The Integumentary System Flashcards
Integumentary System
Composed of skin, hair, hair shafts, nails, sebaceous and sudoriferous (sweat) glands = ?
Integumentary System: Composed of skin, hair, hair shafts, nails, sebaceous and sudoriferous (sweat) glands.
Skin is 0.5-6.0mm thick and made up of three layers:
- Epidermis (keratinocytes, epithelial cells, melanocytes)
- Dermis (collagen, elastin, macrophages, mast cells, Meissner’s corpuscles, free nerve endings and superficial lymph vessels
- Subcutaneous (Subdermis or hypodermis): adipose tissue, fascia, lymphatic vessels
Integumentary System
Outermost layer, composed of keratinocytes, epithelial cells, melanocytes = ?
Epidermis = keratinocytes, epithelial cells, melanocytes
Integumentary System
What layer = ?
- Middle layer
- Composed of collagen, elastin, macrophages, mast cells
- Meissner’s corpuscles
- Free nerve endings and superficial lymph vessels = ?
Dermis = collagen, elastin, macrophages, mast cells, Meissner’s corpuscles, free nerve endings and superficial lymph vessels.
Integumentary System
Inner most layer, composed of adipose tissue, fascia, lymphatic vessels.
Subcutaneous (Subdermis or hypodermis) = adipose tissue, fascia, lymphatic vessels.
Integumentary System
Functions of the integumentary system = ?
- Temperature regulation
- Protection
- Sensation
- Excretion
- Immunity
- Blood reservoir
- Vitamin D synthesis
Integumentary System
Systems Review for the integumentary system includes the assessment of = ?
Systems Review for the integumentary system includes the assessment of:
- pliability (texture)
- presence of scar formation
- skin color, and
- skin integrity
Integumentary System
Integumentary integrity is defined as = ?
Guide to PT Practice: Integumentary Integrity
Integumentary integrity is defined as intact skin, including the ability of the skin to serve as a barrier to environmental threats such as bacteria, pressure, shear, friction, and moisture.
- The PT uses tests and measures to determine whether skin/subcutaneous changes, resulting from a wide variety of disorders and conditions, can serve as an adequate barrier to environmental threats.
- PT Interventions include devices, positioning, debridement, dressings, healing agents, ROM, strengthening, mobility training, environmental adaptations, education
Integumentary System
Examples of Health Conditions That May Cause Impairment of the Integumentary System = ?
Cardiovascular
- Vascular insufficiency
- lymphedema
Pulmonary
- Pulmonary edema
- CF
Musculoskeletal
- Osteomyelitis
- open fracture
Neuromuscular
- SCI
- CVA
- MS
- loss of sensation
Endocrine
- Diabetes
- liver disease
Integumentary System
General integumentary system examination includes = ?
General integumentary system examination includes:
- Skin Color (pallor, cyanosis, jaundice, redness (rubor), hemosiderin staining
- Skin Condition (bruising, blistering, texture)
- Skin Temperature
- Scars
- Hair loss
- Lesions
Integumentary System
3 types of skin cancer are = ?
1) Basal Cell Carcinoma - most common
2) Squamous Cell Carcinoma
3) Malignant Melanoma - 15% mortality rate.
- It is NOT the responsibility of the PT to diagnose that a lesion is benign vs. cancerous
Integumentary System
Signs of an Irregular Mole or Skin Lesion:
The ABCDE Rule = ?
- A - Asymmetry: one half unlike other half
- B - Borders: Irregular, poorly circumscribed
- C - Color variations: Tan, brown, black, white, red, blue
- D - Diameter: > than 6 mm
- E - Elevation: Normal is flat; abnormal is raised
Integumentary System
How to distinguish Benign from Malignant skin lesions
Benign
- < 6 mm in size
- Uniform in color
- Distinct borders
- Symmetric
- Seldom bleed or ulcerate
- Soft to firm consistency
- Slow rate of growth or change
Malignant
- > 6 mm in size
- Multiple shades, varied pigmentation
- Irregular, blurred borders
- Asymmetric
- Often bleed or ulcerate
- Firm to hard consistency
- Variable rate of growth or change
Integumentary System
3 types of burns = ?
- Thermal
- Electrical
- Chemical
Integumentary System
Burn severity dependent on = ?
Burn severity dependent on:
- age
- duration of burn
- type of burn
- affected area
Integumentary System
Burns are classified based on = ?
Classified based on depth of tissue destruction.
Integumentary System
Burn Depth Characteristics:
- Superficial = ?
Superficial:
- Epidermis only
- no blisters
- Red
- painful
Integumentary System
Burn Depth Characteristics:
- Superficial Partial Thickness = ?
Superficial Partial - Thickness:
- Epidermis and superficial dermis
- Blisters
- Red
- Painful
Integumentary System
Burn Depth Characteristics:
- Deep Partial Thickness
= ?
Deep Partial-Thickness:
- Majority dermis
- Hair follicles/sweat glands intact
Integumentary System
Burn Depth Characteristics:
- Full Thickness
= ?
Full Thickness:
- Subcutaneous fat layer
- Minimal pain
- Susceptible infection
- Increased depth = decreasing pain
Integumentary System
Burn Depth Characteristics:
- Subdermal
= ?
