Orthotics, Skin Issues, Positioning, Integ and Burns Flashcards Preview

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Flashcards in Orthotics, Skin Issues, Positioning, Integ and Burns Deck (36)
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List several types of hyperextension orthoses

  1. Jewett
  2. CASH
  3. HE brace with neck support 


List several types of reinforced cervical collars

  1. Philadelphia → good to limit flex/ext but not rotation
  2. Aspen → good for limiting in all 3 planes 
  3. Miami J 



List several types of spinal orthotics

  1. reinforced cervical collars
  2. cervicothoracic
  3. Halo
  4. hyperextensive orthoses
  5. TLSO



List several types of LE orthotics

  1. Walking boot
  2. AFO
  3. Knee splints
  4. Hip ABD wedge



List some types of adaptive equipment and DME

  1. Dressing aids
  2. Sock butler/arm butler
  3. Raised toliet seats
  4. DME
  5. Geri Chairs, cardiac chairs



What are the goals of pt positioning?

  1. Pt comfort
  2. skin hygiene → reduce risk of pressure sores
  3. joint mobility → reduce risk of joint contractures



Things to keep in mind w/pt positioning

  1. Avoid static positioning
    • edu pt on pressure relief
    • turning schedule for individuals unable to reposition themselves
  2. use positioning devices to off-load at-risk skin or reposition pt
    • pillows 
    • DO: float heels, elevate UE, use sidelying, prevent hip ER in supine
    • DO NOT: place under knees, keep neck flexed
  3. speciality beds → inflate max during mobility then return to proper setting at end of PT trx



List some examples of Off-loading devices

  1. pressure relief mattresses
  2. heel floats
  3. cushions
    • air provides highest pressure relief and least postural stability



what is the gold standard for diabetic foot casts?

total contact casts

custom made or off the shelf varieties


What components make up a thorough integumentary eval?

  1. check skin:
    • at high-risk areas (heels, bony prominences)
    • uder orthotics
    • at surgical sites
  2. location, color, temp, condition, edema
  3. look for nonblanching skin
  4. observe skin for pressure areas caused by med devices (ie catheters)
  5. ask pt to ID areas of discomfort



what are the functions of the epidermis?

  1. functions in temp regulation
  2. mositure regulation
  3. sensation
  4. protection from infection/disease
  5. cosmesis
  6. interacts w/environment



List the 5 layers of the epidermis

​Come Lets Get a Sun Burn

  1. Stratum Corneum
  2. Stratum Lucidium
  3. Stratum Granulosum
  4. Stratum Spinosum
  5. Stratum Basale


List other important epidermal cells

  1. Melanocytes → produce melanin, give skin pigment 
  2. Merkel cells → specialized mechanoreceptors
  3. Langerhan cells → help fight infection



describe the dermis 

  • 2 layers that are highly vascularized 
  • fibroblasts produce collagen and elastin
  • Support structures:
    • hair follicles
    • sudoriferous glands
    • sebaceous glands
    • vasculature 
    • lympathics 
  • nerve endings!



List risk factors for acquiring wounds and wound healin

  1. meds → anti-coagulants, steroids, immunosuppressive
  2. DM
  3. tobacco use
  4. poor nutritional status
    • albumin
    • pre-albumin
  5. CV co-morbidities
  6. reactive/autoimmune processes
  7. reduced mobility


what are the norms and relevance of albumin and pre-albumin levels?

  • albumin → long term protein nutrition 
    • normal = 3.4-5.4 g/dL
  • pre-albumin → short term protein nutrition
    • <18 mg/dL poor nutrition



what is a decubitus ulcer?

lesion caused by unrelieved pressure resulting in damage to underlying tissue

"bed sore"


describe the pathogenesis for a decubitus ulcer

  1. pressure causes ischemia (compresses capillaries and occludes blood flow)
  2. excessive pressure can lead to tissue necrosis
  3. if pressure relieved → temporary reactive hyperemia and no tissue damage
    • if non-blanchable erythema (STAGE 1) then damage has begun


what is the ABI?

ankle brachial index

diagnostic test for PAD

test of distal LE perfusion performed in radiology or w/bedside doppler machine

SBP ankle/SBP UE (highest)



list several ABI values and their clinical implications 

  • 1.0- 1.4 → normal
  • 0.8-0.9 → mild PAD, treat risk factors
  • 0.5-0.8 → moderate PAD
  • <0.5 → severe PAD (0.4 considered poor prognostic factor)



when it comes to integumentary and ulcers what is the most important thing to remember?

prevention is key!



list the types of burns that can occur

  1. Thermal → contact w/hot obj, liquid, flame, steam, intense heat
  2. Electrical → entry and exit wounds, multisystem complications. lightening 
  3. Chemical → contact w/alkali or acid substance
  4. UV and Ionizing Radiation → sunburn, radiation trx for cancer




List the degrees of burns and the skin layer they impact

  1. First degree = epidermis
  2. Superficial second degree = epidermis
  3. Deep second degree = dermis
  4. Third degree = subcutaneous fat
  5. Fourth degree = muscle




describe first degree burns

  1. only epidermis affected
  2. red, dry, painful, no blisters
  3. ex: sunburn, burn from curling iron
  4. usually heals in 1 week
  5. no long term damage



describe partial thickness (second degree) burns

  1. epidermis and part of dermis damaged
  2. red, blistered, swollen, painful
  3. skin may appear wet or shiny
  4. skin may be white or have irregular discoloration
  5. dressing changes can be painful - pain management
  6. may heal in 3 week, or require more adv management
  7. can be classified as superficial or deep



describe full thickness (third degree) burns

  1. epidermis and entire dermis are damaged
  2. dry, leathery skin
  3. brown, yellow, white, or black color to skin
  4. no pain -- nerve endings are gone
  5. require extensive med management for healing



how do you calculate the percent of injury for burns?

total body SA for burn is calculate using the rule of 9s


describe the rule of 9s


List medical priorities for burn rehab

  1. pain management
  2. electrolyte and fluid management
  3. nutrition
  4. wound care
    • antimicrobials, skin substitutes
  5. infection prevention
  6. pulmonary status
  7. psychological adjustments support
  8. surgery and skin graft management



what are some PT/OT interventions after burn injury

  1. contracture management and positioning
  2. splinting
  3. scar management
  4. prevent wound infection
  5. improve mobility and CV function