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Integ Skin Disorders
common skin disorders of the integumentary system
| Question | Answer |
|---|---|
| What is Dermatitis (eczema) assoc. with? | inflammation of the skin, redness, itching and skin lesions |
| List 2 causes of Dermatitis | Allergic (contact dermatitis) and Actinic (photosensitivity) |
| What does the acute stage of dermatitis include | red, oozing, crusting rash, extensive erosions, and exudate |
| What does the sub-acute stage of dermatitis include | scaling, scattered plaques and erythamatous skin |
| What does the chronic stage of Dermatitis include | thick skin, marks due to scratching and postinflammatory pigmentation |
| When treating a pt with dermatitis what substance should you avoid using when utilizing some modalities | alcohol |
| Daily care for dermatitis includes what 2 things | lubrication and hydration |
| How does bacteria typically enter the body | by entering an abrasion or puncture wound |
| What 2 bacteria typically cause impetigo | staphylococci and streptococci |
| Give 4 features of impetigo | itching, inflammation, contagious, and assoc. with small pus filled vesicles |
| Cellulitis is suppurative inflamm of ________ or _________ tissue in or close to the skin | cellular, connective |
| What 2 bacteria usually cause cellulitis to form | staphylococci and strptococci |
| Describe the appearence of an area with cellulitis (5) | poorly defined, widespread, hot skin, red skin, edematous (swelled) skin |
| Is cellulitis contagious | yes, it can be |
| A person with cellulitis shouls do what 3 things to manage their condition | cool, wet dressings and antibiotics, and elevate the extremity |
| What conditions can result from untreated cellulitis (4) | lymphangitis, gangrene, sepsis, and abcess |
| What is an abcess | cavity, pus-filled, inflammed tissue |
| An abcess is the result of a ______ infection | local |
| What type of bacteria usually causes an abcess | staphylococcal |
| What 2 places is Herpes I usually found | mouth and face |
| What 2 symptoms are assoc. with herpes I | itching and soreness |
| Where is Herpes II found usually | genital |
| How is Herpes II spread | by sexual contact |
| Shingles is also known as | Herpes Zoster |
| Why does shingles happen | It is a reactiviation of the chicken pox virus lying dormant in the cerebral ganglia, or ganglia of posterior nerve roots |
| in Herpes zoster the pt. gets pain and tingling along spinal or cranial nerve ________ pattern | dermatome, it follows the infected nerve |
| What symptoms are assoc. with herpes zoster (6) | itching, soreness, fever, chills, malaise, and GI disturbances |
| The neuralgic pain from herpes zoster may last _________, ________ or ________ | weeks, months, years |
| Herpes Zoster is only contagious in people that have not had what childhood virus | chicken pox |
| What 2 modalities are contraindicated for patients with active Herpes Zoster | ultrasound and heat |
| Is there a cure for Herpes zoster | no, conservative management using steroids, and anti-viral tx's |
| What virus causes warts | HPV (human papilloma viruses) |
| How are warts contracted | through direct contact |
| What type of precautions should be used with someone who has warts | standard precautions |
| What is the management for warts | cryotherapy, acids, over-the-counter meds, electrodesication |
| Ringworm and athletes foot are 2 types of _______ infection | fungal |
| How is ringworm and athletes foot transmitted | direct contact |
| what type of precautions are used if tx'ing a pt with ring worm or athletes foot | standard precautions |
| Parasitic infections are cuased by | insect or animal contact |
| scabies is becuase of | mites that borrow into the skin |
| you treat scabies with | scabicide |
| lice is a type of _____________ infection | parasitic |
| lice are treated with | special soap or shampoo |
| how are parasitic infections transmitted | direct contact |
| what type of precautions should be used when a patient has a parasitic infection | standard |
| Name some immune disorders of the skin (4) | psoriasis, lupus, scleroderma and polumyositis |
| is psoriasis acute or chronic | chronic |
| what type of course does psoriasis run | exaccerbations and remissions |
| 3 possible causes of psoriasis (3) | hereditary, drugs, assoc. immune disorder |
| what is psoriasis treated with | corticosteroids, coal tar, methotrexate, UV light (be careful make sure patient is sensitive or allergic to UV light) |
| Lupus is a ________, and ____________ inflammatory disorder of ____________ tissue | chronic, progressive, connective |
| Name the 2 types of lupus | discoid (DLE)and systemic (SLE) |
