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Integumentary infections Flashcards

1
Q

Atopic dermatitis: Definition

A
  • chronic or relapsing inflammatory skin disease
  • Characterized by pruritus
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2
Q

Atopic dermatitis Risk factors

A
  • Multifaceted - include genetic, immunologic and environmental factors
  • Family history and aberrant skin barrier gene coding
  • Can go along with allergic reaction sometimes
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3
Q

Atopic Dermatitis: clinical manifestations

A
  • rash: Red, oozing, crusting, mainly on flexor side
  • Xerosis: dry skin
  • Pruritus: itching
  • Typically rash spares diaper area
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4
Q

Atopic dermatitis: medical management

A

Medical management
- Topicals (lanolin): coat the skin to add protection
- Systemic medications (antibiotics, antihistamines, antimicrobials, corticosteroids, immunosuppressants, nonsteroidals)
- UV irradiation: dries out the skin
- Education: controlling and minimizing triggers
- Goal of treatment: break inflammatory cycle causing dryness, cracking, itching and scratching

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5
Q

Atopic dermatitis: PT concerns

A
  • Caution with modalities, gels, creams, soaps, cleansers
  • Avoid agents containing alcohol as it can dry out the skin making it crack/open to further infection/irritation
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6
Q

Contact dermatitis: definition

A

a local inflammatory reaction due to external exposure

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7
Q

Contact dermatitis: risk factors

A

immunocompromised

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8
Q

Contact dermatitis: Clinical manifestations

A
  • Erythema: reddening of skin
  • Pruritus
  • Edema
  • Wheals
  • Maculopapular vesicles
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9
Q

Medical management of contact dermatitis

A
  • Examination, patch testing for allergens, topicals, antihistamines
  • Removal of agent
  • Similar to AD
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10
Q

PT concerns for contact dermatitis

A
  • Prosthetics, silicone, gels, lotions, soaps, cleaning products
  • Learn what to avoid
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11
Q

Eczema and dermatitis: definition

A

periods of remittance and relapse of superficial itch, inflammation of the skin

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12
Q

Eczema and dermatitis types

A
  • Types: seborrheic (scalp), nummular (discoid = disc shaped), and stasis dermatitis (related to circulation usually)
  • relapsing/remitting
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13
Q

Eczema and dermatitis: risk factors

A

Risk factors:
- Common in children and adults
- Can be genetic
- Medications
- Stasis dermatitis = venous hypertension/venous insufficiency)

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14
Q

Eczema and dermatitis: Clinical manifestations:

A

Discoid lesions, circular
Red itchy patches

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15
Q

Eczema and dermatitis: Medical management:

A
  • Topical to bring down the superficial irritation
  • Regulation BP/cholesterol if its related to circulation
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16
Q

PT concerns for eczema and dermatitis

A
  • modalities can irritate
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17
Q

Rosacea:
Definition

A

chronic facial disorder of middle-aged and older people; condition caused by vascular and inflammatory componenets)

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18
Q

Rosacea: Risk factors:

A

no known cause

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19
Q

Rosacea: Clinical manifestations:

A
  • Acneiform rosacea can occur with papules (oil in it), pustules and oily skin
  • Cheeks, nose and chin have persistent rosy appearance
  • Pustules, papules, burning or stinging
  • Fascia edema
  • Certain things may cause it to flare up
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20
Q

Rosacea: Medical management:

A
  • Topical or systemic therapy
  • Pulsed dye lasers to seal superficial vessels and help with discoloration
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21
Q

Incontinence-associated dermatitis:
Definition:

A

damage from chronic exposure to urine of feces

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22
Q

incontinence-associated dermatitis:
Clinical manifestations:

A
  • Person may be uncomfortable in seated position or positions that put pressure on genital area
  • Burning, itching or tingling
  • Erosion of skin and maceration
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23
Q

incontinence-associated dermatitis: Medical management

A
  • Gentle cleaning, moisture barrier cream, pressure relief
  • High-grade moisture-wicking underpads
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24
Q

