Integumentary Flashcards
1
Q
Integumentary PT
A
Treats pts with skin disorders, chronic wounds or burns - recognize that certain changes in skin condition may indicate various diseases/disorders - assesssment of pliability (texture), presence of scar formation, skin color, and skin integrity
2
Q
Integumentary system
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- protects the body from damage - regulates temperature - contains sensory receptors and is composed of skin, hair, and nails - largest organ system of the body
3
Q
Aging changes
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- flattening of the basement membrane (lies between epidermis and dermis and tightly connects the two) - decreased dermal thickness and decrease spatial density of collagen bundles
4
Q
Chronic wounds
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- Wound that does not proceed through normal stages of healing 2. Takes longer than 4 week sto heal 3. We rarely interven with acute wounds
5
Q
Phases of wound healing
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- Hemostasis / coagulation 2. Inflammation 3. Proliferation (angiogenesis- new blood supply and epitheliaization- new tissue) 4. Maturation/remodeling
6
Q
Inflammatory phase
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- first 72 hours - initiates repair - blood loss is controlled by vasoconstriction -platelets cause clotting - fights infection, clearing Ebros, and triggering the proliferation phase - can lead to tissue damage if it lasts too long - reducing this phase is typically a goal in therapeutic settings
7
Q
Proliferation phase
A
- begins 72 hrs post injury and overlaps with inflammation phase - 15-80% of normal strength, very delicate - granulation tissue: fibroblasts first on site to produce collagen and elastin which help to strengthen and reform the wound site - collagen formation increase the strength of the wound - contraction is key: wound edges are pulled together by myofibroblasts
8
Q
Maturation phase
A
- last up to 18 months - remodeling: collagen fibers reorient in pattern similar to original tissue - final shape of wound is dependent upon stresses placed upon them - can lead to scar contractions
9
Q
PT examination components (7)
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- Pt history 2. Cause of wound 3. Measurement of wound 4. Check for signs of infection 5. Periwound skin assess for quality (hair growth, temperature, moisture, and sensation) 6. Distal pulses 7. Full musculoskeletal examination (ROM, MMT, etc)
10
Q
Tests and measures
A
- Location of wound 2. Size and depth of wound 3. Periwound skin changes 4. Color and temperature 5. Girth 6. Skin sensation 7. Amount and type of drainage (color, texture, odor)
11
Q
Types of tissue in the wound base
A
- Red/pink (viable): pink granulation tissue. Goal is to protect wound and maintain a moist environment 2. Yellow (non-viable): moist yellow slough. Goal is to absorb or debride. This will not “convert back” to viable tissue. This is a normal part of the inflammatory process and is not a sign of infection 3. Black (non-viable): black, thick eschar firmly adhered. Treatment goal is to debride necrotic tissue
12
Q
Burns
A
- Painful, may result in disfiguring & scarring 2. Causes: electricity, heat, chemicals, light, friction, radiation 3. Classification 1st, 2nd, 3rd, 4th 4. Worse with decrease sensation
13
Q
1st degree burns
A
- superficial - limited to redness - only epidermis - sunburn
14
Q
2nd degree burns
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- Superficial partial thickness or deep partial thickness - involves damage down into the dermis - blistering of skin
15
Q
3rd degree burns
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- full thickness - epidermis and dermis is lost with damage to subcutaneous tissue - very painful - may require grafting
16
Q
4th degree burns
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- sub-dermal burn - minimal pain because nerves destroyed - requires skin grafts - common with trauma
17
Q
Types of chronic wounds
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- Pressure injuries 2. Burns 3. Diabetic wounds 4. Venous stasis ulcers 5. Arterial wounds
18
Q
Pressure injuries
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- Tissue necrosis and ulceration occurs due to compression between a bony prominence and hard surface - old age - impaired circulation - immobilization - malnourishment - incontinence 2. Blood flow to soft tissue becomes occluded with pressures >32 mmHg 3. Heel area - coccyx - sacrum - elbow - greater trochanter
19
Q
Pressure injury stages
A
I. Non-blanchable erythema of intact skin II. Partial thickness skin loss including epidermis and/or the dermis. Looks like a blister or abrasion, very shallow but visible III. Full thickness loss or death/necrosis of subcutaneous tissue, not extending beyond the fascia IV. Same as III but with damage to bone, muscle, and other deep tissues - Unstageable: obscured by slough or eschar - Deep tissue injury: persistent non-blanchable deep red, maroon or purple discoloration. Intact or non intact skin
20
Q
Rule of nines
A
Determine exten of burned areas in adults - head 9% - each UE 9% - back of trunk 18% - front of trunk 18% - each LE 18% - perineum 1%
21
Q
Chronic wounds
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- Older adults, paralyzed patients, immobile 2. Distinct locations, causes, presentations (characteristics)
22
Q
Diabetic wounds
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- location: plantar surface of foot - cause: decreased sensation, deformity, poor blood sugar control - presentation: deep and surrounded by callus
23
Q
Venous stasis ulcer
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- location: ankle and gaiter area - cause: venous insufficiency and edema - presentation: shallow, irregular shape and heavily draining
24
Q
Arterial wounds
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- location: toes, foot - cause: PVD and poor tissue perfusion - presentation: painful and distinct edges
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Why isnt the wound healing on its own? (7)
1. Decreased circulation 2. Edema 3. Infection 4. Pressure 5. Poorly controlled blood sugars 6. Previous radiation exposure 7. Topical irritants (hydrogen peroxide)
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PT interventions
Need to target reason for delayed healing - pt edu - positioning (to relieve pressure) - therapeutic exercises (increase circulation) - functional training for ADLs, skin and joint protection, - modalities - wound bed preparation
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Interventions for wounds (6)
1. dressing changes 2. Cushions or protective casting 3. Compression garments 4. Pressure relief 5. Modalities 6. Wound bed preparation
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Wound bed preparation
Moisture balance - debridememt (selective vs. non selective - autolytic - enzymatic - sharp
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Autolytic debridement
- use of an occlusive dressing - keeps in body heat - allows body to liquefy slough - is slow, painless, contraindicated with infected wound - PT may not delegate wound debridement to non licensed person but may delegate non selective wound care to a PTA
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Enzymatic debridement
- topical application of enzymes to surface of necrotic tissue - can be used on infected and non-infected wounds with necrotic tissue - PTA cannot because it is selective
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CO state practice act
9/1/18 both autolytic and enzymatic debridement will be included in PTA scope of practice
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Sharp debridement
Removal of necrotic tissue or foreign material from a wound to promote healing - use scalpel and scissors - highly selective - PTA cannot perform
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Modalities
1. Ultrasound: accelerates inflammatory phase, stimulates vascularizaiton of granulation tissue, and decreases pain and edema 2. Electrical stimulation: stimulates collagen formation, stimulates vascularization, antibacterial effect, and stimulates wound contraction
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Scar management
- surgical intervention for contractures - positioning to minimize joint and skin contractures - splints - AROM and PROM exercises - manual techniques: deep friction, cross or transverse friction
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Things to remember during treatment
1. Follow standards of safety and infection control 2. Hand washing 3. Wear gloves, masks, eye protection, and gown 4. Cleaning of patient equipment 5. Cleaning and disinfection of patient treatment area 6. Occupational health and blood-borne pathogen standards
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ICF model
