Session 3: Disorders of Skin Integrity/ Healing / MSK Flashcards
functions of the skin
protection , thermoregulation, sensation
epidermis
- 1st layer; protective layer / physical barrier
dermis
provides strength and supports the epidermis, has sweat glands, nerve endings, blood vessels, and lymph glands within
subcutaneous fat
subcutaneous fat - provides insulation and a cushion to surround your vital organs
Infectious process affecting the skin
bacterial , viral, fungal, or parasitic
Allergic / Hypersensitivity infectious process affecting the skin
atopic dermatitis ,urticaria, drug induced skin eruptions, allergic contact dermatitis
inflammation response
Viral infection process affecting the skin
warts (HPV) , Herpes Simplex (HSV-1 & -2) , Herpes zoster, Shingles
Fungal Infectious Process affecting the skin
organisms that cause infection known as tinea (all fungal infections have tinea)
Yeast Infectious Process affecting the skin
thrust (white patch on tongue and around mouth)
Bacterial Infectious Process affecting the skin
impetigo and staph infections
Cellulitis
acute condition spreading infection of the dermis or SQ layer of the skin; it is an inflammatory infection; diabetes, immunodeficiency , or impaired circulation , and conditions that result in breaks of skin integrity
atopic dermatitis
Eczema >Type I hypersensitivity (true allergic reaction)
Lichenification in the chronic stage due to chronic inflammation
Treatment focus = dryness , pruritus, infection, and inflammation
Urticaria (hives) =
hypersensitivity
results from histamine release from mast cells and basophils
increased vascular permeability allows fluid to leak into the tissues , causing edema and wheal formation
contact dermatitis
cutaneous reaction to topical irritation or allergy
Type IV Hypersensitivity
Angioedma
life threatening, development of edema around mouths , lips, tongue, pharynx , larynx
Hypersensitivity
epidermal cell detachment and bullae (fluid-filled blisters) form
Drug induced Skin Eruptions
Hypersensitivity
-erythema multiforme
occurs after herpes infection
-Toxic epidermal necrolysis
erythema multiforme
Drug induced Skin Eruptions Hypersensitivity
occurs after herpes infection
Toxic epidermal necrolysis
Drug induced Skin Eruptions Hypersensitivity
exaggerated response to ultraviolet light when the drug is taken in combination with sun exposure; people can experience photo sensitivity on drugs
anti-infective agents
antihistamines
diuretics
NSAIDs
1st degree burn
superficial partial thickness burns
involved only outer layer of epidermis
-painful, reddened, dry (sunburn)
second degree partial thickness
burns involve the epidermis and various degrees of the dermis
painful , moist, red, and water filled blisters
second degree full thickness
burns involve entire epidermis and dermis
very painful, loss of tactile sensation, dry, flat blisters
third degree burns
full thickness burns extend into SQ tissue and may involve muscle and bone
waxy white or yellowish tan, painless, hard, dry , and leathery
all nerve fibers destroyed
Pressure Ulcers
Blood flow becomes obstructed
-May be due to external pressure or shear
external pressure = blocks oxygen to tissue and accumulation of metabolic end products
shear = sliding of one tissue to another , stretching and bending blood vessels causing damage and clots
-Tissue damage from
ischemia to skin
friction = damages the epidermis interface
moisture = alters pH of skin and compromises epidermal integrity
strain
a stretching injury to a muscle or a musculotendinous unit caused by mechanical overloading
Sprain
involves the ligamentous structures surrounding the joint , pain and swelling subside more slowly than in a strain
caused by abnormal or excessive movement of the joint
subluxation
a partial dislocation in which the bone ends in the joint are still in partial contact with each other
can be congenital , traumatic, or pathological
avulsion
is an injury in which a body structure is torn off by either trauma or surgery
Compartment syndrome
- condition of increased pressure within a limited space that compromises the circulation and function of the tissues in the space
limited space for swelling due to fascia
can be acute or chronic
acute = after a fracture
chronic = exertion from long distance runners and others involved in a major change in activity level
tissue becomes Ischemic (restriction in blood supply)
you can have : pain out of proportion, nerve damage, paralysis, muscle infraction
Rhabdomyolysis
- life threatening complication of severe muscle trauma with muscle cell loss
- can lead to Acute tubular necrosis, cardiac dysrhythmias, shock
- rapid breakdown of muscle that causes the release of intracellular contents
- other causes : medications, anesthesia, malignant hyperthermia
acute or chronic infection of the bone causes
(can be internal or external infection)
direct penetration or contamination of an open fracture or wound
seeding through the bloodstream
extension from a contiguous site
skin infection in people with vascular insufficiency
acute or chronic infection of the bone complications
large abscesses and the need for multiple surgical debridements. Other potential complications include growth arrest/limb length discrepancy
acute or chronic infection of the bone treatment
how to identify cause?
