Orthotics, Skin Issues, Positioning, Integ and Burns Flashcards
1
Q
List several types of hyperextension orthoses
A
- Jewett
- CASH
- HE brace with neck support
2
Q
List several types of reinforced cervical collars
A
- Philadelphia → good to limit flex/ext but not rotation
- Aspen → good for limiting in all 3 planes
- Miami J
3
Q
List several types of spinal orthotics
A
- reinforced cervical collars
- cervicothoracic
- Halo
- hyperextensive orthoses
- TLSO
4
Q
List several types of LE orthotics
A
- Walking boot
- AFO
- Knee splints
- Hip ABD wedge
5
Q
List some types of adaptive equipment and DME
A
- Dressing aids
- Sock butler/arm butler
- Raised toliet seats
- DME
- Geri Chairs, cardiac chairs
6
Q
What are the goals of pt positioning?
A
- Pt comfort
- skin hygiene → reduce risk of pressure sores
- joint mobility → reduce risk of joint contractures
7
Q
Things to keep in mind w/pt positioning
A
- Avoid static positioning
- edu pt on pressure relief
- turning schedule for individuals unable to reposition themselves
- 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
- speciality beds → inflate max during mobility then return to proper setting at end of PT trx
8
Q
List some examples of Off-loading devices
A
- pressure relief mattresses
- heel floats
- cushions
- air provides highest pressure relief and least postural stability
9
Q
what is the gold standard for diabetic foot casts?
A
total contact casts
custom made or off the shelf varieties
10
Q
What components make up a thorough integumentary eval?
A
- check skin:
- at high-risk areas (heels, bony prominences)
- uder orthotics
- at surgical sites
- location, color, temp, condition, edema
- look for nonblanching skin
- observe skin for pressure areas caused by med devices (ie catheters)
- ask pt to ID areas of discomfort
11
Q
what are the functions of the epidermis?
A
- functions in temp regulation
- mositure regulation
- sensation
- protection from infection/disease
- cosmesis
- interacts w/environment
12
Q
List the 5 layers of the epidermis
A
Come Lets Get a Sun Burn
- Stratum Corneum
- Stratum Lucidium
- Stratum Granulosum
- Stratum Spinosum
- Stratum Basale
13
Q
List other important epidermal cells
A
- Melanocytes → produce melanin, give skin pigment
- Merkel cells → specialized mechanoreceptors
- Langerhan cells → help fight infection
14
Q
describe the dermis
A
- 2 layers that are highly vascularized
- fibroblasts produce collagen and elastin
- Support structures:
- hair follicles
- sudoriferous glands
- sebaceous glands
- vasculature
- lympathics
- nerve endings!
15
Q
List risk factors for acquiring wounds and wound healin
A
- meds → anti-coagulants, steroids, immunosuppressive
- DM
- tobacco use
- poor nutritional status
- albumin
- pre-albumin
- CV co-morbidities
- reactive/autoimmune processes
- reduced mobility
16
Q
what are the norms and relevance of albumin and pre-albumin levels?
A
- albumin → long term protein nutrition
- normal = 3.4-5.4 g/dL
- pre-albumin → short term protein nutrition
- <18 mg/dL poor nutrition
17
Q
what is a decubitus ulcer?
A
lesion caused by unrelieved pressure resulting in damage to underlying tissue
“bed sore”
18
Q
describe the pathogenesis for a decubitus ulcer
A
- pressure causes ischemia (compresses capillaries and occludes blood flow)
- excessive pressure can lead to tissue necrosis
- if pressure relieved → temporary reactive hyperemia and no tissue damage
- if non-blanchable erythema (STAGE 1) then damage has begun
19
Q
what is the ABI?
A
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)
20
Q
list several ABI values and their clinical implications
A
- 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)
21
Q
when it comes to integumentary and ulcers what is the most important thing to remember?
A
prevention is key!
22
Q
list the types of burns that can occur
A
- Thermal → contact w/hot obj, liquid, flame, steam, intense heat
- Electrical → entry and exit wounds, multisystem complications. lightening
- Chemical → contact w/alkali or acid substance
- UV and Ionizing Radiation → sunburn, radiation trx for cancer
23
Q
List the degrees of burns and the skin layer they impact
A
- First degree = epidermis
- Superficial second degree = epidermis
- Deep second degree = dermis
- Third degree = subcutaneous fat
- Fourth degree = muscle
24
Q
describe first degree burns
A
- only epidermis affected
- red, dry, painful, no blisters
- ex: sunburn, burn from curling iron
- usually heals in 1 week
- no long term damage
25
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
26
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
27
how do you calculate the percent of injury for burns?
total body SA for burn is calculate using the rule of 9s
28
describe the rule of 9s
29
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
30
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
31
describe contracture management
* healing scar is at high risk for contracture development
* positioning is key for acute injury and to manage post-surgical edema
* initiate positioning program ASAP
* consider use of pillows, towels, wash clothes
* splinting more likely w/increased depth of injury
32
what is the goal of splinting with burns?
promote neutral alignment for optimal function
33
what are the two types of scars that can form after burns?
1. Hypertrophic → raised above normal skin surface. occur at time of injury
2. Keloid → grow beyond area of original injury. Grow months/years after injury
\*related to growth of collagen fibers in disorganized manner, lack of balance between deposition and breakdown
34
describe scar management through the use of compression garments
1. customized to patient, frequent re-assessment
2. 24-30 mmHg
3. Goal → scar maturation, protect healing skin, shrink scar
4. 23 hr/day week schedule
5. 6-12 months wear time
6. unknown MOA
7. dependent on pt compliance and efficacy
8. can be used to protect tissues when grafting is delayed
9. studies demonstrate inconclusive effects
35
what are silicone sheets?
a form of scar management
applied under compression garments or where garments cannot conform to skin
comfy, do not restrict movement
36
List other options to manage scars
1. scar massage
* perpendicular to collagen fibers, moisturizing w/appropriate lotions
2. injections
* corticosteroids into scar
* 3-4x every month
3. surgery
* last resort, if severly impacts function
* creates new wound, cycle of healing begins again
