The Integumentary System Flashcards

1
Q

Integumentary System

Composed of skin, hair, hair shafts, nails, sebaceous and sudoriferous (sweat) glands = ?

A

Integumentary System: Composed of skin, hair, hair shafts, nails, sebaceous and sudoriferous (sweat) glands.

Skin is 0.5-6.0mm thick and made up of three layers:

  • Epidermis (keratinocytes, epithelial cells, melanocytes)
  • Dermis (collagen, elastin, macrophages, mast cells, Meissner’s corpuscles, free nerve endings and superficial lymph vessels
  • Subcutaneous (Subdermis or hypodermis): adipose tissue, fascia, lymphatic vessels
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2
Q

Integumentary System

Outermost layer, composed of keratinocytes, epithelial cells, melanocytes = ?

A

Epidermis = keratinocytes, epithelial cells, melanocytes

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3
Q

Integumentary System

What layer = ?

  • Middle layer
  • Composed of collagen, elastin, macrophages, mast cells
  • Meissner’s corpuscles
  • Free nerve endings and superficial lymph vessels = ?
A

Dermis = collagen, elastin, macrophages, mast cells, Meissner’s corpuscles, free nerve endings and superficial lymph vessels.

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4
Q

Integumentary System

Inner most layer, composed of adipose tissue, fascia, lymphatic vessels.

A

Subcutaneous (Subdermis or hypodermis) = adipose tissue, fascia, lymphatic vessels.

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5
Q

Integumentary System

Functions of the integumentary system = ?

A
  • Temperature regulation
  • Protection
  • Sensation
  • Excretion
  • Immunity
  • Blood reservoir
  • Vitamin D synthesis
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6
Q

Integumentary System

Systems Review for the integumentary system includes the assessment of = ?

A

Systems Review for the integumentary system includes the assessment of:

  • pliability (texture)
  • presence of scar formation
  • skin color, and
  • skin integrity
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7
Q

Integumentary System

Integumentary integrity is defined as = ?

Guide to PT Practice: Integumentary Integrity

A

Integumentary integrity is defined as intact skin, including the ability of the skin to serve as a barrier to environmental threats such as bacteria, pressure, shear, friction, and moisture.

  • The PT uses tests and measures to determine whether skin/subcutaneous changes, resulting from a wide variety of disorders and conditions, can serve as an adequate barrier to environmental threats.
  • PT Interventions include devices, positioning, debridement, dressings, healing agents, ROM, strengthening, mobility training, environmental adaptations, education
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8
Q

Integumentary System

Examples of Health Conditions That May Cause Impairment of the Integumentary System = ?

A

Cardiovascular

  • Vascular insufficiency
  • lymphedema

Pulmonary

  • Pulmonary edema
  • CF

Musculoskeletal

  • Osteomyelitis
  • open fracture

Neuromuscular

  • SCI
  • CVA
  • MS
  • loss of sensation

Endocrine

  • Diabetes
  • liver disease
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9
Q

Integumentary System

General integumentary system examination includes = ?

A

General integumentary system examination includes:

  • Skin Color (pallor, cyanosis, jaundice, redness (rubor), hemosiderin staining
  • Skin Condition (bruising, blistering, texture)
  • Skin Temperature
  • Scars
  • Hair loss
  • Lesions
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10
Q

Integumentary System

3 types of skin cancer are = ?

A

1) Basal Cell Carcinoma - most common

2) Squamous Cell Carcinoma

3) Malignant Melanoma - 15% mortality rate.

  • It is NOT the responsibility of the PT to diagnose that a lesion is benign vs. cancerous
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11
Q

Integumentary System

Signs of an Irregular Mole or Skin Lesion:

The ABCDE Rule = ?

A
  • A - Asymmetry: one half unlike other half
  • B - Borders: Irregular, poorly circumscribed
  • C - Color variations: Tan, brown, black, white, red, blue
  • D - Diameter: > than 6 mm
  • E - Elevation: Normal is flat; abnormal is raised
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12
Q

Integumentary System

How to distinguish Benign from Malignant skin lesions

A

Benign

  • < 6 mm in size
  • Uniform in color
  • Distinct borders
  • Symmetric
  • Seldom bleed or ulcerate
  • Soft to firm consistency
  • Slow rate of growth or change

Malignant

  • > 6 mm in size
  • Multiple shades, varied pigmentation
  • Irregular, blurred borders
  • Asymmetric
  • Often bleed or ulcerate
  • Firm to hard consistency
  • Variable rate of growth or change
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13
Q

Integumentary System

3 types of burns = ?

A
  1. Thermal
  2. Electrical
  3. Chemical
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14
Q

Integumentary System

Burn severity dependent on = ?

A

Burn severity dependent on:

  • age
  • duration of burn
  • type of burn
  • affected area
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15
Q

Integumentary System

Burns are classified based on = ?

A

Classified based on depth of tissue destruction.

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16
Q

Integumentary System

Burn Depth Characteristics:

  • Superficial = ?
A

Superficial:

  • Epidermis only
  • no blisters
  • Red
  • painful
17
Q

Integumentary System

Burn Depth Characteristics:

  • Superficial Partial Thickness = ?
A

Superficial Partial - Thickness:

  • Epidermis and superficial dermis
  • Blisters
  • Red
  • Painful
18
Q

Integumentary System

Burn Depth Characteristics:

  • Deep Partial Thickness
    = ?
A

Deep Partial-Thickness:

  • Majority dermis
  • Hair follicles/sweat glands intact
19
Q

Integumentary System

Burn Depth Characteristics:

  • Full Thickness
    = ?
A

Full Thickness:

  • Subcutaneous fat layer
  • Minimal pain
  • Susceptible infection
  • Increased depth = decreasing pain
20
Q

Integumentary System

Burn Depth Characteristics:

  • Subdermal
    = ?
A

Subdermal:

  • Muscle, bone, adipose tissue injury
  • Insensate
21
Q

Integumentary System

American Burn Association recommends medical care at a burn center if = ?

