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Integumentary PT > Unit 1 > Flashcards

Unit 1 Flashcards

1
Q

How thick is the epidermis?

A

0.06 - 0.6 mm

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1
Q

How thick is the dermis?

A

2 - 4 mm

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2
Q

What are the 5 layers of the epidermis?

A

CLGSB

Stratum Corneum
Stratum Lucidum
Stratum Granulosum
Stratum Spinosum
Stratum Basale

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3
Q

Which layer of the epidermis is the thickest?

A

Stratum Corneum

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4
Q

Which layer of the epidermis is only found in the palms and soles of the feet?

A

Stratum Lucidum

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5
Q

Which layer of the epidermis is the water resistant barrier?

A

Stratum Granulosum

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6
Q

Which layer of the epidermis is also known as the prickly layer?

A

Stratum Spinosum

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7
Q

Which layer of the epidermis is the deepest layer and contains stem cells?

A

Stratum Basale

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8
Q

Which cell of the epidermis is responsible for light touch sensation?

A

Merkel cells

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9
Q

Which cell of the epidermis fights infection?

A

Langerhans

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10
Q

What is the function of mast cells?

A

Chemical mediators for inflammation - when you get a scratch and the area becomes raised, that is due to histamine released by mast cells

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11
Q

T/F: The dermis can regenerate.

A

False - the dermis is replaced with scar tissue

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12
Q

How do blisters occur?

A

Friction between the epidermis and dermis

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13
Q

What tissues are involved in superficial wounds?

A

Epidermis only

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14
Q

What tissues are involved in partial-thickness wounds?

A

Epidermis and Dermis

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15
Q

What tissues are involved in full thickness wounds?

A

Epidermis, dermis, subcutaneous tissue, may extend to sub-dermal layers

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16
Q

What is the purpose of the inflammatory stage of healing?

A

Control bleeding, fight germs and bacteria

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17
Q

What is the purpose of the proliferation stage of healing?

A

Growth and production of cells, produce tissues required to close the wound

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18
Q

What are the 4 crucial events that occur in the proliferation stage?

A

AGCE - A girl can eat

Angiogenesis
Granulation Tissue Formation
Wound Contraction
Epithelialization

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19
Q

What wound shape contracts the slowest?

A

Circular wounds

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20
Q

What is the function of fibroblasts?

A

Build granulation tissue

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21
Q

What is the function of myofibroblasts?

A

Cause wound contraction

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22
Q

What is the function of keratinocytes?

A

Re-epithelialize the surface of the wound

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23
Q

What is primary closure?

A

Simplest and quickest form of closure; the wound is clean, edges are approximated by sutures/staples/wound glue

