Musculoskeletal Flashcards
What does the integumentary system consist of?
consists of the skin, hair, oil and sweat glands and sensory receptors
What is the main function of the integumentary system?
primarily, as a protective membrane between the internal and external environment as part of our innate immune system
What are first degree burns?
-Superficial partial thickness burn
-Involves only the outer layers of the epidermis and usually doesn’t include blistering
-The skin maintains its ability as a water vapor and bacterial barrier
-Presents as red or pink discoloration, dry skin and mild-moderate pain
-Self-limiting within 3 to 10 days
-Larger surface area burns may be more problematic in medically fragile population
What is a second degree partial thickness burn?
-Involves the epidermis and various degrees of the dermis
-Painful, moist, red and blistered
-Beneath the blisters is weeping bright red/pink skin that is sensitive to temperature changes, air exposure and touch
-The blisters help prevent water loss and may promote wound healing
-Healing process is approximately 1 to 2 weeks
What is a second degree full thickness burn?
-Involves the entire epidermis and dermis
-Pain sensors remain in tact - very painful
-Present as mottled pink, red or waxy white areas with blisters and edema
-The blisters resemble flat, dry tissue paper instead of the bullous blisters seen with
second degree partial thickness burns
-Heal within 1 month but may result in permanent scar tissue and some diminished sensations
What is a third degree burn?
-A full thickness burn extending into subcutaneous tissue and may involve muscle and bone
-Vary in color from waxy white or yellow to tan, brown, deep red or black
-They are often hard, dry and leathery
-Edema becomes extensive in the burn area and surrounding tissues
-Sensory nerves have been destroyed so these burns are pain free (usually surrounded by second degree burns)
What is hemodynamic instability and how is it caused by burns?
-Burn shock can result from massive fluid loss in significant burnt tissue
-Initial vascular damage causes fluid loss leading to hypovolemia
-Fluid shifting (vascular to interstitial) occurs for several reasons
-Membrane permeability decreases when it becomes damaged
-Capillary pressure increases while interstitial pressure decreases
What is hypermetabolic response to burns?
-Burn injuries increase metabolic and nutritional requirements causing an increase in secretion of stress hormones like cortisol and catecholamines
-Heat production is increased to counteract heat loss
-Hypermetabolism (increased oxygen/glucose use and protein/fat wasting) peaks approximately 7 to 17 days post injury
-Recovering burn patients require a substantially higher amount of nutritional and metabolic support during the healing process
How do burns cause respiratory system dysfunction?
-A very common and serious complication of many burn injuries is smoke inhalation
-May include thermal/chemical airway damage and associated inflammatory response
(endothelial damage, edema, loss of parenchymal tissue)
-Inhaled CO binds to Hb with a stronger affinity than O2
-Other inhaled gas from burning materials can dissociate in the blood stream to form strong acid or alkalis (acidosis/alkalosis)
How can burns cause dysfunction of different organ systems?
-Patients with burn shock have decreased perfusion to their vital organs
-This can lead to decreased function in any or all organ systems (renal, cardiac, pulmonary, neurological, etc.)
How can burns cause sepsis?
-The destruction of the innate immune system leads the patient open to secondary
infections that can progress to sepsis
-This can be compounded by systemic hypoperfusion
What is urticaria?
-Urticaria are pale/red raised itchy papules that occur in the superficial aspect of the dermis
-They tend to blanch with palpation and vary in size
-May or may not be associated with angioedema (swelling in the deeper dermis tissue)
-Histamine release from mast cells and basophils results in an increase in capillary permeability - fluid shifts from intravascular to the interstitial tissue in the skin
What is the difference between acute and chronic urticaria?
-Acute urticaria is usually a result of an IgE mediated immune response
-Chronic urticaria is not well understood but may be a sign of underlying disease or an autoimmune disorder mediated by IgG
What is necrotizing fasciitis?
An acute bacterial skin and soft tissue infection that causes necrosis of the muscle fascia and subcutaneous tissue
What causes necrotizing fascitis?
-The infection travels along the muscle fascia (poor blood supply - no leukocytes)
-The insidious onset allows the infection to spread rapidly before it is detected
-The infection then spreads to the surrounding subcutaneous and muscle tissue causing necrosis
What is an arthropod infestation?
-The skin is susceptible to a variety of rashes and disorders as a result of arthropod infestations
-Some common examples include mites, lice, or bedbugs
-The type of rash, lesion or disease is dependent upon the specific arthropod
-Infestations can be very difficult to exterminate once they have made their way into your
home
What is the musculoskeletal system?
-The musculoskeletal (msk) system is composed of muscles, bones, and their supporting tissues (tendons, ligaments, bursae, etc)
-It functions to generate movement, protect internal organs, maintain posture and
generate heat and also plays a role in mineral homeostasis (calcium)
What is osteomyelitis?
-An acute or chronic infection of the bone
-Any foreign antigen can produce osteomyelitis however it is more commonly caused by
specific bacterial agents
-Infectious process can affect any or all bone tissues (spongy, compact, marrow, etc)
What occurs is osteomyelitis?
-Purulent exudate can occur as a result of micro abscesses within the bone tissue
-The rigid structure of the bone leaves very little room for swelling causing the fluid to get under the periosteum
-This can cause reduced blood flow with resultant ischemia and necrosis
-Weakened bone tissue can fracture and resultant wound healing can sequester the infection in place
What is arthritis?
-Arthritis is a blanket term describing more than 100 different rheumatic diseases
-The two most prevalent forms of arthritis include: Rheumatoid arthritis and Osteoarthritis
What is Rheumatism?
any disease marked by inflammation and pain in the joints, muscles or fibrous tissues
What is osteoarthritis?
-Most prevalent form of arthritis characterized by the progressive destruction of articular cartilage in weight-bearing joints and fingers
-Caused by long term wear-and-tear
-With chronic wear and tear, inflammation and destruction of the cartilage occurs, and the composition of ECM is altered
-Cracks in the articular cartilage allow synovial fluid to enter and worsen the damage
-Eventually erodes the articular cartilage completely causing increased friction between the articulating bones
-Bones begin to wear on each other causing damage to the bone tissue
What are the clinical manifestations of osteoarthritis?
-Aching active joint pain relieved by rest (worsens with progression)
-Crepitus/grinding during movement
What is rheumatoid arthritis?
-Systemic inflammatory disease that occurs more predominantly in the elderly population and targets joint tissues
-Irregular immune response leads to synovial inflammation and destruction of the joint architecture by inflammatory cells
-Due to the chronic inflammatory response, the destructive process is continuous
-The destruction of the join tissue (cartilage, ligaments, bone) leads to pain and a decrease in use
-This can lead to joint instability, muscular atrophy, and loss of elasticity in the ligament
What are the clinical manifestations of rheumatoid arthritis?
-Disease progression often starts in the fingers, hands, wrists knees and feet
-Joint pain/stiffness and eventually joint deformities
-Joint subluxation (incomplete or partial dislocation)
-Systemic complications (rare) - fatigue, weakness, anorexia, weight loss, low grade fever
What is osteoporosis?
Metabolic bone disease characterized by a loss of mineralized bone mass causing increased porosity of the skeleton and susceptibility to fractures
