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47 Cards in this Set

  • Front
  • Back

Role of Integument

-protection


-insulation


-sensory perception


-fluid balance


-temperature control


-absorbs UV


-Vitamin D synthesis

Primary Lesion

-first lesion to appear on the skin


-visually recognizable structure: macule, papule, plaque, nodule, tumor, wheal, vesicle, pustule

Secondary Lesion

-occurs when primary lesion undergoes changes: scale, crust, thickening, erosion, ulcer, scar, excoriation, fissure, atrophy


-may result from various factors such as scratching, rubbing, medication, natural disease progression, or processes of healing

Pruritis

-itching


-one of the most common manifestations of dermatologic disease


-can lead to damage if the skin's protective barrier is injured

Uritcaria

-hives


-vascular reaction of the skin marked by the appearance of smooth, slightly elevated patches


-can be redder or paler than surrounding skin and are often accompanied by itching

Rash

-general term for an eruption on the skin


-accompanied by itching


-typically occur as a response to some primary agent: sun exposure, allergens, irritants, or medications

Blisters

-fluid-containing elevated lesions of the skin with clear watery or bloody contents


-occur as a manifestation of a wide variety of diseases

Xeroderma

-mild form of ichthyosis or excessive dry skin


-characterized by dry, rough, discolored skin with the formation of scaly desquamation

Changes with Age

-decreased pain perception

-decreased vascularity


-weakened inflammatory response


-impaired thermoregulation


-thinning of stratum corneum


-decreased protection against UV


-decreased vitamin D production


-loss of collagen


Cyanosis

skin turns blue

Erythema

skin turns red

Jaundice

skin turns yellow

Carotenemia

skin turns orange

Mongolian spots

-skin can be bluish gray, deep brown, or black


-often appear on the base of the spine, buttocks, back and sometimes shoulders, ankles, or wrists


-usually fade with age

Causes of Pressure Ulcers

-pressure


-friction


-shearing forces


-maceration


-decreased skin resilience


-malnutrition


-decreased circulation

Risk Factors of Pressure Ulcers

-decreased sensation


-impaired mobility or activity level


-incontinence


-diaphoresis


-altered level of consciousness


-impaired nutrition


-contractures


-obesity

Clinical Manifestations of Ulcers

-over bony prominences


-circular shaped like inverted volcano OR shaped like the object causing pressure

PUSH Tool for Ulcers

can be described, measured, and categorized by surface area, exudates, and type of wound tissue

Braden Scale for Ulcers

-used to assess a patient's risk for developing ulcers


-factors include sensory perception, moisture, activity, mobility, nutrition, and friction and shear


-categories include completely limited, very limited, slightly limited, and no impairment

Norton Scale for Ulcers

-used to assess a patient's risk for developing uclers


-factors include physical condition, mental condition, activity, mobility, and incontinence


-graded on a 1-4 scale, 1 being the lowest, or worst, score

Role of Physical Therapy for Ulcers

delivery of therapeutic modalities, positioning, management of tissue load, and good mobility

Risk Assessment Tools

-Braden Scale


-Norton Scale

Prevention of Ulcers

-clients should be evaluated at least every 3 months


-acute care clients should be reassessed daily or at least weekly


-high-risk client will need frequent position changes, at least every 2 hours in bed and at least every hour while sitting

Positioning for Ulcers

-Rule of 30s: sidelying 30-45 degrees oblique angle and do not elevate head of bed above 30 degrees


-equipment for transfers to reduce shear


-pressure redistribution devices, but covers can cause heat and friction


-NO doughnut cushions

Burns

-direct contact with thermal, chemical, electrical, or radiation source


-heat source transferred to body tissues

Risk Factors of Burns

-high risk: under 3 and older than 70 years old


-lack of adult supervision


-impaired judgment/orientation


-impaired mobility


-rural location


-occupation


-lack of smoke detector


-cigarettes/fireworks

Rule of Nines for Burns

-quick and easy division of the body into anatomic sections each of which represents 9% or a multiple of 9%


-head: 9%


-anterior/posterior thorax: each 18%


-each arm: 9%


-each leg: 18%


-genitals: 1%



Lund-Browder method for Burns

modifies the percentages for body segments and provides a more accurate estimate of burn size according to age

First-degree Burn

only affects the epidermis

Second-degree Burn

affects the dermis and epidermis

Third-degree/Fourth-degree Burn

affects subcutaneous tissue, dermis, and epidermis

Role of Physical Therapy for Burns

-promote wound healing


-reduce edema and promote venous return


-prevent/minimize deformities/scarring


-increase ROM, strength, and function


-increase independence in ADLs


-encourage emotional and psychological well-being

What should a PT/PTA monitor in a burn patient?

