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Flashcards in Skin Deck (41):
1

What are the layers of the skin?
What is their function?
And what do they contain?

Epidermis
-outer layer
-no blood vessels

Dermis
-collagen and elastin connective tissue
-contains lymphatic system, blood vessels, nerves, hair follicles, sebaceous and sweat glands

Subcutaneous
-loose connective and fat tissue
Insulates, support, cushion, stores energy

Muscle and fascia underneath all

2

What are sebaceous glands?

Exocrine, secrete fatty substance, lubricates skin, defends against bacteria and fungus

3

What are sweat glands?

Eccrine glands, control body temp

4

What is dermatitis/eczema?

Inflammation of skin, causing itching redness lesions.

5

What is cellulitis?

Inflammation of cellular or connective tissue in or close to skin

6

How does cellulitis present?
How do you treat it?

Red, hot, edema
elevate limb, cool, wet dressings

7

What are the types of herpes?

Herpes 1 simplex- cold sore
Herpes 2- genital herpes
Herpes zoster/shingles- chicken pox, pain tingling rash in dermatomes of infected nerve root

8

What are herpes zoster/shingles contraindications?

Heat, US can increase symptoms

9

What is psoriasis? And it's symptoms?

Chronic autoimmune disease of skin.
Red/erythema skin with silvery scales on ears, scalp, knees, elbows, genitalia, itching, pain, dry skin, cracked lesions

10

What is the PT intervention for psoriasis?

Long wave UV, combo UV light with oral photo synthesizing drugs

11

What is lupus?
What are its symptoms?

Chronic, progressive autoimmune disorder of connective tissue

Red rash, butterfly rash across nose, skin lesions, chronic fatigue, arthralgia, anemia, hair loss, Raynaud's

12

What is scleroderma?
What are its symptoms?
What types are there?
What can PT do?

Chronic autoimmune disease of connective tissues causing fibrosis of skin, joints, blood vessels, internal organs

Skin is taught, firm, edema, firmly bound to subcutaneous tissue

Types - limited, diffuse

Associated with CREST syndrome (Calcinosis, raynauds, esophageal dysfunction, sclerodactyly, tenangiectasia)

PT- slows contracture deformity

13

What is polymyositis?
What can PT do?

Disease of connective tissue

edema, inflammation, degen of muscles

affects proximal muscles, symmetrical

PT- fatigue mx, conserve energy, exercise (precaution of too much exs damages muscles), prevent contracture and pressure ulcers

14

What are the types of malignant skin tumors?

Basal cell- slow growing, rarely mets

Squamous cell- quickly grows, mets, sun exposed areas, poorly defined margins

Malignant melanoma- tumor from melanocytes. ABCDEs refer to dermatologist asap

15

What is a epidermal/1st degree burn?

Damage to epidermis only
Pink/red
No blisters
Minimal edema
Tender, delayed pain
Healing- 3-7 days, no scarring

16

What is a superficial partial-thickness/2nd degree burn?

Epidermis and upper layers of dermis

Bright pink and red
Blanching, brisk cap refill
Blisters, moist surface, weeping
Moderate edema
Painful, sensitive, temp changes
Healing- spontaneous, 7-21 days, min scarring

17

What is deep partial-thickness/2nd degree burn?

Severe damage to dermis including nerve endings, hair follicles, sweat glands

Mixed red and waxy white
Blanching, slow cap refill
Broken blisters, wet
Marked edema
Sensitive to pressure but not to light tough/soft pin prick
Healing- slow, reepithelialization. Scars w/o Rx

18

What is a full thickness/3rd degree burn?

Complete three layer destruction

White/ischemic, chard, tan, black, leathery, parchment like
No blanching, poor distal circulation
Little pain, nerve endings destroyed
Healing- grafting, remove eschar

19

What is the rule of nines?

Head/neck 9%
Ant trunk 18%
Post trunk 18%
Arms 9% each
Legs 18% each
Perineum 1%

20

What are the types of scars?

Normal - white, raised, soft

Hypertrophic- raised, red, firm, stays in boundaries of wound

Keloid- raised, red, firm, extends beyond wound boundaries

Hypotrophic- flat, depressed

21

What are the phases of tissue healing?

Inflammation- lasts 3-5 days, red, edema, warmth, pain, decrease ROM

Proliferation/granulation- fibroblasts synthesize type 3 collagen, type 1 then replaces, scar tissue

Maturation- remodeling, up to 2 years

22

What is PT care for burns? Wound care, rehab?

Sharp debridement, autolytic dressings, hydrotherapy tank

Rehab- Deep breathing, chest expansion, ambulation, positioning and splinting to prevent contractures, edema control, AROM and PROM, massage, promote ADL, manage pain

23

What positions do you place the patient with burns to each area?
Anterior neck?
Shoulder?
Elbow?
Hand?
Hip?
Knee?
Ankle?

Anterior neck- hyper extension in cervical orthosis
Shoulder- abduction, flexion, ER in axiliary splint
Elbow- extension, supination in posterior arm splint
Hand- wrist ext, MP flexion, PIP DIP ext, thumb abduction
Hip- ext, abduction
Knee- extension in posterior knee splint
Ankle- DF neutral in AFO

24

What is the difference between a venous ulcer and an arterial ulcer?