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24
What is secondary closure?
Wound is too large for edges to approximate and must heal by going through phases of healing
25
What is delayed primary closure?
Combination of primary and secondary closure; dirty wound left open for healing
26
T/F: Inflammation is necessary for healing.
True - it is the first stage of healing
27
Which wounds are considered at risk for hypertrophic scarring/keloids?
Wounds that cross joints, prolonged proliferation stage, burns
28
What is the difference between a keloid scar and hypertrophic scar?
Keloids extend outside the margin of the original wound
29
Why are scabs poor for wound healing?
Scabs are collections of dead cells and proteins that retard epithelial cell migration
30
What are arterial wounds?
Wounds that result from a lack of blood flow which deprives the area of oxygen
31
Etiology of arterial insufficiency
Trauma - damage to an artery Acute embolism DM RA Thomboangitis (Buerger's disease) Arteriosclerosis - thickening/hardening of vessels
32
What conditions can AI typically present with?
Intermittent claudication or Ischemic rest pain
33
What is intermittent claudication?
Activity-specific discomfort due to local ischemia Pain stops within 1-5 mins of ceasing the activity Pain characterized as cramping, burning, fatigue
34
What is ischemic rest pain?
More significant arterial disease Burning pain is exacerbated with elevation and relieved by dependency
35
What is the progression of AI to an ulcer?
AI > Intermittent claudication > Ischemic rest pain > Ulcer
36
Dry vs wet gangrene
Dry = stable; circulation proximal to wound; body would be able to close it off and start to heal underneath and toe would fall off Wet = requires surgery; shows signs of infection
37
What are some contributing factors to arterial disease?
Smoking Trauma HTN DM
38
Generally, what shape and where do arterial insufficiency wounds present?
Circular shape Primarily LE, distal toes, dorsal foot
39
Where is the common site for occlusion?
Common femoral artery bifurcation
40
What test is the first you should do when suspecting arterial insufficiency?
ABI
41
What is a normal ABI range?
0.9-1.1
42
What is TCOM?
Transcutaneous oxygen monitoring - used for slow healing wounds, measures healing potential (notebook for values)
43
What are some PT management techniques for AI?
General considerations and education Address etiology and modifiable risk factors Limb protection education - protect from trauma, chemicals (including caffeine), excessive heat/cold, open wounds Healthy living - diet, exercise, meds, smoking, proper footwear When to contact MD Protect surrounding skin - moisturize, avoid adhesives, reduce friction between toes
44
What types of therapeutic exercise can pts with AI participate in?
Gait training and mobility Aerobic conditioning - usually have CAD Resistive exercise Stretching Positioning - avoid excess knee and hip flexion
45
What is venous insufficiency?
Condition where the veins, particularly in the LE have difficulties sending blood back to the heart
46
Which type of vein carries 80-90% of blood back to the heart? a) Deep b) Superficial c) Perforating
Deep
47
Which type of vein is subject to trauma? a) Deep b) Superficial c) Perforating
Superficial
48
Which method is the main way we get blood back to heart? a) calf muscle pump b) respiratory pump c) valves
Calf muscle pump
49
What is the etiology of VI?
Sustained venous HTN
50
T/F: Most VI appears to be caused by reflux.
True
51
What is the WBC trapping theory?
Congestion and distention is caused by VI. Distention encourages WBC to come to the area which further increases congestion. WBCs adhere vessels walls and become trapped. They then trigger the inflammatory response which encourages more cells to an already congested area as well as WBC releasing substances that further damage endothelial lining of veins. Ulcer ultimately will develop from local hypoxia caused by trapped WBC and congestion. This is why VI was once called venous stasis ulcers.
52
What is fibrin cuff theory?
Suggests that the distention by venous HTN will make the veins leaky. These leaky veins allow proteins to escape into interstitial tissue causing swelling or edema. One of the proteins = fibrinogen which converts to fibrin which adheres to capillary walls and prevents oxygen and nutrient exchange which leads to death of skin and ulcer develops.
53
What are the risk factors for VI ulcer development?
Vein dysfunction Valve damage Calf muscle pump failure Trauma Previous VI Advanced Age Obesity DM
54
What is the gold standard for clinical assessment for DVT?
Venogram
55
Wha's the average healing time for venous ulcers?
8 weeks
56
What are contraindications to using compression on VI pts?
ABI < 0.5 Acute infection Pulmonary edema Uncontrolled or severe CHF Active DVT Claustrophobia (relative)
57
T/F: Short stretch compression wrap has a high working pressure and a low resting pressure.
True
58
T/F: Pressure ulcers may not develop for days after pressure application.
True
59
Risk factors for PI
Shear Anhydrous skin and moist skin Incontinence
60
Prevention of PI
Education - daily skin checks, position changes, transfer techniques, incontinence mgmt Positioning Mobility Nutrition Mgmt of incontinence
61
Prognosis of PI
Heal very slowly Stage 1 = 1-3 wks Stage 2 = 23 days Stage 3-4 = 8-13 wks
62
At what time frame should PIs be reassessed for alternative/adjunctive interventions when they are not decreasing in size?
2 weeks
63
What is Charcot foot?
Tarso-metatarsal joints are most affected, and the bones start to fracture. They end up looking like they have rocker bottom sole so the mid foot collapses and there’s a pressure point on the bottom of the foot
64
Which location of ulcer heals faster: forefoot or heel?
Forefoot
65
What gait pattern is used to decrease plantar pressure?
Step-to pattern
66
T/F: MLD can be used on any kind of edema.
True
67
Zone of coagulation
Central portion, irreparable damage Characterized by coagulation, ischemia, necrosis
68
Zone of Stasis
Area of cellular injury and compromised perfusion Conversion - widening and deepening of necrosis
69
Zone of Hyperemia
Outer edges, minimal cellular injury

Integumentary PT (3 decks)

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