Session 3: Disorders of Skin Integrity/ Healing / MSK

Question 1

functions of the skin

Answer 1

protection , thermoregulation, sensation

Question 2

epidermis

Answer 2

• 1st layer; protective layer / physical barrier

Question 3

dermis

Answer 3

provides strength and supports the epidermis, has sweat glands, nerve endings, blood vessels, and lymph glands within

Question 4

subcutaneous fat

Answer 4

subcutaneous fat - provides insulation and a cushion to surround your vital organs

Question 5

Infectious process affecting the skin

Answer 5

bacterial , viral, fungal, or parasitic

Question 6

Allergic / Hypersensitivity infectious process affecting the skin

Answer 6

atopic dermatitis ,urticaria, drug induced skin eruptions, allergic contact dermatitis

inflammation response

Question 7

Viral infection process affecting the skin

Answer 7

warts (HPV) , Herpes Simplex (HSV-1 & -2) , Herpes zoster, Shingles

Question 8

Fungal Infectious Process affecting the skin

Answer 8

organisms that cause infection known as tinea (all fungal infections have tinea)

Question 9

Yeast Infectious Process affecting the skin

Answer 9

thrust (white patch on tongue and around mouth)

Question 10

Bacterial Infectious Process affecting the skin

Answer 10

impetigo and staph infections

Question 11

Cellulitis

Answer 11

acute condition spreading infection of the dermis or SQ layer of the skin; it is an inflammatory infection; diabetes, immunodeficiency , or impaired circulation , and conditions that result in breaks of skin integrity

Question 12

atopic dermatitis

Answer 12

Eczema >Type I hypersensitivity (true allergic reaction)

Lichenification in the chronic stage due to chronic inflammation

Treatment focus = dryness , pruritus, infection, and inflammation

Question 13

Urticaria (hives) =

Answer 13

hypersensitivity

results from histamine release from mast cells and basophils
increased vascular permeability allows fluid to leak into the tissues , causing edema and wheal formation

Question 14

contact dermatitis

Answer 14

cutaneous reaction to topical irritation or allergy

Type IV Hypersensitivity

Question 15

Angioedma

Answer 15

life threatening, development of edema around mouths , lips, tongue, pharynx , larynx

Hypersensitivity

Question 16

epidermal cell detachment and bullae (fluid-filled blisters) form

Answer 16

Drug induced Skin Eruptions
Hypersensitivity

-erythema multiforme
occurs after herpes infection

-Toxic epidermal necrolysis

Question 17

erythema multiforme

Answer 17

Drug induced Skin Eruptions Hypersensitivity

occurs after herpes infection

Question 18

Toxic epidermal necrolysis

Answer 18

Drug induced Skin Eruptions Hypersensitivity

exaggerated response to ultraviolet light when the drug is taken in combination with sun exposure; people can experience photo sensitivity on drugs

anti-infective agents
antihistamines
diuretics
NSAIDs

Question 19

1st degree burn

Answer 19

superficial partial thickness burns
involved only outer layer of epidermis
-painful, reddened, dry (sunburn)

Question 20

second degree partial thickness

Answer 20

burns involve the epidermis and various degrees of the dermis
painful , moist, red, and water filled blisters

Question 21

second degree full thickness

Answer 21

burns involve entire epidermis and dermis

very painful, loss of tactile sensation, dry, flat blisters

Question 22

third degree burns

Answer 22

full thickness burns extend into SQ tissue and may involve muscle and bone

waxy white or yellowish tan, painless, hard, dry , and leathery

all nerve fibers destroyed

Question 23

Pressure Ulcers

Answer 23

Blood flow becomes obstructed

-May be due to external pressure or shear

external pressure = blocks oxygen to tissue and accumulation of metabolic end products

shear = sliding of one tissue to another , stretching and bending blood vessels causing damage and clots

-Tissue damage from
ischemia to skin

friction = damages the epidermis interface

moisture = alters pH of skin and compromises epidermal integrity

Question 24

strain

Answer 24

a stretching injury to a muscle or a musculotendinous unit caused by mechanical overloading

Question 25

Sprain

Answer 25

involves the ligamentous structures surrounding the joint , pain and swelling subside more slowly than in a strain caused by abnormal or excessive movement of the joint

Question 26

subluxation

Answer 26

a partial dislocation in which the bone ends in the joint are still in partial contact with each other can be congenital , traumatic, or pathological

