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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
Q

What is secondary closure?

A

Wound is too large for edges to approximate and must heal by going through phases of healing

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25
Q

What is delayed primary closure?

A

Combination of primary and secondary closure; dirty wound left open for healing

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26
Q

T/F: Inflammation is necessary for healing.

A

True - it is the first stage of healing

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27
Q

Which wounds are considered at risk for hypertrophic scarring/keloids?

A

Wounds that cross joints, prolonged proliferation stage, burns

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28
Q

What is the difference between a keloid scar and hypertrophic scar?

A

Keloids extend outside the margin of the original wound

29
Q

Why are scabs poor for wound healing?

A

Scabs are collections of dead cells and proteins that retard epithelial cell migration

30
Q

What are arterial wounds?

A

Wounds that result from a lack of blood flow which deprives the area of oxygen

31
Q

Etiology of arterial insufficiency

A

Trauma - damage to an artery
Acute embolism
DM
RA
Thomboangitis (Buerger’s disease)
Arteriosclerosis - thickening/hardening of vessels

32
Q

What conditions can AI typically present with?

A

Intermittent claudication or Ischemic rest pain

33
Q

What is intermittent claudication?

A

Activity-specific discomfort due to local ischemia

Pain stops within 1-5 mins of ceasing the activity

Pain characterized as cramping, burning, fatigue

34
Q

What is ischemic rest pain?

A

More significant arterial disease

Burning pain is exacerbated with elevation and relieved by dependency

35
Q

What is the progression of AI to an ulcer?

A

AI > Intermittent claudication > Ischemic rest pain > Ulcer

36
Q

Dry vs wet gangrene

A

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
Q

What are some contributing factors to arterial disease?

A

Smoking
Trauma
HTN
DM

38
Q

Generally, what shape and where do arterial insufficiency wounds present?

A

Circular shape
Primarily LE, distal toes, dorsal foot

39
Q

Where is the common site for occlusion?

A

Common femoral artery bifurcation

40
Q

What test is the first you should do when suspecting arterial insufficiency?

A

ABI

41
Q

What is a normal ABI range?

A

0.9-1.1

42
Q

What is TCOM?

A

Transcutaneous oxygen monitoring - used for slow healing wounds, measures healing potential (notebook for values)

43
Q

What are some PT management techniques for AI?

A

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
Q

What types of therapeutic exercise can pts with AI participate in?

A

Gait training and mobility

Aerobic conditioning - usually have CAD

Resistive exercise

Stretching

Positioning - avoid excess knee and hip flexion

45
Q

What is venous insufficiency?

A

Condition where the veins, particularly in the LE have difficulties sending blood back to the heart

46
Q

Which type of vein carries 80-90% of blood back to the heart?
a) Deep
b) Superficial
c) Perforating

A

Deep

47
Q

Which type of vein is subject to trauma?
a) Deep
b) Superficial
c) Perforating

A

Superficial

48
Q

Which method is the main way we get blood back to heart?
a) calf muscle pump
b) respiratory pump
c) valves

A

Calf muscle pump

49
Q

What is the etiology of VI?

A

Sustained venous HTN

50
Q

T/F: Most VI appears to be caused by reflux.

A

True

51
Q

What is the WBC trapping theory?

A

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
Q

What is fibrin cuff theory?

A

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
Q

What are the risk factors for VI ulcer development?

A

Vein dysfunction
Valve damage
Calf muscle pump failure
Trauma
Previous VI
Advanced Age
Obesity
DM

54
Q

What is the gold standard for clinical assessment for DVT?

A

Venogram

55
Q

Wha’s the average healing time for venous ulcers?

A

8 weeks

56
Q

What are contraindications to using compression on VI pts?

A

ABI < 0.5
Acute infection
Pulmonary edema
Uncontrolled or severe CHF
Active DVT
Claustrophobia (relative)

57
Q

T/F: Short stretch compression wrap has a high working pressure and a low resting pressure.

A

True

58
Q

T/F: Pressure ulcers may not develop for days after pressure application.

A

True

59
Q

Risk factors for PI

A

Shear
Anhydrous skin and moist skin
Incontinence

60
Q

Prevention of PI

A

Education - daily skin checks, position changes, transfer techniques, incontinence mgmt
Positioning
Mobility
Nutrition
Mgmt of incontinence

61
Q

Prognosis of PI

A

Heal very slowly
Stage 1 = 1-3 wks
Stage 2 = 23 days
Stage 3-4 = 8-13 wks

62
Q

At what time frame should PIs be reassessed for alternative/adjunctive interventions when they are not decreasing in size?

A

2 weeks

63
Q

What is Charcot foot?

A

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
Q

Which location of ulcer heals faster: forefoot or heel?

A

Forefoot

65
Q

What gait pattern is used to decrease plantar pressure?

A

Step-to pattern

66
Q

T/F: MLD can be used on any kind of edema.

A

True

67
Q

Zone of coagulation

A

Central portion, irreparable damage

Characterized by coagulation, ischemia, necrosis

68
Q

Zone of Stasis

A

Area of cellular injury and compromised perfusion

Conversion - widening and deepening of necrosis

69
Q

Zone of Hyperemia

A

Outer edges, minimal cellular injury

Integumentary PT (3 decks)

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