Venous-
Irregular
Dark pigmentation
Fibrotic
Good granulation
Shallow
Distal lower leg, medial mall
Pulse present
Little pain, ok with legs elevated
Exudate present
Edema

Arterial-
Irregular smooth edges
No granulation
Deep
Lateral mall, toes, feet, ant tib
No pulse
Gangrene
Painful especially with legs elevated

25

What is a diabetic ulcer and how do you treat it?

Repetitive trauma to insensitive skin. Associated with arterial disease and peripheral neuropathy

Wound care, off loading, skin and foot care, exs

26

What is a pressure ulcer and how do you treat it?

Lesion caused by unrelieved pressure resulting in ischemic hypoxia and tissue damage

Rx- wound care, edu and skin hygiene, incontinence mx, seating, pressure relief, positioning, exs, nutrition

27

What are the four stages of an ulcer?

1- nonblanchable erythema of intact skin, skin temp changes, skin firm or boggy, sensation pain and itchy

2- partial thickness skin loss, epidermis and/or dermis, superficial, abrasion, blister, shallow crater

3- full thickness skin loss, damage or necrosis of subcutaneous, maybe into fascia, deep crater

4- full thickness, tissue necrosis, damage to muscle, bone, sinus tracts

28

What is autolytic debridement? Indications? Contra?

Selective
Natural
Moisture retentive dressing
Solubilization of necrotic tissue

Indications- patients on anticoagulant therapy, can't do other forms, all wounds on medically stable

Contra- infected wounds, immunosuppressed, dry gangrene or ischemic wounds

29

What is enzymatic debridement? Indications? Contra?

Selective chemical
Liquified necrotic tissue by applying topical collagenolytic enzymes

Indications- moist necrotic tissue, eschar after cross hatching, home bound, can't do surgical

Contra- ischemic wounds, dry gangrene, clean granulated wounds

30

What is mechanical debridement? Indications? Contra?

Nonselective
Removes foreign material (wet to dry gauze, dextranomers, pulsating lavage, whirlpool)

Indications- moist necrotic tissue or foreign material present

Contra- clean, granulated wound. Can remove healthy skin

31

What is sharp debridement? Indications? Contra?

Selective
Sterile instruments
No anesthesia
Little bleeding

Indications- scoring and excision of leathery eschar, excision of moist necrotic tissue

Contra- clean wounds, advancing cellulitis, infection threatens life, patient on anticoagulant therapy

32

What is surgical debridement? Indications? Contra?

Performed by surgeon/physician with sterile instrument
Deep stage 3 or 4, complicated pressure ulcer
Most effective
Pain, bleeding, may need anesthesia

Indications- Advancing cellulitis, immunocompromised, infection threatens life, granulation and scar may be excised

Contra- cardiac disease, pulmonary disease, diabetes, spasticity, cannot tolerate surg, QOL can't be improved

33

What is kilohertz US? Indications? Contra?

Selective
Long wave low frequency US 20-50kHz

Indications- Increase angiogenesis, Remove necrotic tissue, Prep for grafting/flap closure

Contra- DVT, PVD, tumors, organs, electrical devices
Precaution over nerves, infections, anesthetic areas

34

What are transparent film dressings?
Indications?
Pros/Cons?

For stage 1 and 2 ulcers
Used as secondary dressings
Autolytic debridement
Can see through to view wound healing
Comfortable
Impermeable to water, bacteria, environment
Non absorptive
Difficult to apply
Do not use on fragile surrounding skin
Do not use on infection

35

What are hydrocolloid dressings?
Indications?
Pros/Cons?

Contains hydroactive/absorptive particles that form gelatinous mass over wound
Protection of partial-thickness wounds
Autolytic debridement
Used for mild exudate
Maintains moisture
Comfortable
Min-Mod absorption
Easy to apply
Time saving
waterproof
Nontransparent
Odor and yellow drainage on removal
Do not use on infection

36

What are hydrogel dressings?
Indications?
Pros/Cons?

Partial and full thickness with min-mod exudate
Burns
Soothing and cooling
Fill dead space
Autolytic debridement
Conforms to wound
Nonadherent, requires secondary dressing
Transparent
Do not use sheet form on infection
May macerate surrounding skin

37

What are alginate dressings?
Indications?
Pros/Cons?

Soft, absorbent seaweed
Moderate-Large amounts of exudate
Packing and absorption
Infected and nonifected wounds
Easy to apply
Requires secondary dressing
Can dry wound bed

38

What are gauze dressings?
Indications?
Pros/Cons?

Large exudate
Dead space, tunneling, sinus tracts
WET TO DRY- mechanical debridement
CONTINUOUS DRY- heavy exudate
CONTINUOUS WET- autolytic, protect clean wounds
Cost effective
Can use on infected wounds
Pain on removal
Delayed healing if used wrong
Labor intensive
Avoid direct contact with granulating tissue

39

What are foam dressings?
Indications?
Pros/Cons?

Partial and full thickness with min to mod exudate
Protection and insulation
Nonadherent, requires secondary dressing
Conformable
Easy to use
For deep cavitites
Nontransparent
Not comfortable
Not for dry eschar

40

What are the following types of exudate?
serous
purulent
sanguineous

serous - watery
purulent - pus
sanguineous - blood

41

What can you use for infection control during wound healing?

antimicrobial agents - silver nitrate
anti inflamm - corticosteroids
anesthetics - lidocaine
hand washing
sterile tools/techniques
negative pressure wound therapy