Question 27

avulsion

Answer 27

is an injury in which a body structure is torn off by either trauma or surgery

Question 28

Compartment syndrome

Answer 28

- condition of increased pressure within a limited space that compromises the circulation and function of the tissues in the space limited space for swelling due to fascia can be acute or chronic acute = after a fracture chronic = exertion from long distance runners and others involved in a major change in activity level tissue becomes Ischemic (restriction in blood supply) you can have : pain out of proportion, nerve damage, paralysis, muscle infraction

Question 29

Rhabdomyolysis

Answer 29

- life threatening complication of severe muscle trauma with muscle cell loss - can lead to Acute tubular necrosis, cardiac dysrhythmias, shock - rapid breakdown of muscle that causes the release of intracellular contents - other causes : medications, anesthesia, malignant hyperthermia

Question 30

acute or chronic infection of the bone causes

Answer 30

(can be internal or external infection) direct penetration or contamination of an open fracture or wound seeding through the bloodstream extension from a contiguous site skin infection in people with vascular insufficiency

Question 31

acute or chronic infection of the bone complications

Answer 31

large abscesses and the need for multiple surgical debridements. Other potential complications include growth arrest/limb length discrepancy

Question 32

acute or chronic infection of the bone treatment how to identify cause?

Answer 32

identify the cause through blood aspiration cultures, antimicrobial agents first parenterally and then orally

Question 33

Hematogenous osteomyelitis

Answer 33

Type of Osteomyelitis infection that reaches the bone through the blood stream

Question 34

Contiguous Spread Osteomyelitis

Answer 34

Type of Osteomyelitis secondary to a contiguous focus of infection direct inoculation from an exogenous source

Question 35

chronic osteomyelitis

Answer 35

Type of Osteomyelitis occurs secondary to an open wound or infected tissue, occurs in adults hallmark = sequestrum

Question 36

osteoporosis

Answer 36

complex , multifactorial chronic dx a loss of mineralized bone mass causing increased porosity of the skeleton and susceptibility to fractures = weakening of bone develops when the remodeling cycle is disrupted and imbalanced manifestations = pain, bone deformity, pathological fractures management = wt bearing exercise , adequate calcium, vitamin D

Question 37

Osteomalacia

Answer 37

inadequate mineralization of bone = bones not hardening / soft bones causes : vitamin D deficiency , critical low levels of phosphate due to renal losses results in : bone pain ,tenderness, fx

Question 38

Rickets

Answer 38

failure or delay in calcification of the cartilaginous growth plate in children whose epiphyses have not yet fused manifestations : deformation of long bones and delay in mineralization

Question 39

osteoarthritis

Answer 39

not systemic most prevalent form of arthritis about wear and tear of bone; a slow progressive destruction of articular cartilage of weight bearing joints and fingers you lose the covering of the bone (articular cartilage) over time and now it's exposed to synovial fluid and then osteophytes are made manifestations : Heberden and Bouchard, pain stiffness

Question 40

gout

Answer 40

disruption in uric acid production or excretion rich man dx; has more to do with the diet of the patient have high levels of uric acid in the blood and other body fluids urate crystal precipitates into the joint space causing crystallization in joint space causes : purine synthesis or breakdown is accelerated, poor uric acid secretion in kidneys

Question 41

rheumatoid arthritis

Answer 41

systemic inflammatory dx unknown cause with a genetic predisposition begins in the synovium and then you develop a pannus it's not a tumor but impedes the joint space

Question 42

Articular issues of RA

Answer 42

synovial inflammation and joint architecture is damaged due to pannus swan neck & boutonniere deformity (fingers will swoop and dip)

Question 43

Extra-articular issues of RA

Answer 43

a systemic problem; going to happen well beyond the joint space elevated erythrocyte sedimentation rate (ESR) correlates with dx Rheumatoid factor (RF) antibody they can develop rheumatoid nodules

Question 44

Fracture Blisters

Answer 44

skin bullae and blisters representing areas of epidermal necrosis with separation of the epidermis form underlying dermis by edema fluid because of localized swelling, the intracompartmental pressure becomes to high and fluid is coming to surface can be a warning for compartment syndrome seen in twisting injuries and excessive joint manipulation

Question 45

Complex Regional Pain Syndrome (CRPS)

Answer 45

neurological condition that impacts limbs and results from surgery or injury pain is prominent symptom of the disorder; abnormal pain response treatment focus on pain management

Question 46

Thromboemboli

Answer 46

the person with a lower extremity fracture is at risk for development of pulmonary embolism and deep vein thrombosis emboli enters into blood stream and can kill

Question 47

Fat Embolism Syndrome

Answer 47

presence of fat droplets in small blood vessels of lungs, kidneys , brain, and other organs after a long bone or pelvic fracture manifestations : seizures , focal neurological deficits