Intro to PT Chapter 12 Flashcards
1
Q
Integument
A
Largest organ of the body
1 to 4mm thick
2
Q
Three layers of Integument
A
Epidermis
Dermis
Subcutaneous tissue
3
Q
Epidermis
A
.06 to .1 mm thick
4
Q
Epidermis
thicker on soles of feet and palms of hands.
A
.6mm - stratum corneum
5
Q
epidermis
Basal Cell layer
A
connects it to the dermus
6
Q
Callus
A
stratum corneum
7
Q
Keratinocytes
A
take 28 days to mature and be sloughed off after traveling through the layers.
8
Q
Stratum Corneum and moisture
A
restricts the loss of fluid. and semi-water resistant.
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
10
Q
Merkel cells
A
sensory recpetor cells that provide information about tactile stimuli
11
Q
Melanocytes
A
sythesize melanin, a pigment that principally serves as a primary protection against harmful ultraviolet radiation. - transfered from melanocytes to keratinocytes.
12
Q
Melanocytes and other locations
A
they are also present in dermis and hair folicles. and the retina of the eye.
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.
14
Q
follicle
A
an invagination of the epidermis.
keratinization that produces three layers of cells - produces hair.
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.
16
Q
Aprocrine glands
A
axila and anogenital areas - oily sweat begins in puberty - oder is bacteria breaking down sweat.
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
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
19
Q
ground substance
A
water, glycosaminoglycans - proteoglycans and glycoprotiens.
20
Q
Dermis
Other structures
A
Blood vessels, nerves, sweat and sebacious glands and hair follicles.
21
Q
Dermis
other functions
A
provides sensory input, temperature regulation and assists in wound healing
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.)
23
Q
Dermal Papillae
A
create epidermal ridges.
24
Q
Fibrous collagen
A
fortification against mechanical stress while allowing for deformation.
25
Reticular Dermis
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.
26
arrector pili muscels
move hair to stand on end.
27
Subcutaneous Tissue
Lose connective tissue and fat
Binds deeper structures
28
# Wound Healing
Inflammatory phase
Vasoconstriction (5-10 min) followed by vasodilation
Local edema, which could restrict motion
Lasts generally about 2 weeks.
29
# Inflammatory phase
Vasoconstriction
5-10 min - clotting phase. Platlet clots and eventual fibrin clots.
30
# Inflammatory phase
Vasodilation
Increased capillary permeability. Leukocytes
Neutrophils
Macrophages
31
# Inflammatory phase
macrophages
eat wound debris, release cytokines, growth factors and collagenases.
32
# Inflammatory phase
Lymphocytes
stimulate macrophages and fibroblasts.
33
Cronic Inflamation
Inflammatoryh phase that lasts more than 2 weeks
34
Proliferative phase
Collagen produced by fibroblasts; provide strength to
wound
Ground substance
Vascular growth
Wound contracts
35
# Proliferative phase
collagen fibrils
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.
36
# Proliferative phase
Ground substance
composed of glycosaminoglycans, water and salts.
Occupies space between elastin, collagen, vascular structures and other cells in the healing wound.
37
# Proliferative phase
angiogenesis
formation of new blood vessels.
38
# Proliferative phase
epidermal regeneration
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.
39
# Proliferative phase
wound contraction
aggressive contraction occurs here.
fibroblasts and myofibroblasts have contractile capabililty.
decreases the surface area of wound
causes decreased mobility in large wounds
40
PT interventions for Proliferative phase
wound care, edema management, positioning, splinting, cautous passive ROM, AROM, ambulation, and functional activities.
stretching, strengthening, and endurance exercises may be appropriate.
41
Maturation phase
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
# Maturation phase
hypertrophic scar
if deposition of collagen exceeds collagen lysis (breakdown.) Get really big scar. - associated with contracture
43
# Maturation phase
Keloid scar
extend beyond the boundary of the wound. - not associated with contracture.
44
# Maturation phase
Stretching and collagen
stretching a forming scar will cause the collagen to form along the length of the stretch - favors mobility.
45
# Maturation phase
Scar contraaction
leads to scar contracture. (permanent)
46
# Maturation phase
PT
Can be more aggressive with wound site.
Work hardening work conditioning - help individuals recover functional abilities needed for work after an injury.
47
Additional considerations (burns)
Depth, location, size (percent total body surface
area [TBSA]), healing time, cause of disruption
48
# Common Conditions
Vascular compromise
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
# Common Conditions
Pressure ulcer
Pressure reduces blood flow and tissue dies.
