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Intro to PT > Intro to PT Chapter 12 > Flashcards

Intro to PT Chapter 12 Flashcards

1
Q

Integument

A

Largest organ of the body
1 to 4mm thick

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2
Q

Three layers of Integument

A

Epidermis
Dermis
Subcutaneous tissue

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3
Q

Epidermis

A

.06 to .1 mm thick

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4
Q

Epidermis

thicker on soles of feet and palms of hands.

A

.6mm - stratum corneum

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5
Q

epidermis

Basal Cell layer

A

connects it to the dermus

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6
Q

Callus

A

stratum corneum

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7
Q

Keratinocytes

A

take 28 days to mature and be sloughed off after traveling through the layers.

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8
Q

Stratum Corneum and moisture

A

restricts the loss of fluid. and semi-water resistant.

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9
Q

Langerhans cells

A

The skin’s version of dendritic cells or antigen-presenting cells they are called Langerhans cells when they are in the skin for some reason. Immune response

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10
Q

Merkel cells

A

sensory recpetor cells that provide information about tactile stimuli

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11
Q

Melanocytes

A

sythesize melanin, a pigment that principally serves as a primary protection against harmful ultraviolet radiation. - transfered from melanocytes to keratinocytes.

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12
Q

Melanocytes and other locations

A

they are also present in dermis and hair folicles. and the retina of the eye.

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13
Q

Components of the epidermis that penitrate into the dermis:

A
  • Hair follicles
  • Sebacious glands
  • apocrine glands
  • eccrine glands

A basal cell layer surrounds each of these structures.

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14
Q

follicle

A

an invagination of the epidermis.
keratinization that produces three layers of cells - produces hair.

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15
Q

Sebacious glands

A

produce fatty secretions - found in association with every hair follicle.

also in general distribution, but not on soles of feet or palms of hands and the lower lip.

keep skin moisturized and pliant.

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16
Q

Aprocrine glands

A

axila and anogenital areas - oily sweat begins in puberty - oder is bacteria breaking down sweat.

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17
Q

eccrine glands

A

hypotonic sweat - hypotonic means it has a lower concentration of solutes than the fluids inside your body.

Critical in temperature regulation

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18
Q

Dermis

A

Inner layer
Fibrous and elastic connective tissue - (maintains resting arrangement of collagen) within a ground substance (provides cushion against compression.)

1-4mm thick

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19
Q

ground substance

A

water, glycosaminoglycans - proteoglycans and glycoprotiens.

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20
Q

Dermis

Other structures

A

Blood vessels, nerves, sweat and sebacious glands and hair follicles.

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21
Q

Dermis

other functions

A

provides sensory input, temperature regulation and assists in wound healing

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22
Q

Papillary dermis

A

loosely organizedcollagen matrix and is highly vascular

Junction between dermis and basal layer of epidermis (reason for all the blood vessels.)

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23
Q

Dermal Papillae

A

create epidermal ridges.

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24
Q

Fibrous collagen

A

fortification against mechanical stress while allowing for deformation.

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25
Q

Reticular Dermis

A

Dense Irregular Connective Tissue - rich in collagen and elastin

has hair follicles
Sebacoius glands and sweat glands
Sensory receptors - Pacinian corpuscles.
blood vessels
Lymphatic vessels
Fibroblasts - produce the extracellular matrix - especcially collagen.

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26
Q

arrector pili muscels

A

move hair to stand on end.

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27
Q

Subcutaneous Tissue

A

Lose connective tissue and fat
Binds deeper structures

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28
Q

Wound Healing

Inflammatory phase

A

Vasoconstriction (5-10 min) followed by vasodilation
Local edema, which could restrict motion
Lasts generally about 2 weeks.

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29
Q

Inflammatory phase

Vasoconstriction

A

5-10 min - clotting phase. Platlet clots and eventual fibrin clots.

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30
Q

Inflammatory phase

Vasodilation

A

Increased capillary permeability. Leukocytes
Neutrophils
Macrophages

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31
Q

Inflammatory phase

macrophages

A

eat wound debris, release cytokines, growth factors and collagenases.

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32
Q

Inflammatory phase

Lymphocytes

A

stimulate macrophages and fibroblasts.

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33
Q

Cronic Inflamation

A

Inflammatoryh phase that lasts more than 2 weeks

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34
Q

Proliferative phase

A

 Collagen produced by fibroblasts; provide strength to
wound
 Ground substance
 Vascular growth
 Wound contracts

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35
Q

Proliferative phase

collagen fibrils

A

formed by fibroblasts, combine and form collagen figers which supply most of the strength to the wound. don’t need a big scar to have a well healed wound.