| Describe discoid lupus (4) | only skin involvement, flares up with sun exposure, hypo/hyper pigmentation, scars b/c of lesions |
| Descibe SLE (systemic) | chronic, multiple organ systems involved, can be fatal b/c of involvemnt in the major organ systems |
| what gender does SLE occur in more men or women | women |
| Symptoms of SLE | butterfly rash, fever, malaise, chronic fatigue, skin lessions, arthralgia, arthritis, anemia, hair loss, photosensitivity, and raynaud's phenomenon (sensitivity to cold) |
| is there a cure for lupus | no |
| how do they treat lupus | corticosteroid, anti-malarials, cytotoxic agents (immunosuppressive agents), pain medicine |
| What are some side effects of corticosteroids to look for in your patients | increased risk of infection, osteoporosis, wt. gain, HTN, bruising, myopathy, tendon ruptures, diabetes, gastric irritation, and low paotassium |
| Scleroderma is a _______, _______ disease of connective tissue | chronic, diffuse (widespread) |
| What does it cause int eh skin, joints, blood vessels and internal organs | fibrosis |
| define fibrosis | taut, firm, hardening |
| In scleroderma with skin involvement is it symmetrical or assymetrical | symmetrical |
| What treatments are there for scleroderma | corticosteroids, vasodilators, analgesics, immunosuppressive agents |
| How can physical therapy affect scleroderma | slow the development of contracture and deformity |
| Scleroderma skin is ________ sensitive skin | pressure |
| Polymyositis is a disease of ________ tissue characterized by inflamm, edema, and degeneration of __________ | connective, muscles |
| What types of muscles are affected by polymyositis | proximal muscles |
| is the damage done by polymyositis symmetrical or assymetrical | symmetrrical |
| If there is cardiac muscle involvement with the patients polymyositis it can be _______ | fatal |
| too much exercise in a patient with polymyositis can cause ___________ muscle fiber ________ | additonal , muscle |
| In polymyositis ____________ and ________ ulcers can result from prolonged bedrest | contractures and pressure |
| is a basal cell carcinoma benign or malignant | malignant |
| does a basal cell carcinoma metastisize | not usually |
| A basal cell carcinoma is assoc with pronlonged _____ ___________- | sun exposure |
| is a basal cell carcinoma fast or slow growing | slow growing |
| Describe the features of a basal cell carcinoma (4) | raised patch, ivory in color, rolled border, indented center |
| Does a squamous cell carcinoma usually metastasize | yes |
| is a squamous cell carcinoma fast or slow growing | fast |
| A squamous cell carcinoma is common on _____ exposed areas | sun |
| Describe a squamous cell carcinoma (3) | flat, red, poorly defined margins |
| What is a malignant melanoma | tumor arsing from melanocytes |
| What are the clincial manifestations of a malignant melanoma? Hint ABCD's | A - assymetry, uneven edgesB - borders, irregular, poorly definedC - color, black , brown, red or whiteD - diameter, larger than 6mm |
| What are the risk factors for a malignant melanoma | intense sun exposure (repeated sun burns), family hx, people with fair skin and/or freckles |
| what is the tx for malignant melanoma | surgical resection |
| define contusion | bruise with pain, swelling, and discoloration, skin is unbroken, APPLY cold immed |
| define ecchymosis | trauma to underlying blood vessels, turns blue cuase blood enters subcutaneous tissue |
| define Petechiae | tiny hemorrhage w/in dermal/submucosal layers, pinpoint in size red or purple in color |
| define abrasion | scraping away of skin |
| define laceration | irregular tear of skin (jagged wound) |
| define Pruritus | itching |
| define urticaria | smooth, red, elevated patches of skin (hives) |
| define rash | local redness and itching |
| define xeroderma | excessive dryness |
| How many integumenatary preferred practice patterns are there | 5 |
| What is pattern A for Integ | primary prevention for integ disorders |
| What is pattern B for Integ | Superficial skin involved - impaired integrity |
| What is pattern C for Integ | Partial thickness skin and scar formation - impaired integrity |
| What is pattern D for integ | Full-thickness skin and scar formaiton - impaired integrity |
| What is pattern E for integ | skin involvement extending to fascia, muscle or bone and scar formation - impaired ingteg integrirty |
| What types of modalities can you use with a broad spectrum of integumentary disorders (11) | manual lyphatic drainage, therapeutic massage, dressing and topical agents, TENS, HVPC, EMS (electrical muscle stimulation), ultrasound, phonophoresis, hydrotherapy, UV light, compression therapies |
| Name 4 types of Burns | thermal, chemical, electrical and radioactive agents |
| Name the 3 zones of a burn wound | zone of coagulation, zone of statis, zone of hyperemia |