identify the cause through blood aspiration cultures, antimicrobial agents first parenterally and then orally
Hematogenous osteomyelitis
Type of Osteomyelitis
infection that reaches the bone through the blood stream
Contiguous Spread Osteomyelitis
Type of Osteomyelitis
secondary to a contiguous focus of infection
direct inoculation from an exogenous source
chronic osteomyelitis
Type of Osteomyelitis
occurs secondary to an open wound or infected tissue, occurs in adults
hallmark = sequestrum
osteoporosis
complex , multifactorial chronic dx
a loss of mineralized bone mass causing increased porosity of the skeleton and susceptibility to fractures = weakening of bone
develops when the remodeling cycle is disrupted and imbalanced
manifestations =
pain, bone deformity, pathological fractures
management =
wt bearing exercise , adequate calcium, vitamin D
Osteomalacia
inadequate mineralization of bone = bones not hardening / soft bones
causes : vitamin D deficiency , critical low levels of phosphate due to renal losses
results in : bone pain ,tenderness, fx
Rickets
failure or delay in calcification of the cartilaginous growth plate in children whose epiphyses have not yet fused
manifestations : deformation of long bones and delay in mineralization
osteoarthritis
not systemic
most prevalent form of arthritis
about wear and tear of bone; a slow progressive destruction of articular cartilage of weight bearing joints and fingers
you lose the covering of the bone (articular cartilage) over time and now it’s exposed to synovial fluid and then osteophytes are made
manifestations : Heberden and Bouchard, pain stiffness
gout
disruption in uric acid production or excretion
rich man dx; has more to do with the diet of the patient
have high levels of uric acid in the blood and other body fluids
urate crystal precipitates into the joint space causing crystallization in joint space
causes : purine synthesis or breakdown is accelerated, poor uric acid secretion in kidneys
rheumatoid arthritis
systemic inflammatory dx
unknown cause with a genetic predisposition
begins in the synovium and then you develop a pannus
it’s not a tumor but impedes the joint space
Articular issues of RA
synovial inflammation and joint architecture is damaged due to pannus
swan neck & boutonniere deformity (fingers will swoop and dip)
Extra-articular issues of RA
a systemic problem; going to happen well beyond the joint space
elevated erythrocyte sedimentation rate (ESR) correlates with dx
Rheumatoid factor (RF) antibody
they can develop rheumatoid nodules
Fracture Blisters
skin bullae and blisters representing areas of epidermal necrosis with separation of the epidermis form underlying dermis by edema fluid
because of localized swelling, the intracompartmental pressure becomes to high and fluid is coming to surface
can be a warning for compartment syndrome
seen in twisting injuries and excessive joint manipulation
Complex Regional Pain Syndrome (CRPS)
neurological condition that impacts limbs and results from surgery or injury
pain is prominent symptom of the disorder; abnormal pain response
treatment focus on pain management
Thromboemboli
the person with a lower extremity fracture is at risk for development of pulmonary
embolism and deep vein thrombosis
emboli enters into blood stream and can kill
Fat Embolism Syndrome
presence of fat droplets in small blood vessels of lungs, kidneys , brain, and other organs after a long bone or pelvic fracture
manifestations : seizures , focal neurological deficits