-vitals


-medical complications


-lab values


-prealbumin


-glucose


-hypothermia


-exposed body surfaces

Actinic Keratosis

-precancerous


-results from chronic skin exposure


-well-defined, crusty or sandpaper-like patch or bump


-disappear only to appear later


-looks like squamous cell carcinoma


-known risk of malignant degeneration and metastatic potential

Bowen's Disease

-precancerous


-can occur anywhere on the skin or mucous membranes


-persistent, brown/red scaly plaque with well-defined margins


-person usually has a history of arsenic exposure

Basal Cell Carcinoma

-malignant


-slow-growing surface epithelial skin tumor originating from undifferentiated basal cells contained in epidermis


-rarely metastasizes


-pearly or ivory appearance, rolled edges, slightly elevated, small blood vessels on surface


-sun exposure is a significant risk factor

Squamous Cell Carcinoma

-malignant


-tumor of epidermal keratinocytes


-in situ: confined to epidermis, but may extend into dermis


-invasive: arises from precancerous lesion


-poorly defined margins


-unexposed skin is more likely to metastasize


-sun exposure is a significant risk factor

Malignant Melanoma

-tumor originating from melanocytes


-4 types: superficial spreading, nodular, lentigo maligna, and acral lentiginous


-appears on head & neck in men/legs in women


-70% arise from pre-existing mole


-curable if caught early, but can be fatal


-lesions have unique characteristics

ABCD Skin Exam

-Asymmetry: uneven edges, lopsided


-Border: irregularity, poorly defined edges


-Color: black, brown, red, white, pink, blue


-Diameter: larger than a pencil eraser

Psoriasis

-chronic, inherited, recurrent inflammatory but noninfectious dermatosis


-well-defined erythematous plaques covered with a silvery scale


-cause is unknown, but appears to be hereditary


-aggravated by cold weather and stress


-accompanied by itching and pain

Herpes Zoster

-reactivation of the chickenpox virus


-brought on by an immunocompromised state


-pain and tingling along the affected nerve dermatome accompanied by fever chills, malaise, and GI distress


-after 1-3 days, red papules develop into blisters


-papules erupt then dry out 5 days later


-healing takes place over 2-4 weeks

Cutaneous Lupus Erythematosus

-chronic inflammatory disorder of the connective tissues


-characteristic rash is red


-exact cause remains unknown


-appears in several forms: cutaneous LE and systemic LE


-raised, red, smooth plaques on skin normally exposed to sunlight (face, scalp, neck, etc)

Skin Turgor

-skin's ability to change shape and return to normal form (elasticity)


-can reflect dehydration

Cellulitis

-rapidly spreading acute inflammation with infection of the skin and subcutaneous tissue that spreads widely throughout tissue spaces


-patches of skin that are red, hot, and painful


-affects older adults and people with lowered resistance from diabetes, malnutrition, steroid therapy, and the presence of wounds, ulcers, and/or edema

Impetigo

-superficial skin infection commonly caused by staphyl/streptococci


-common in infants, children between 2-5, and older people


-small macules rapidly develop into vesicles that become pustular


-vesicle breaks and a thick yellow crust forms from the exudate, causing pain, erythema, adenitis, cellulitis, and itching

Atopic Dermatitis

-chronic inflammatory skin disease


-most common type of eczema


-exact cause is unknown


-infancy: red, oozing, crusting rash


-adolescence: dry, thick, brown/gray skin


-accompanied by xerosis and pruritis


-no cure exists, but often resolves spontaneously

Contact Dermatitis

-acute or chronic skin inflammation caused by exposure to a chemical, mechanical, physical, or biologic agent


-can occur at any age


-intense pruritis, erythema, and edema that may progress to vesiculation, oozing, crusting, and scaling