| Name the zone assoc with cell death and irreversible cell injury | zone of coagulation |
| Name the zone assoc with cell injury, patient needs to get treatment within 24-48 hours | zone of stasis |
| Name the zone assoc with minimal cell injury and cell recovery | zone of hyperemia |
| Define a critical burn | 10% of body or more with 3rd degree burns, 30% or more with 2nd degree burns |
| Define a moderate burn | less than 10% with 3rd degree burns, 15-30% of body with 2nd degree burns |
| Define a minor burn | less than 2% with 3rd degree burns and less than 15% with 2nd degree burns |
| Rule of nines (adult) | Head and neck - 9%Ant trunk - 18%Post trunk - 18%Each arm - 9%Each Leg - 18%Perineum - 1% |
| Head, Right ant arm and front of trunk are burned what percentage of the body is burned | 31.5% |
| Left leg (ant/post), perineum, and right ant leg is burned what percentage of the body is burned | 28% |
| post trunk, perinueum and post of both legs is burned what percentage of the body is burned | 37% |
| 1st degree burn is also known as a | superficial burn |
| What is damaged in a 1st degree burn | epidermis only |
| Healing of a 1st degree burn occurs in | 3-7 days |
| A superficial burn (1st) is characterized by (3) | erythema, slight edema, tenderness (NO BLISTERS) |
| A 2nd degree burn is also known as a | superficial partial-thickness burn or Deep partial thickness burn |
| what is damaged in a sup partial thickness burn | epidermis and upper layers of dermis |
| what is a sup partial thickness burn characterized by (3) | inflammation, pain, blisters |
| how long does a sup partial thickness burn take to heal | 7-21 days |
| A deep partial thickness burn damages what structures | epidermis, dermis, and injury to nerve endings, hair follicles and sweat glands |
| what are the characteristics of a deep partial thickness burn | red/white, edema, blistering and severe pain |
| how long does a deep partial thickness burn take to heal | 21-28 days |
| full thickness burn is also known as | 3rd degree burn |
| A 3rd degree burn is what color | white, gray or black (charred) |
| is a 3rd degree burn wet or dry | dry |
| do people have pain with 3rd degree burns | no |
| What is eschar | scab or dry crust must be debrided |
| 3rd degree burns are assoc. with an increased risk of ___________ | infection |
| what is the difference b/t a hypertrophic scar and a keloid scar | BOTH are raised red and firmhypertrophic- stays w/in the borders of original burnkeloid scar - extends beyond the boundaries of the original burn |
| What is a 4th Degree burn also known as | subdermal burn |
| what is destroyed in a 4th degree burn | epidermis, dermis, subcutaneous tissues with muscle and/or bone involvement |
| What causes 4th degree burns | electrical burn, prolonged exposure to flame |
| A 4th degree burn often requires _________ or _________ | surgery or amputation |
| what is the first thing you should do in emergency burn management | immersion in cold water or cold compresses, then cover with sterile bandage (no ointments or creams) |
| What are some of the complications that can occur with a burn injury? | infection, shock, pulm complications (smoke inhalation, pneumonia, restrictive lung disease if trunk is burned), metabolic complications (wt. loss, neg nitrogen balance, decreased energy, Cardiac complications (increased fluid loss = decreased CO) |
| The Epidermis heals by | epithelization |
| the dermis heals by | scar formation (injured tissue replaced by CT) |
| Describe the inflammatory phase of healing | 3-5 days, red, edema, warmth, pain, decreased ROM |
| Describe the proliferative phase of healing | fibroblasts form scar, Wound contraction, Re-epithelization may still occur |
| Describe the maturation phase of healing | up to 2 years long, b/c scar formation can last that long, hypertrophic or keloid scar forms |
| What is sepsis | local or generalized invasion of the body by pathogenic microorganisms or their toxins |
| Asepsis and wound care - should clothing be removed | yes |
| Asepsis and wound care - should the wound be cleansed | yes |
| Asepsis and wound care - what 2 techniques are used in wound care management | open - topical anti-bacterial agents on skin with no bandageclosed - dressing on top of a topcial agent |
| Name 3 anti-bacterial topical agents typically used with burns | silver nitrate (used w/wet dressings)surface organisms only, Silver sulfadiazine, andSulfamylon penetrates through eschar |
| If you were working in the hospital with a burn victim what should be monitored | vital signs, urinary output, electrolyte levels, arterial blood gases, gastrointestinal function |
| Primary excision removes what | surgical removal of the eschar |