Skin bacterial infections

A
  • Impetigo contagiosa - contagious
  • Pyoderma - contagious
  • Folliculitis (pimple/boil) = contagious but minimal chance of spread
  • Cellulitis - contagious
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25
Skin viral infections
- Verrucae (warts) - contagious, self inoculable - Verruca plantaris (plantar wart) - contagious; self inoculable - Herpes type 1: cold sore = contagious - Herpes 2: genital = contagious - varicella -zoster virus: contagious (chickenpox)
26
Skin fungal infections
- Tinea corporis (ringworm): person to person, animal to personal, object to person - Tinea capitis (scalp) = person to person, animal to person - Tinea cruris (jock itch) = person to person, animal to person - Tinea pedis (athletes foot) = transmission to other people rare - Candidiasis = person-person; transmitted during birth from mother to neonate
27
Impetigo definition
superficial skin infection, highly contagious, more in children 2-6 or older adults commonly caused by staph or strep.
28
Impetigo: risk factors
Risk factors: - Poor hygiene - Close contact - Malnutrition - Minor skin trauma
29
Impetigo Clinical manifestations:
- Erythematous macules (flat spots) that develop into papular lesions of vesicles (small blisters) - Become pustular (pus-filled) - Itching and scratching of vesicles after they break/crust
30
Impetigo Medical management:
- Self-limiting with good hygiene - Topical and or systemic antibiotics (cover both staph/strep)
31
PT concerns for impetigo
highly contagious
32
Cellulitis: Definition:
rapidly spreading bacterial infection of skin and subcutaneous tissue most common in extremities
33
cellulitis: risk factors
Risk factors: Immunocompromised Older adults Venous insufficiency Thrombophlebitis Obesity Surgery Substance abuse Open wounds
34
cellulitis Clinical manifestations:
Pain Erythema Edema Elevated temperature of affected skin fever/chills Malaise Most commonly affects extremities
35
cellulitis: Medical management:
Intravenous antibiotic infusion Debridement
36
Cellulitis: PT concerns:
Monitor progression Education Wound care
37
Warts (verrucae) Definition:
common, benign viral infections of skin and adjacent mucus membranes caused by human papillomaviruses
38
Warts verrucae: Risk factors:
Usually direct contact
39
Warts Verrucae: Clinical manifestations:
Depends on type and location Verruca vulgaris (hands nad extremities) Plantar (foot) - no drainage and occur on pressure points
40
Warts verrucae: Medical management:
Diagnosis on visual exam OTC salicylic acid Surgical removal Cryotherapy Laser Chemical cautery Oral medications Immunotherapy
41
Ringworm (tinea corporis)
- fungal - scales forming circular lesions with clear centers - commonly in hair, skin or nails - Transmission with direct contact
42
Athletes foot (tinea pedis)
- peeling, itching, strong odor
43
Yeast (candidiasis)
- wet moist areas; bright red rash with tiny macules and papules, scaly
44
Medical management of fungal infections
Medical management: antifungal cream or oral antifungal medications
45
PT concerns with fungal infections
PT concerns: education hygiene
46
Parasitic infections of the skin
Scabies: highly contagious, spread by mites Lice
47
Scabies: clinical presentation
- Intense pruritus (worse at night), excoriated skin, one or more burrows with vesicle at one end - Direct or indirect contact - Flexor surface of wrist, web spaces of fingers, axilla, waistline, nipples (females), genitalia (males), umbilicus
48
Scabies: treatment
Treatment; removal of mites - scabicide ) permethrin of lidane
49
Pediculosis (lousiness) - lice/human pediculus humanus parasite
- Severe itching, eczematous changes, white or gray nits (eggs) at base of hair follicle - Spread by direct or indirect contact - Diagnosis: inspection - Treatment: disinfectant solution (shampoo or soap containing permethrin)
50
Seborrheic Keratosis - where is it? - when is it likely to occur? - Describe characteristics - treatment:
- Basal cells - Usually middle age - Waxy, smooth, or raised - After inflammatory dermatosis - Don't treat unless they become itchy/painful - Treatment: cryotherapy
