Skin Flashcards
What are the layers of the skin?
What is their function?
And what do they contain?
Epidermis
- outer layer
- no blood vessels
Dermis
- collagen and elastin connective tissue
- contains lymphatic system, blood vessels, nerves, hair follicles, sebaceous and sweat glands
Subcutaneous
-loose connective and fat tissue
Insulates, support, cushion, stores energy
Muscle and fascia underneath all
What are sebaceous glands?
Exocrine, secrete fatty substance, lubricates skin, defends against bacteria and fungus
What are sweat glands?
Eccrine glands, control body temp
What is dermatitis/eczema?
Inflammation of skin, causing itching redness lesions.
What is cellulitis?
Inflammation of cellular or connective tissue in or close to skin
How does cellulitis present?
How do you treat it?
Red, hot, edema
elevate limb, cool, wet dressings
What are the types of herpes?
Herpes 1 simplex- cold sore
Herpes 2- genital herpes
Herpes zoster/shingles- chicken pox, pain tingling rash in dermatomes of infected nerve root
What are herpes zoster/shingles contraindications?
Heat, US can increase symptoms
What is psoriasis? And it’s symptoms?
Chronic autoimmune disease of skin.
Red/erythema skin with silvery scales on ears, scalp, knees, elbows, genitalia, itching, pain, dry skin, cracked lesions
What is the PT intervention for psoriasis?
Long wave UV, combo UV light with oral photo synthesizing drugs
What is lupus?
What are its symptoms?
Chronic, progressive autoimmune disorder of connective tissue
Red rash, butterfly rash across nose, skin lesions, chronic fatigue, arthralgia, anemia, hair loss, Raynaud’s
What is scleroderma?
What are its symptoms?
What types are there?
What can PT do?
Chronic autoimmune disease of connective tissues causing fibrosis of skin, joints, blood vessels, internal organs
Skin is taught, firm, edema, firmly bound to subcutaneous tissue
Types - limited, diffuse
Associated with CREST syndrome (Calcinosis, raynauds, esophageal dysfunction, sclerodactyly, tenangiectasia)
PT- slows contracture deformity
What is polymyositis?
What can PT do?
Disease of connective tissue
edema, inflammation, degen of muscles
affects proximal muscles, symmetrical
PT- fatigue mx, conserve energy, exercise (precaution of too much exs damages muscles), prevent contracture and pressure ulcers
What are the types of malignant skin tumors?
Basal cell- slow growing, rarely mets
Squamous cell- quickly grows, mets, sun exposed areas, poorly defined margins
Malignant melanoma- tumor from melanocytes. ABCDEs refer to dermatologist asap
What is a epidermal/1st degree burn?
Damage to epidermis only Pink/red No blisters Minimal edema Tender, delayed pain Healing- 3-7 days, no scarring
What is a superficial partial-thickness/2nd degree burn?
Epidermis and upper layers of dermis
Bright pink and red Blanching, brisk cap refill Blisters, moist surface, weeping Moderate edema Painful, sensitive, temp changes Healing- spontaneous, 7-21 days, min scarring
What is deep partial-thickness/2nd degree burn?
Severe damage to dermis including nerve endings, hair follicles, sweat glands
Mixed red and waxy white
Blanching, slow cap refill
Broken blisters, wet
Marked edema
Sensitive to pressure but not to light tough/soft pin prick
Healing- slow, reepithelialization. Scars w/o Rx
What is a full thickness/3rd degree burn?
Complete three layer destruction
White/ischemic, chard, tan, black, leathery, parchment like
No blanching, poor distal circulation
Little pain, nerve endings destroyed
Healing- grafting, remove eschar
What is the rule of nines?
Head/neck 9% Ant trunk 18% Post trunk 18% Arms 9% each Legs 18% each Perineum 1%
What are the types of scars?
Normal - white, raised, soft
Hypertrophic- raised, red, firm, stays in boundaries of wound
Keloid- raised, red, firm, extends beyond wound boundaries
Hypotrophic- flat, depressed
What are the phases of tissue healing?
Inflammation- lasts 3-5 days, red, edema, warmth, pain, decrease ROM
Proliferation/granulation- fibroblasts synthesize type 3 collagen, type 1 then replaces, scar tissue
Maturation- remodeling, up to 2 years
What is PT care for burns? Wound care, rehab?
Sharp debridement, autolytic dressings, hydrotherapy tank
Rehab- Deep breathing, chest expansion, ambulation, positioning and splinting to prevent contractures, edema control, AROM and PROM, massage, promote ADL, manage pain
What positions do you place the patient with burns to each area? Anterior neck? Shoulder? Elbow? Hand? Hip? Knee? Ankle?
Anterior neck- hyper extension in cervical orthosis
Shoulder- abduction, flexion, ER in axiliary splint
Elbow- extension, supination in posterior arm splint
Hand- wrist ext, MP flexion, PIP DIP ext, thumb abduction
Hip- ext, abduction
Knee- extension in posterior knee splint
Ankle- DF neutral in AFO
What is the difference between a venous ulcer and an arterial ulcer?