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36
Q

Proliferative phase

Ground substance

A

composed of glycosaminoglycans, water and salts.
Occupies space between elastin, collagen, vascular structures and other cells in the healing wound.

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37
Q

Proliferative phase

angiogenesis

A

formation of new blood vessels.

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38
Q

Proliferative phase

epidermal regeneration

A

wounds that aren’t deep enough to destroy basal layer can regrow epidermis. basal cells from surface of hair follicles can play a role and lead to wound coverage.

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39
Q

Proliferative phase

wound contraction

A

aggressive contraction occurs here.
fibroblasts and myofibroblasts have contractile capabililty.
decreases the surface area of wound
causes decreased mobility in large wounds

40
Q

PT interventions for Proliferative phase

A

wound care, edema management, positioning, splinting, cautous passive ROM, AROM, ambulation, and functional activities.

stretching, strengthening, and endurance exercises may be appropriate.

41
Q

Maturation phase

A

 Normally there is balance between collagen
formation and dissolution
 Influences scar formation
 Excessive collagen forms abnormal scars
* Hypertrophic scar
* Keloid scar: extend beyond boundary of the wound; take
longer to mature
 Scar contraction; if not managed can lead to scar
contracture
 Lasts several months

42
Q

Maturation phase

hypertrophic scar

A

if deposition of collagen exceeds collagen lysis (breakdown.) Get really big scar. - associated with contracture

43
Q

Maturation phase

Keloid scar

A

extend beyond the boundary of the wound. - not associated with contracture.

44
Q

Maturation phase

Stretching and collagen

A

stretching a forming scar will cause the collagen to form along the length of the stretch - favors mobility.

45
Q

Maturation phase

Scar contraaction

A

leads to scar contracture. (permanent)

46
Q

Maturation phase

PT

A

Can be more aggressive with wound site.
Work hardening work conditioning - help individuals recover functional abilities needed for work after an injury.

47
Q

Additional considerations

A

Depth, location, size (percent total body surface
area [TBSA]), healing time, cause of disruption

48
Q

Common Conditions

Vascular compromise

A

 Arterial insufficiency
* Loss of blood flow to area - leads to tissue death - common on feet

 Venous insufficiency
* Venous blood accumulates - lead to ulceration - lower part of leg - “fibrin cuff formation” “white cell trapping”

49
Q

Common Conditions

Pressure ulcer

A

Pressure reduces blood flow and tissue dies.

50
Q

Pressure ulcer

Supine:

A

Occiput, elbows, scapulae, spinous
processes, sacrum, coccyx, heels

51
Q

Pressure ulcer

Seated

A

Elbows, spinous processes, sacrum, coccyx,
ischial tuberosities, greater trochanters, heels

52
Q

Pressure ulcer

Side-lying

A

Ear, shoulder, elbow, greater trochanters,
medial and lateral aspects of knees, medial and
lateral malleoli, heels

53
Q

Pressure ulcer

Prone

A

Forehead, nose, chin, anterior of shoulder,
iliac crest, patella, dorsal surface of foot or toes

54
Q

Trauma

Abrasions

A

Skin is scraped away through contact with a rough object or surface

55
Q

Trauma

Lacerations

A

Cuts or tears of the integument.

56
Q

Trauma

avulsion issue

A

Inguries in which much if not all of the skin and the subcutaneous tissue are separated from the underlying tissue

57
Q

Trauma

Degloving injury

A

When a avulsion issue occurs to a hand or foot.

58
Q

Trauma

Puncture wound

A

hole in skin created by a sharp pointed object

59
Q

Trauma

Burn injuries

A

include skin damage from many possible causes, such as flame, chemicals, scalding, radiation and electrical current.

60
Q

Trauma

ischemic skin damage and sensory feedback

A

Can cause injury due to loss of sensory feedback.

61
Q

Diseases

Inflammatory skin diseases

A

dermatitis.

62
Q

Diseases

worts or rashes

A

viruses

63
Q

Diseases

Acne skin abscesses

A

bacteria or foreign bodies

64
Q

Diseases

Neoplastic skin diseases

A

basal cell caracinoma
squamous cell carcinoma,
malignant melanoma

65
Q

Examination

should include firstly

A

History, cause, depth, size, and signs of infection. Also inspect skin ajacent.

66
Q

Examination

Check normal function

A

sensation, temp, hair growth, mobility, pliability

67
Q

Examination

Size of wound

A

charted over months, including TBSA estimates and photography

68
Q

examination

dental alginate

A

impression of wound, transfereed to volumeter to measure wound size.

69
Q

examination

Inject saline

A

into the wound until it’s full and subtract the volume left over from the total volume to get the size of the wound.