50
# Pressure ulcer
Supine:
Occiput, elbows, scapulae, spinous
processes, sacrum, coccyx, heels
51
# Pressure ulcer
Seated
Elbows, spinous processes, sacrum, coccyx,
ischial tuberosities, greater trochanters, heels
52
# Pressure ulcer
Side-lying
Ear, shoulder, elbow, greater trochanters,
medial and lateral aspects of knees, medial and
lateral malleoli, heels
53
# Pressure ulcer
Prone
Forehead, nose, chin, anterior of shoulder,
iliac crest, patella, dorsal surface of foot or toes
54
# Trauma
Abrasions
Skin is scraped away through contact with a rough object or surface
55
# Trauma
Lacerations
Cuts or tears of the integument.
56
# Trauma
avulsion issue
Inguries in which much if not all of the skin and the subcutaneous tissue are separated from the underlying tissue
57
# Trauma
Degloving injury
When a avulsion issue occurs to a hand or foot.
58
# Trauma
Puncture wound
hole in skin created by a sharp pointed object
59
# Trauma
Burn injuries
include skin damage from many possible causes, such as flame, chemicals, scalding, radiation and electrical current.
60
# Trauma
ischemic skin damage and sensory feedback
Can cause injury due to loss of sensory feedback.
61
# Diseases
Inflammatory skin diseases
dermatitis.
62
# Diseases
worts or rashes
viruses
63
# Diseases
Acne skin abscesses
bacteria or foreign bodies
64
# Diseases
Neoplastic skin diseases
basal cell caracinoma
squamous cell carcinoma,
malignant melanoma
65
# Examination
should include firstly
History, cause, depth, size, and signs of infection. Also inspect skin ajacent.
66
# Examination
Check normal function (skin)
sensation, temp, hair growth, mobility, pliability
67
# Examination
Size of wound
charted over months, including TBSA estimates and photography
68
# examination
dental alginate
impression of wound, transfereed to volumeter to measure wound size.
69
# examination
Inject saline
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
# examination
moist pink or red wound
probably partial thickness
71
# examination
where muscle or tenden is visable
probably full thickness wound
72
# examination
Full evaluation of pt
Communication, comprehension, mobility, strength,
and so on
73
# Examination in Vascular Compromise
Arterial wounds
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
# Examination in Vascular Compromise
Venous ulcers
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
# Examination in Vascular Compromise
Neuropathic ulcers
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
# Examination in Vascular Compromise
Pressure ulcers
Found over bony prominences
Vary in depth and size
77
# Pressure ulcers
Stage I pressure ulcer
nonblanchable erythema
78
# Pressure ulcers
pressure ulcer stage II
partial thickness
79
# Pressure ulcers
stage III pressure ulcer
full-thickness skin loss
80
# Pressure ulcers
stage IV pressure ulcer
full-thickness tissue loss
Exposes bone, tendon, or muscle
81
# Pressure ulcer
unstageeable pressure injury
full thickness loss but extent of damage obscured by slough or eschar.
82
Deep Tissue pressure injury
intact or nonintact skin with localized area of persistent nonblanchable deep red maroon or purple discoloration.
83
# Examination
Trauma
Initially referred to primary medical intervention
Abrasions, lacerations, puncture wounds, avulsions,
degloving injuries, and burns
84
# Examination
Burns
* 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
# Examination
Disease
PTs and PTAs must recognize signs and symptoms
of skin cancer.
86
# Examination
Scar tissue
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
# Examination
Vancouver Burn Scar Scale
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
PT completes detailed evaluation
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
# Intervention
Prevention
Essential when patients at risk for pressure ulcers
90
# Wound management
Arterial and neuropathic ulcers
* Cleaning the wound, applying dressings and topical agents
* Maintain moisture at wound
* total contact casting
91
# Wound management
Venous wounds
Compression and positioning to reduce edema
Dressing - usually absorbant or gel type
92
# Wound management
Pressure ulcers
wound care and pressure relief
* seat cushouns
* WC fit
* Foam
* Air matresses
* turning schedules
93
# Wound management
Exercises
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
# Scar management
Must monitor scar contraction
to avoid scar contracture
Include positioning, splints, passive and active stretching
* Anticontracture positions, such as extension
(elbow) or neutral (ankle)
Pressure garments
95
Patient education
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.