51
Nev
- Aggregation of melanocytes - Usually doesn't spread bleed/itch = could be a problem
52
Benign lesions of the skin
- serborrheic keratosis - nevi
53
Premalignant lesions
- actinic keratosis (solar keratosis) - Bowen disease
54
Actinic keratosis (solar keratosis) - Caused by - incidence - characteristics - treatment
- UV rays - Nearly 100% older caucasian population - Well-defined crusty patch (3-6mm) - Treatment: 5-fluorouracil, masoprocol cream, cryotherapy, curettage (cutting out) - Avoid sun - Can be multicolored - ask have you noticed a change in this
55
Bowen Disease definition
Squamous cell in situ or SCC in situ Definition: nonmelanoma skin cancer
56
Bowen disease: risk factors
Risk factors: - fair-skinned men >50 - Sun - Chemical exposure (arsenic) - HPV - Associated with internal malignancy
57
Bowen disease clinical manifestations
Clinical manifestation Persistent, brown to reddish brown, scaly plaque with well-defined margins
58
Bowen disease: Medical management:
surgical removal, cryosurgery, curettage 5-fluorouracil
59
bowen disease: PT concerns:
Potential to become invasive and metastasize
60
Malignant non melanoma carcinoma
- basal cell carcinoma - squamous cell carcinoma
61
Basal cell carcinoma: Definition
slow growing epithelial
62
Basal cell carcinoma: Etiologic and risk factors:
Sun exposure Caucasian Head and neck
63
Basal cell carcinoma: Clinical manifestations:
Red Crusty Non-healing
64
Basal cell carcinoma: Medical management:
Biopsy Excision Chemotherapy
65
Basal cell carcinoma:PT concerns:
Potential to metastasize Caution with contamination Modalities Patient education
66
Squamous cell carcinoma: Definition and incidence:
2nd most common, epidermal keratinocytes, caucasian, ear, face, lips, dorsum of hand and nose
67
Squamous cell carcinoma: Risk factors:
Sun exposure
68
Squamous cell carcinoma: Clinical manifestations
Red to flesh colored surrounded by scaly tissue Poorly defined margins Discolored Raised and crusty over
69
Squamous cell carcinoma: Medical management - diagnosis
Biopsy CT MRI Blood work: change in WBCs
70
Squamous cell carcinoma: PT concerns:
Metastasis (lymph node) Caution with modalities and contamination education with patient
71
Malignant melanoma: definition
invasive melanomas
72
Malignant melanoma: risk factors
- UV exposure (intensity>duration) - Personal or family history of melanoma - Fair skin, light hair, blue/green eyes - Presence of marked freckling on upper back, nevi, congenital melanocytic nevi - Ultraviolet radiation exposure - Immune suppression - Genetic disorder: xeroderma, pigmentosum - Age: older adults or individuals younger than 30 - Being male
73
Malignant melanoma: Clinical manifestation:
70% from pre existing nevi Most common on head, neck, trunk, legs Raised, changing appearance, Pruritus Hyperkeratosis
74
Malignant melanoma: Medical Management
Excision Oral chemotherapy Immunotherapy
75
Malignant melanoma: PT concerns:
Potential to metastasize Caution with contamination, modalities Education with patient
76
Malignant melanoma: Types:
- Superficial spreading melanoma: 70% of all cutaneous melanomas - Nodular melanoma: most aggressive - Lentigo maligna melanoma - Acral lentiginous melanoma
77
Kaposi Sarcoma: definition
Connective tissue malignancy, 4 types - Older Mediterranean or Eastern European men (classic), - Younger African (endemic) - Organ transplant (iatrogenic), - Individuals with HIV (epidemic)
78
Kaposi Sarcoma: Etiologic and Risk Factors-
Immunocompromised, male, herpes virus
79
Kaposi Sarcoma Clinical Manifestations-
usually Leg, early- pink mistaken for bruise or nevi, later red/purple/blue macules-> ulcers, itching
80
Kaposi Sarcoma: Medical Management- (diagnosis and treatment)
biopsy, CT, MRI Tx. Antiviral therapy, chemotherapy, surgical removal, laser, cryotherapy
81
Kaposi Sarcoma: PT Concerns-
Potential to metastasize, caution with friction, and open areas. Prevent infection, education
82
Psoriasis: Definition:
Chronic genetic recurrent inflammatory dermatosis, equal general incidence across lifespan, remitting/recurring
83
Psoriasis: risk factors
Genetic link Immune system dysregulation Rapid skin turnover that can cause build up
84
Psoriasis: clinical manifestations
Well-defined erythematous plaques covered with silvery scale Does not spread
85
Psoriasis: Medical management - Dx - Tx
- Diagnosis history/presentation - Treatment: topical corticosteroids, vitamin D, UVB treatment (control flaky), oral meds - methotrexate, psoralens, retinoids
86
Psoriasis:PT concerns
Skin care Maintain mobility Complications from immunosuppressants Long term corticosteroid use
87
Lupus Erythematosus: definition
cutaneous (discoid) incidence increases with age 60-69, women: men = 10:1 Systemic women:men = 3:1 characteristic rash – butterfly rash that spreads across nose and cheeks
88
Lupus Erythematosus: Risk factors
Unknown, autoimmune defect Thought to be related to infection or genetic
89
Lupus Erythematosus: clinical manifestations
- Cutaneous (Discoid) raised, red, smooth plaques - Follicular plugging: white, oily discharge - Central atrophy - Face, scalp, ears, neck, arms - Fatigue, arthralgia, anemia, arthritis - Acute cutaneous LE, - Butterfly rash over nose and cheeks and forehead - Rash on extensor surface of arms, widespread erythema and bullous lesion (concentrated in an area and has fluid) - Cardiovascular changes, pulmonary changes live and kidney
90
Lupus Erythermatosus: medical management
- Topical - Intralesional or systemic medication - Plaquenil for pulmonary inflammation
91
Lupus Erythermatosus: PT concerns
Variable presentation Caution with exercise intensity during flares Skin care Education Watch for multisystem involvement
92
Systemic Sclerosis: definition/incidence:
Previously called scleroderma, autoimmune disease affecting connective tissue → fibrosis of the skin, joints, blood vessels and internal organs Women (3):men (1) onset around 20-50
93
Systemic Sclerosis: Risk factors
Dysfunctional connective tissue repair following injury
94
Systemic Sclerosis: clinical manifestations
- B/L non pitting edema in fingers and hands - Thick, hardening skin - change in pigmentation and skin mobility - thinning –> ulcerations –> raynauds - Mulitsystem involvement
95
Systemic Sclerosis: medical management
Difficult to diagnosis, antibody presence CT, skin presentation Symptoms management Medications Exercises, joint protection techniques Skin protection techniques Stress management
96
Systemic sclerosis: PT concerns
Possible multisystem presentation Education Maintain mobility (stress strain curve)
97
Raynaud phenomenon
Vascular vasoconstriction usually with cold exposure Sudden blanching, cyanosis and erythema of fingers and toes Hands/feet become white, numb, and then bluish During rewarming, fingers and toes become painful
98
Polymyositis and dermatomyositis: definition/incidence
Idiopathic inflammatory disease of muscle More common in women than men
99
Polymyositis and dermatomyositis: risk factors
Cause unknown, autoimmune Related to environmental or genetic factors
100
Polymyositis and dermatomyositis: clinical manifestations
- Exacerbations and remissions - characterized by symmetric and progressive proximal weakness (pelvis, neck, pahryns) - Gottron papules of gottron sign
101
Polymyositis and dermatomyositis: Medical management -diagnosis
Diagnosis difficult - progressive symmetric weakness Labs (CK) biopsy EMG
102
Polymyositis and dermatomyositis: PT concerns
Skin lesions Immunosuppressed Other system involvement Education Prevention of decreased mobility
103
Cold injuries: definition
Cold (frostbite) can be superficial or deep and hypothermia
104
Cold injuries risk factors
Prolonged exposure to cold Lack of insulating body fat Advanced age Homelessness drug/alcohol abuse Various peripheral vascular vasoconstriction disease Diabetes Altered mental status Improper clothing Improper use of cryotherapy
105
Cold injuries: clinical manifestations