70
Q

examination

moist pink or red wound

A

probably partial thickness

71
Q

examination

where muscle or tenden is visable

A

probably full thickness wound

72
Q

examination

Full evaluation of pt

A

Communication, comprehension, mobility, strength,
and so on

73
Q

Examination in Vascular Compromise

Arterial wounds

A

 Commonly found in lower part of leg
 Minimal to no exudates (dry)
 Irregular shape
 Often deep and pale
 Severe pain that increases when leg is elevated
 Adjacent skin is pale on elevation, cool to touch, hairless, and appears thin and shiny
 Pulses are weak or absent

74
Q

Examination in Vascular Compromise

Venous ulcers

A

 Lower part of leg
 Exudates and edema present
 Irregular shape
 Shallow with red or pink wound base
 Edema leads to poor healing
 Mild pain, decreased with elevation
 Adjacent skin is inflamed, dilated veins, abnormal pigmentation and induration (hard), may be dry and scaly
 Pulses are present

75
Q

Examination in Vascular Compromise

Neuropathic ulcers

A

 Located on plantar surface of foot at pressure points or bony prominences
 Bleed easily (unless also arterial insufficiency)
 Circular shape
 Deep
 Painless (sensory neuropathy led to wound)
 Skin adjacent appears normal but has sensory deficit

76
Q

Examination in Vascular Compromise

Pressure ulcers

A

 Found over bony prominences
 Vary in depth and size

77
Q

Pressure ulcers

Stage I pressure ulcer

A

nonblanchable erythema

78
Q

Pressure ulcers

pressure ulcer stage II

A

partial thickness

79
Q

Pressure ulcers

stage III pressure ulcer

A

full-thickness skin loss

80
Q

Pressure ulcers

stage IV pressure ulcer

A

full-thickness tissue loss
 Exposes bone, tendon, or muscle

81
Q

Pressure ulcer

unstageeable pressure injury

A

full thickness loss but extent of damage obscured by slough or eschar.

82
Q

Deep Tissue pressure injury

A

intact or nonintact skin with localized area of persistent nonblanchable deep red maroon or purple discoloration.

83
Q

Examination

Trauma

A

 Initially referred to primary medical intervention
 Abrasions, lacerations, puncture wounds, avulsions,
degloving injuries, and burns

84
Q

Examination

Burns

A
  • Flame, chemical, scalding, radiation, or electrical
  • Severity of burn injury depends on total body surface area (TBSA) affected, location, depth, associated trauma, and smoke inhalation
85
Q

Examination

Disease

A

 PTs and PTAs must recognize signs and symptoms
of skin cancer.

86
Q

Examination

Scar tissue

A

 Assessed using Vancouver Burn Scar Scale
* Scale from 0 to 5 based on pigmentation, vascularity, pliability, and height
 Location also important; over a joint could impair movement

87
Q

Examination

Vancouver Burn Scar Scale

A

0- Normal pigment - Normal vas - normal pliant - flat height
1- Hypopigment - pink vas - flexible with min res- raised <2mm
2- hyperpigmentation - Red Vas - gives way to pressure - raised <5mm
3- purple vas - firm not easily moved - raised >5mm
4- Banding: raised tissue that blanches with stretching of scar
5- contracture permanent tightening that produces a deformity.

88
Q

PT completes detailed evaluation

A

 Includes assessment of condition, related
impairments, level of loss of function, general health, and social factors

 Prognosis depends on when wound will be stable, clean, and healing or healed
* Includes potential for scar
* Develop goals and plan of care

89
Q

Intervention

Prevention

A

Essential when patients at risk for pressure ulcers

90
Q

Wound management

Arterial and neuropathic ulcers

A
  • Cleaning the wound, applying dressings and topical agents
  • Maintain moisture at wound
  • total contact casting
91
Q

Wound management

Venous wounds

A

Compression and positioning to reduce edema

Dressing - usually absorbant or gel type

92
Q

Wound management

Pressure ulcers

A

wound care and pressure relief
* seat cushouns
* WC fit
* Foam
* Air matresses
* turning schedules

93
Q

Wound management

Exercises

A

should emphasize joint mobility, muscle
performance, gait, ventilation, and circulation

 If patient unable to move independently, the body should be turned to relieve pressure every 2 hours.

94
Q

Scar management

Must monitor scar contraction

A

to avoid scar contracture

 Include positioning, splints, passive and active stretching
* Anticontracture positions, such as extension
(elbow) or neutral (ankle)

 Pressure garments

95
Q

Patient education

A

 Patient should be focus of the rehabilitation team
 Must include other caregivers
 Instruction on
* Skin care
* Wound management
* Positioning techniques
* Exercise programs
* Application of pressure garments
must include why proceedures are necessary.

Intro to PT (12 decks)

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