A
  • Partial-thickness burns greater than 10% TBSA
  • Burns on face, hands, feet, genitalia, perineum or major joints
  • Any full thickness (3rd degree) burns
  • Electrical burns, including lightning injury
  • Chemical burns
  • Inhalation Injuries
  • Burns in children in hospitals not specifically equipped for pediatric burn care
  • Burns with concomitant trauma
22
Q

Integumentary System

Acute PT Management of Burn Injury = ?

A
  • PT works on a dedicated team with nurses, physicians, RTs, OTs, mental health practitioners, dietitians, etc.
  • PT coordinates session with pain medication administration by RN
  • Wound cleansing, debridement, protective dressings
  • ROM/Strength training
  • Mobility training
23
Q

Integumentary System

Ulcer/ Wound Types = ?

A

Ulcer/ Wound Types:

  • Traumatic wounds
  • Surgical wounds
  • Arterial insufficiency wounds
  • Venous insufficiency wounds
  • Neuropathic wounds
  • Pressure Wounds
24
Q

Integumentary System

Signs of an arterial insufficiency wound = ?

A

Signs of an arterial insufficiency wound:

  • Intermittent Claudication
  • Pain with activity, exercise and elevation, decreased with rest
  • Decreased or absent pedal pulses
  • Decreased temperature of distal limb
  • Distinct, well defined wound edges
  • Deep wound bed, minimal or no granulation tissue or drainage
  • Cyanosis, anhydrous surrounding skin
  • Most common in distal, anterolateral LE and dorsum of foot
  • Difficult to heal, high risk of gangrene
  • Most arterial insufficiency wounds are caused by tissue ischemia, usually related to atherosclerosis
  • Anhydrous-dry, flaky skin
25
# *Integumentary System* Signs of an venous insufficiency wound = **?**
**Signs of an venous insufficiency wound**: * Localized limb pain, decreased with elevation and increased with dependent positioning * Pedal pulses present * Increased skin temperature around wound * Indistinct, irregular edges * Lower extremity edema * Shallow, fibrous covered wound bed, substantial drainage * Hemosiderin staining * Most common location is foot and medial lower leg, many times at medial malleolus
26
# *Integumentary System* Peripheral Neuropathy = **?**
**Peripheral Neuropathy**: * Nerve damage, usually related to diabetes, may also be result of alcoholism, tertiary syphilis, spina bifida, Vitamin deficiency, Lyme disease, shingles, Hep C, HIV, Epstein-Barr Virus, chemotherapy * Diminished light touch, proprioception, temperature and pain perception * Shiny skin with trophic changes of skin, hair and nails due to neuropathy * Person can’t sense trauma, shear forces, pressure which cause ulcers * Progressive weakness of intrinsic foot muscles lead to bony collapse of foot causing abnormal pressure, Charot foot (rocker bottom foot)
27
# *Integumentary System* Neuropathic Ulcers = **?**
**Neuropathic Ulcers**: * Caused by a triad of disorders: PVD, peripheral neuropathy and infection. * Painless, sometimes generalized LE pain * If atherosclerosis = Absent pedal pulses. * Deep wound bed frequently located at pressure points (bony prominences). * Loss of protective sensation * High incidence of LE amputation
28
# *Integumentary System* Decubitus (Pressure Ulcers) = **?**
**Decubitus** (Pressure Ulcers): * Tissue ischemia (death) as a result of prolonged weight bearing or pressure on tissue, frequently over a bony prominence * Friction, shear, moisture and malnutrition are contributing factors **Common sites include**: * Back of skull * ears * scapular spines * spinous processes * elbows * ischial tuberosities * sacrum * heels * trochanters * med/lat condyles
29
# *Integumentary System* Stages of pressure ulcers = **?**
* **Stage 1**: intact, reddened skin that does not blanch * **Stage 2**: shallow open ulcer with red/pink wound bed, denoting partial-thickness loss of dermis, without slough. Can present as open or ruptured blister * **Stage 3**: subcutaneous fat may be visible but no bone, muscle or tendon exposed. May include tunneling or undermining * **Stage 4**: muscle/tendon/bone exposure. Tunneling/undermining, eschar/slough over at least part of wound bed * Wounds are not stageable and will not heal if wound bed is obscured completely with slough and/or echar. * Physician, wound specialist RN or PT will debride non-viable tissue to determine wound stage to begin healing process
30
# *Integumentary System* Examination Of The Skin: Wound Assessment includes = **?**
Inspecting the wound is simply one component for evaluation. Include, along with wound information, in your assessment: * ROM – especially near wounds * Sensation – especially near wounds * Strength * Functional mobility (Bed mobility, transfers, gait, etc) * Neuromuscular coordination * Balance * Equipment used **Key point**: Consider the patient’s comprehensive needs and the entire Rx plan.
31
# *Integumentary System* PT Intervention of Wounds in Acute Care.
**History** * Wound history * Risk factors * Psychosocial Factors * Medications/Nutrition/Comorbidities **Examination** * Wound assessment * Strength/ROM/Mobility limitations **Intervention** * Wound treatment/protection * Strength/ROM/Mobility training