endings, lymph and blood vessels
- receptors for pain, pressure, heat, & cold
Functions of skin
First line of defense! innate immunity
- prevents excessive fluid loss
- controls body temp
- sensory info against environmental hazards
- synthesizes ad activates Vit d
Older adults
- flattening of the basement membrane
- loss of elastic fibers
- weakened collagen
- decreased subcutaneous fate
- thinner stratum corneum
Skin lesion treatment
- antihistamine (itching)
- local wound care
- systemic meds if severe
- surgical removal
Descriptive information
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
Pressure injury
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
Pressure injury stages
- Alteration in intact skin temp, consistency, sensation, persistent redness
- Loss of epidermis/dermis, blister abrasion, partial thickness
- Full thickness / subcutaneous, deep crater
- Full thickness, necrosis, muscle, bone, tendon, capsule
- unstageable: Escher / necrotic tissue requires debridement
- deep tissue injury
Treatment of pressure injury
- pressure relief
- wound care: clean, debride, infection control, moisture balance, nutrition, address circulation
- exercise
- hi volt e stim
Diabetic (neuropathic) wounds
- 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
Diabetic wounds
- Risk factors
- poorly controlled blood sugars
- poor nutrition
- obesity
- peripheral neuropathy - Testing: monofilament for protective sensation
Treatment of diabetic wounds
- Prevention of infection
- Off loading
- Surgical debridement
- Growth factors
- Manage blood glucose levels
Venous wounds
- venous insufficiency
- gaiter area of leg
- edema
- superficial wound (no tunneling)
- lots of drainage
- common with severe lymphedema
Treatment of venous wounds
- wound care
- compression
- treat underlying medical conditions (fluid control and infections)
Arterial wounds
- 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
Inflammatory skin disorders
A broad category that includes many conditions, ranging in severity from mild to itching to serious medical health complications
Treatment of inflammatory skin disorders
- refer to physician (meds and phototherapy)
- identify and remove irritant
- apply emollients
Auto-immune: psoriasis
- 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
Auto-immune: scleroderma
- 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
Eschar
- a slough or dead tissue that sheds from healthy skin
- eschar may be shed naturally or with debridement to prevent infection
PT interventions
- Debridement / wound care
- remove eschar and non-viable tissue
- sharp debridement, autolytic, enzymatic, mechanical, maggots
- Techniques to increase ROM/function
- stretching, splinting, positioning, compression
- Techniques to increase muscle strength/function
- exercise
- assess for appropriate assistive devices
Pressure garments
- 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
Have you made these connections?
- S&S = impairments
- Healing is predictable (time and sequence)
- Diagnosis does not equal acuity
Cellulitis
- 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
Impetigo
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
