Wounds, Ulcers, and skin conditions Flashcards
Woundsmodifiable risk factors
- autonomic dysreflexia
- Incontinence
- smoking
- obesity
- poor nutrition
- comorbidities (renal, cv, pulmonary, diabetes)
- depression
Wounds non-modifiable risk factors
- Decreased sensation
- activity, and mobility
- muscle atrophy
- completeness of injury
- Age
- history of previous wounds
- Increased tissue temp, moisture
- spasticity
What areas are at risk of a wound when in lying
- occiput
- elbows
- sacrum and coccyx
- heel
What areas are at risk of a wound when in side lying
- shoulder
- greater trochanter
- anterior knee
- malleolus
What areas are at risk of a wound when in sitting
- shoulder blade
- sacrum and coccyx
- ischial tubs
- posterior knee
- foot
What causes an ulcer
- Pressure (round sore)
- shearing (abrasion/scrape)
- friction (blisters can be a sign, spasticity are common causes)
- Deep tissue damage from banging or bumping (purple or bruising)
What are the 4 stages of wounds
Stage 1: reddened (non-blanchable)
Stage 2: skin is broken, small crater
Stage 3: deep crater, might be infected, may be black, dead tissue
Stage 4: deep through muscle to the bone or joint
What are 7 components used in describing wounds
location, size, wound base, wound edges, surrounding skin, stage, photos
Client education for wound prevention
- look at skin 2X/day, check all bony prominences, use a mirror and attendants
- look for change in temp, colour, temperature, texture, persistent erythema, discolouration
Tool for assessing risk of wound
Braden Scale
Wound Rx
- multidisciplinary team, dressings, mobility restrictions
- PT: HVPC level 1 evidence for wound healing
What is Psoriasis? What causes it?
- autoimmune disease that affects the skin
- faulty signals that speed up the growth cycle of skin cells: profound cutaneous inflammation and epidermal hyperproliferation
What are the 5 cardinal signs of psoriasis
- plaque (raised lesion)
- well circumscribed margins
- bright salmon red colour
- silvery micaceous scale
- symmetrical distribution
Common sites for psoriasis
- Extensor surfaces over bony prominences (elbows, knees)
- scalp
- retroauricular, ears
- palms and soles
- umbilicus
- penis
- lumbar
- shins
- nails plaques
…but can affect any area
Does psoriasis normally affect the inside or outer side of the joint
outer side - unlike eczema
Complications associated with psoriasis
- physical (pruitis, bleeding of lesions)
- emotional and psychological (isolation, loss of self-esteem)
- economic (cost of meds, time away from work)
- severe psoriasis is associated with risk of cardiovascular disease and death, psoriatic arthritis
Psoriasis Rx
- Topical creams containing glucocorticoids
- Tars
- vitamin D or A
- phototherapy with UV light
- systemic therapy with immunosuppressive drugs
What is eczema? What is it’s apperance?
- form of dermatitis or inflammation of the epidermis (skin outer layer)
- itchy, red, scaly disorder
2 types of eczema
Atopic dermatitis
Contact dermatitis
Atopic dermatitis is also referred to as _____
Endogenous eczema
What is atopic dermatitis? What is the underlying cause?
intensely itchy inflammatory skin disorder associated with “atopy”
- predisposition toward developing certain allergic hypersensitivity reactions
- asthma, hay fever, and allergic conjunctivitis
Presentation of atopic dermatitis
- itchiness is the most outstanding feature (pruitis)
- lichenification (thickening skin lines)
- excoriations (scratching or picking at skin)
- crusting
3 phases of atopic dermatitis and their corresponding distributions
- Infantile (2mo-2years)-facial and extensor distribution
- Childhood-dry skin, flexural distribution (popliteal and cuboid fossa)
- Adult-atopic dermatitis generally improves with age, less flexural distribution, primarily affect the hands
Atopic dermatitis Rx
- avoid irritating factors
- Use moisturizers, topical glucocorticoids, oral antihistamines, UV therapy for resistant or severe cases
What is another term for contact dermatitis
Exogenous eczema
What are two types of contact dermatitis
Allergic
Irritant
What is Allergic contact dermatitis
immune hypersensitivity to an allergen in contact with the skin (e.g. nickel, poison ivy)
What is irritant contact dermatitis
contact of skin with something that primarily causes direct local irritation (harsh detergents, chemicals)
Rx for contact dermatitis
usually topical steroids, clears up in 7-10 days
What is seborrheic dermatitis
Dandruff - ill-defined areas of erythema with greasy-appearing scale
Where does seborrheic dermatitis occur and what is the cause
- occurs in areas of higher sebaceous gland activity (oily areas)- scalp, face, central chest and back
- probably due to an excessive immune response to a yeast
Seborrheic dermatitis associated disorders
seen frequently in PD, neurologic disorders (stroke, TBI, SCI), HIV pts that decreased mobility
Seborrheic dermatitis Rx
antifungals
