PBLs + readings Flashcards
what are the risk factors assciated with skin tears?
- hx. skin tears
- age, gender
- dry/fragile skin
- med e.g. steroids
- echmoses (bruising/discolouration of skin caused by leaky BVs as a result of trauma to BVs)
- impaired mobility or vision
- poor nutrition and hydration
- cognitive or sensory impairement
- comorbidities that compromise vascularity and skin status
- ability to self care
function of the skin?
- thermo-reg
- homeostasis
-vit. D
protection - sensation
- sweat
outline the classification of skin tears
1: skin tear without loss of tissue. epidermal flap covers it mostly. A= white B= dark
2: skin tears with partial tissue loss: edges cant be realigned to normal position. a= white B= darkened
3: skin tear where skin flap is completely absent
outline the key principles for management of the wound
- assess and document the wound
- classify
- manage using an appropriate dressing
- prevent further trauma
- control bleed
- clean wound
- approximate skin flap
- apply dressing
- review and reassess
what are some things we should consider RE: skin tears
- oedema: if its over an area of oedema there will be more exudate
- pain
- infection
when do we refer a skin tear?
when the skin tear is full thickness skin injury or infected
outline the stages of wound healing?
hemostasis, inflammation, proliferation, remodelling
what is angiogenesis?
formation of new BVs (capillaries)
what can lead to impaired wound healing?
- -oxygenation
- infection
- foreign body
- venous insufficiency
- age/gender
- hormones
- stress
- obesity
- other comorbidities e.g. diabetes, healing disorders
- meds : glucocorticoid steroids, NSAIDs, chemo
- alcohol/smoking
- immunocompromised conditions: cancer/radiation therapy, AIDS
- nutrition
what is recommended therapeutic range of INR with warfarin? (approx.)
2-3
or 2.5-3.5 depending on condition
risk factors for DVT:
- immob: hospo/surg/long haul travel
- recently ocmmenced oestrogen therapy
- intravascular device (e.g. venous catheter)
- chemo, leg paralysis, oestrogen therapy,
- hx.
- inherited conditions e.g. natural anticoagulant deficiency
signs of DVT:
- pitting oedema (greater in asx. leg)
- T-score
what is pathogenesis of osteoporosis?
rate of bone resorption exceeds rate of bone formation
- decrease in bone mass esp. trabeculae
- lack of oestrogen causes the level of cytokines to rise and therefore increases bone resorption through increase activity of osteoclasts
when you have osteoporosis and you get a fracture (irrespective of fracture site) how much more at risk are you of having another one?
2-4 fold
what does a T-score of below -1.5 mean in osteoporosis?
pharm intervention is indicated
tell your pt. how can you reduce your risk of osteoporosis/further dev. of osteoporosis/ further complications
- WB exercise
- easy on the smokes and the drinking
- nutrition
what systemic conditions increase your risk of osteoporosis? ( so much so that it is considered clinical risk factor for medicare payment for dx. testing)
RA, hyperparathyroidism, hyperthyroidism, chronic kidney disease, chronic liver disease, premature menopause of at least 6 months in women age <45 yrs, hypogonadism in men and/or proven malabsorption
they say that we should assume a pt has OP if they get a # after “minimal trauma” /// what is considered minimal trauma
falling from standing height or less
what is the gold standard for dx. of osteoporosis (OP)
DXA: dual energy x-ray absorptiometry
ddx. of CMT?
- other hereditary neuropathies, acquired neuropathies
- motor neuron diseass
- hereditary ataxia
- mitochondrial disorders
- hereditary spastic paraplegias,
- leucodystrophies
- cellulitis
what is hereditary ataxia (ddx. of CMT)
- hereditary (yas we know what that means)
- ataxia= uncontrolled loss of co-ordination of mms etc.
–> gait abnormalities
rx. of CMT
intervention aimed at improving posture and balance
AFOs can help with foot drop
what is paget’s disease?
- increased bone remodely, bone hypertrophy, abnormal bone structure –> pain nd bone deformity.
complications: #, degen, OA
what is rx. of pagets disease (of bone)
- calcitonin, bisphophonates
- offloading
- footwear: padding, space/accomodative
- orthotics if LLD or anything else like that
- wound management
- mobility aids if indicated
- emollient use if neuropathy
-
how do you dx. pagets disease?
x-ray
alkaline test
what is prognosis of pagets disease?
no cure but can be managed
what is a side effect of bisphosphonates?
cold/flu like sx.
how does paget’s disease affect the foot specifically?
- # risk
- HD/Hk due to bony abnormalities
- bow legs
- scoliosis –> potential LLD?
- PAIN
- neuropathies possible if spine affected –> tingling etc. and no sweating
- can cause damage to soft tissue
what is ddx. of pagets disease?
arthritis, gout (esp. 1st MPJ)