- Nose, cheeks and/or ears initial vasoconstriction - Freezing with ice formation on tissues - Additional injury with thawing - Superficial: burning, tingling, numbness, swelling and mottled blue, gray skin color - Deep: skin becomes white until thawed and then turns purplish blue, produces pain, blisters, tissue necrosis and gangrene
106
Cold injuries: medical management
- Diagnosis with history and presenting symptoms - Localized superficial - Slow rewarming - Avoid rubbing or massage - Deeper or more severe needs medical treatment - topical aloe vera cream - Foam dressings to maintain moisture and provide insulation
107
Burns: defintion
68% of patients with burns are males Most occur at home Children vulnerable
108
burns: risk factors
Exposure to thermal, chemical, electrical or radiation source 25% or greater of total body surface will have systemic response
109
Burns clinical manifestations
Superficial to full thickness (down to muscle)
110
Burns: medical management
Depends on type and extent Major burn treatment 3 phases: - Emergent and resuscitation phase: right then and there of injury - Acute phase: other systems kick in - Rehabilitation phase: mobilizing
111
Burns PT concerns
- Infection - Multisystem involvement - Prevention mobility restrictions - More deep = more systemic
112
What is the burn chart used for kids called
Pediatric burn chart = pediatric scald burn/corresponding lund and browder chart
113
What other complications can arise from burns and what systems?
- Urinary: fluids maintained and need to get things out of body (look for change in urine0 - Respiratory: excess fluids puts pressure on the lungs; can also burn the lungs - Peripheral vascular: overload + swelling - Infection: increase risk - GI: exchanging in GI therefore it is in high alert with filtering
114
Pressure injuries: risk factors
- Poor health - Poor nutrition - Decrease mobility - Neuropathy - Skin perfusion - Microclimate - Prolonged pressure - Shearing
115
Clinical manifestation sof pressure injuries
Over bony prominences Circular pattern Necrotic tissue
116
Medical management of pressure injuries
- Clinical observation - Eliminate cause - Wound care - topical antimicrobials/antibiotics - Surgical removal of tissue/repair and replace tissue
117
PT concerns of pressure injuries
- Prevent breakdown - Turning schedules, wound care - Caution with transfers - Bed mobility and positioning
118
Pigmentation disorders: definition
Altered melanin primary or secondary
119
Pigmentation disorders: risk factors
External Other exogenous pigments
120
clinical manifestations of pigmentation disorders
- Hyperpigmentation pigmented nevi - Mongolian spots - Juvenile freckles - Lentigines (liver spots = darker) from sun exposure - Cafe au lait spots (flattened areas of dark skin)
121
Early melanoma detection
A: asymmetry B: borders - clear and even is good C: color - multicolored is not good D: Diameter - bigger than an eraser E: evolution - changing over time
122
Cutaneous sarcoidosis defintion
- Abnormal masses or growths (granulomas) - 20% of diagnoses get skin lesions, women, scandinavians, african americans, more serious
123
Cutaneous sarcoidosis risk factors
genetic
124
Cutaneous sarcoidosis clinical manifestations
Raised patches, deep lumps Open sores Granulomas Skin, lung, live, lymph nodes, eyes
125
Cutaneous sarcoidosis medical management
- X-ray, CT other - Corticosteroids, immunosuppressants - Methotrexate, azathioprine, hydroxychloroquine, tumor necrosis factor alpha
126
PT concerns fo cutaneous sarcoidosis
- Progression may limit motion - Fatigue - Other system involvement
127
Blistering disease: Definition:
middle aged or older adults all races, unknown cause
128
Blistering disease: Risk factors
None
129
Blistering disease: Clinical manifestations:
Formation of flaccid bullae or blisters, oral mucous membranes or scalp
130
Blistering disease: Medical management
Depends- hospitalization, symptomatic Corticosteroids, intravenous antibiotics
131
Blistering disease: PT concerns:
Protect open areas, caution with modalities, gels and creams

Medical Conditions 2 (22 decks)

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