Venous- Irregular Dark pigmentation Fibrotic Good granulation Shallow Distal lower leg, medial mall Pulse present Little pain, ok with legs elevated Exudate present Edema
Arterial- Irregular smooth edges No granulation Deep Lateral mall, toes, feet, ant tib No pulse Gangrene Painful especially with legs elevated
What is a diabetic ulcer and how do you treat it?
Repetitive trauma to insensitive skin. Associated with arterial disease and peripheral neuropathy
Wound care, off loading, skin and foot care, exs
What is a pressure ulcer and how do you treat it?
Lesion caused by unrelieved pressure resulting in ischemic hypoxia and tissue damage
Rx- wound care, edu and skin hygiene, incontinence mx, seating, pressure relief, positioning, exs, nutrition
What are the four stages of an ulcer?
1- nonblanchable erythema of intact skin, skin temp changes, skin firm or boggy, sensation pain and itchy
2- partial thickness skin loss, epidermis and/or dermis, superficial, abrasion, blister, shallow crater
3- full thickness skin loss, damage or necrosis of subcutaneous, maybe into fascia, deep crater
4- full thickness, tissue necrosis, damage to muscle, bone, sinus tracts
What is autolytic debridement? Indications? Contra?
Selective
Natural
Moisture retentive dressing
Solubilization of necrotic tissue
Indications- patients on anticoagulant therapy, can’t do other forms, all wounds on medically stable
Contra- infected wounds, immunosuppressed, dry gangrene or ischemic wounds
What is enzymatic debridement? Indications? Contra?
Selective chemical
Liquified necrotic tissue by applying topical collagenolytic enzymes
Indications- moist necrotic tissue, eschar after cross hatching, home bound, can’t do surgical
Contra- ischemic wounds, dry gangrene, clean granulated wounds
What is mechanical debridement? Indications? Contra?
Nonselective
Removes foreign material (wet to dry gauze, dextranomers, pulsating lavage, whirlpool)
Indications- moist necrotic tissue or foreign material present
Contra- clean, granulated wound. Can remove healthy skin
What is sharp debridement? Indications? Contra?
Selective
Sterile instruments
No anesthesia
Little bleeding
Indications- scoring and excision of leathery eschar, excision of moist necrotic tissue
Contra- clean wounds, advancing cellulitis, infection threatens life, patient on anticoagulant therapy
What is surgical debridement? Indications? Contra?
Performed by surgeon/physician with sterile instrument
Deep stage 3 or 4, complicated pressure ulcer
Most effective
Pain, bleeding, may need anesthesia
Indications- Advancing cellulitis, immunocompromised, infection threatens life, granulation and scar may be excised
Contra- cardiac disease, pulmonary disease, diabetes, spasticity, cannot tolerate surg, QOL can’t be improved
What is kilohertz US? Indications? Contra?
Selective
Long wave low frequency US 20-50kHz
Indications- Increase angiogenesis, Remove necrotic tissue, Prep for grafting/flap closure
Contra- DVT, PVD, tumors, organs, electrical devices
Precaution over nerves, infections, anesthetic areas
What are transparent film dressings?
Indications?
Pros/Cons?
For stage 1 and 2 ulcers Used as secondary dressings Autolytic debridement Can see through to view wound healing Comfortable Impermeable to water, bacteria, environment Non absorptive Difficult to apply Do not use on fragile surrounding skin Do not use on infection
What are hydrocolloid dressings?
Indications?
Pros/Cons?
Contains hydroactive/absorptive particles that form gelatinous mass over wound Protection of partial-thickness wounds Autolytic debridement Used for mild exudate Maintains moisture Comfortable Min-Mod absorption Easy to apply Time saving waterproof Nontransparent Odor and yellow drainage on removal Do not use on infection
What are hydrogel dressings?
Indications?
Pros/Cons?
Partial and full thickness with min-mod exudate Burns Soothing and cooling Fill dead space Autolytic debridement Conforms to wound Nonadherent, requires secondary dressing Transparent Do not use sheet form on infection May macerate surrounding skin
What are alginate dressings?
Indications?
Pros/Cons?
Soft, absorbent seaweed Moderate-Large amounts of exudate Packing and absorption Infected and nonifected wounds Easy to apply Requires secondary dressing Can dry wound bed
What are gauze dressings?
Indications?
Pros/Cons?
Large exudate Dead space, tunneling, sinus tracts WET TO DRY- mechanical debridement CONTINUOUS DRY- heavy exudate CONTINUOUS WET- autolytic, protect clean wounds Cost effective Can use on infected wounds Pain on removal Delayed healing if used wrong Labor intensive Avoid direct contact with granulating tissue
What are foam dressings?
Indications?
Pros/Cons?
Partial and full thickness with min to mod exudate Protection and insulation Nonadherent, requires secondary dressing Conformable Easy to use For deep cavitites Nontransparent Not comfortable Not for dry eschar
What are the following types of exudate?
serous
purulent
sanguineous
serous - watery
purulent - pus
sanguineous - blood
What can you use for infection control during wound healing?
antimicrobial agents - silver nitrate anti inflamm - corticosteroids anesthetics - lidocaine hand washing sterile tools/techniques negative pressure wound therapy