Subdermal:
- Muscle, bone, adipose tissue injury
- Insensate
Integumentary System
American Burn Association recommends medical care at a burn center if = ?
- Partial-thickness burns greater than 10% TBSA
- Burns on face, hands, feet, genitalia, perineum or major joints
- Any full thickness (3rd degree) burns
- Electrical burns, including lightning injury
- Chemical burns
- Inhalation Injuries
- Burns in children in hospitals not specifically equipped for pediatric burn care
- Burns with concomitant trauma
Integumentary System
Acute PT Management of Burn Injury = ?
- PT works on a dedicated team with nurses, physicians, RTs, OTs, mental health practitioners, dietitians, etc.
- PT coordinates session with pain medication administration by RN
- Wound cleansing, debridement, protective dressings
- ROM/Strength training
- Mobility training
Integumentary System
Ulcer/ Wound Types = ?
Ulcer/ Wound Types:
- Traumatic wounds
- Surgical wounds
- Arterial insufficiency wounds
- Venous insufficiency wounds
- Neuropathic wounds
- Pressure Wounds
Integumentary System
Signs of an arterial insufficiency wound = ?
Signs of an arterial insufficiency wound:
- Intermittent Claudication
- Pain with activity, exercise and elevation, decreased with rest
- Decreased or absent pedal pulses
- Decreased temperature of distal limb
- Distinct, well defined wound edges
- Deep wound bed, minimal or no granulation tissue or drainage
- Cyanosis, anhydrous surrounding skin
- Most common in distal, anterolateral LE and dorsum of foot
- Difficult to heal, high risk of gangrene
- Most arterial insufficiency wounds are caused by tissue ischemia, usually related to atherosclerosis
- Anhydrous-dry, flaky skin
Integumentary System
Signs of an venous insufficiency wound = ?
Signs of an venous insufficiency wound:
- Localized limb pain, decreased with elevation and increased with dependent positioning
- Pedal pulses present
- Increased skin temperature around wound
- Indistinct, irregular edges
- Lower extremity edema
- Shallow, fibrous covered wound bed, substantial drainage
- Hemosiderin staining
- Most common location is foot and medial lower leg, many times at medial malleolus
Integumentary System
Peripheral Neuropathy = ?
Peripheral Neuropathy:
- Nerve damage, usually related to diabetes, may also be result of alcoholism, tertiary syphilis, spina bifida, Vitamin deficiency, Lyme disease, shingles, Hep C, HIV, Epstein-Barr Virus, chemotherapy
- Diminished light touch, proprioception, temperature and pain perception
- Shiny skin with trophic changes of skin, hair and nails due to neuropathy
- Person can’t sense trauma, shear forces, pressure which cause ulcers
- Progressive weakness of intrinsic foot muscles lead to bony collapse of foot causing abnormal pressure, Charot foot (rocker bottom foot)
Integumentary System
Neuropathic Ulcers = ?
Neuropathic Ulcers:
- Caused by a triad of disorders: PVD, peripheral neuropathy and infection.
- Painless, sometimes generalized LE pain
- If atherosclerosis = Absent pedal pulses.
- Deep wound bed frequently located at pressure points (bony prominences).
- Loss of protective sensation
- High incidence of LE amputation
Integumentary System
Decubitus (Pressure Ulcers) = ?
Decubitus (Pressure Ulcers):
- Tissue ischemia (death) as a result of prolonged weight bearing or pressure on tissue, frequently over a bony prominence
- Friction, shear, moisture and malnutrition are contributing factors
Common sites include:
- Back of skull
- ears
- scapular spines
- spinous processes
- elbows
- ischial tuberosities
- sacrum
- heels
- trochanters
- med/lat condyles
Integumentary System
Stages of pressure ulcers = ?
- Stage 1: intact, reddened skin that does not blanch
- Stage 2: shallow open ulcer with red/pink wound bed, denoting partial-thickness loss of dermis, without slough. Can present as open or ruptured blister
- Stage 3: subcutaneous fat may be visible but no bone, muscle or tendon exposed. May include tunneling or undermining
- Stage 4: muscle/tendon/bone exposure. Tunneling/undermining, eschar/slough over at least part of wound bed
- Wounds are not stageable and will not heal if wound bed is obscured completely with slough and/or echar.
- Physician, wound specialist RN or PT will debride non-viable tissue to determine wound stage to begin healing process
Integumentary System
Examination Of The Skin:
Wound Assessment includes = ?
Inspecting the wound is simply one component for evaluation.
Include, along with wound information, in your assessment:
- ROM – especially near wounds
- Sensation – especially near wounds
- Strength
- Functional mobility (Bed mobility, transfers, gait, etc)
- Neuromuscular coordination
- Balance
- Equipment used
Key point: Consider the patient’s comprehensive needs and the entire Rx plan.
Integumentary System
PT Intervention of Wounds in Acute Care.
History
- Wound history
- Risk factors
- Psychosocial Factors
- Medications/Nutrition/Comorbidities
Examination
- Wound assessment
- Strength/ROM/Mobility limitations
Intervention
- Wound treatment/protection
- Strength/ROM/Mobility training