| A Z-plasty is a resection of a ______ contracture | scar, used to lenthen it |
| Grafts are used to _______ the wound | close |
| Autograft | use pt's own skin |
| Allograft (homograft) | another human's skin |
| Xenograft (heterograft) | skin from another species |
| biosynthetic grafts | collagen and synthetics |
| cultured skin | lab grown from pt's own skin |
| split-thickness graft | epidermis and upper layers of dermis from donor site |
| full-thickness graft | epidermis and dermis from donor site |
| ant neck splinting for burns | hyperext w/plastic cervical orthosis |
| shoulder splinting for burns | flexion, ER, ABD |
| elbow splinting for burns | extension and sup |
| hand splinting for burns | 15 deg wrist extension70 deg MCP extensionPIP and DIP extensionthumb ABD |
| Hip splinting for burns | extension, ABD, neutral rot |
| knee splinting for burns | extension w/post knee splint |
| ankle splinting for burns | df with foot in ankle neutral |
| what is the etiology of arterial ulcers | arteriosclerosis obliterans, non-healing trauma, chronic arterial insufficiency, artheroembolism |
| what is the etiology of venous ulcers | chronic venous infufficicency, venous HTN, hx of DVT, valvular incompetance |
| An arterial ulcer appears | irregular, smooth edges, DEEP wound |
| an venous ulcer appears | dark pigmented, sometimes fibrotic, shallow |
| Where does an arterial ulcer form | distal lower leg usually on toes and feet, lat malleolus, ant tibial area |
| where does on venous ulcer form | med malleolus, and distal lower leg |
| Are pedal pulses absent or present in an arterial ulcer | diminished or absent |
| Are pedal pulses absent or present in an venous ulcer | present |
| When the legs are elevated an arterial ulcer feels _______ painful and a venous ulcer feels _______ painful | more, less |
| does a venous ulcer have exudate | yes |
| Gangrene may be _________ in an arterial ulcer and _________ in a venous ulcer | present, absent |
| what are the assoc signs of a arterial ulcer | trophic changes, pallor in foot upon elevation, Rubor upon dependency |
| What are the assoc signs of venous ulcer | edema, cyanosis upon dependency (not always) |
| what is the etiology of a diabetic ulcer | DIABETES - assoc with arterial and neuropathy |
| where do diabetic ulcers usually occur | plantar aspect of foot sometimes lat malleolus |
| are diabetic ulcers painful | not usually |
| what fatal condition is assoc with diabetic foot ulcers | sepsis |
| Will the pt with a diabetic neuropathy have an ankle reflex | no, b/c of neuropathy |
| A pressure ulcer (Decub, bed sore) is caused by | unrelieved pressure resulting in ishcemic hypoxia and damage to underlying tissues |
| shearing is caused by an | external force |
| friction is caused by an | rolling or sliding over something |
| what color is a pressure ulcer | red, brown/black or yellow |
| how many stages of pressure ulcers are there | 4 |
| A stage I pressure ulcer | nonblanchable erythema, pain/itching, skin may be cool or warm, tissue consitency may be firm or boggy |
| A stage II pressure ulcer | superficial ulcer involves epidermis and/or dermis, abrasion, blister |
| a stage III pressure ulcer | full-thickness skin loss may extend down to but not through underlying fascia, deep crater |
| a stage IV pressure ulcer | full thickness skin loss, extensive destruction of tissue, damage to muscle or bone or suppporting structures |
| To assess the size of a wound what 4 things should be looked at | length, width, depth, and wound area |
| what 2 tools should you use to assess area and depth | film grid, q-tip (depth) |
| What is tunneling | underlying tissue destruction beneath intact skin |
| what is serous fluid | watery-like serum |
| what is purulent fluid | contains pus |
| what is sanguinous fluid | contains blood |
| what is a red wound indicative of | healthy granulated tissue |
| what is a yellow wound indicative of | contains slough(dead tissue) is fibrous tissue |
| what is a black wound indicative | dried necrotic tissue(eschar) |
| what is an indolent ulcer | an ulcer slow to heal, not painful |
| what is a halo of erythema around a wound indicative of | cellulitis |
| What is maceration indicative of | may lead to wound deterioration or enlargement |
| what are trophic changes | wound is poorly arterially supported |
| Name some topical anti-mircrobials | silver nitrate, silver sulfadiazine, erythromycin, gentamycin, neomycin, triple antibiotic |
| Name some anti-inflammatory agents | corticosteroids, hydrocortisone, ibuprofen, indomethacin |
| Name one topic anesthetic | lidocaine |
| Describe a vacuum assisted closure | open cell foam dressing put in a wound, the subatmospheric pressure is controlled, 125mmHG, controls edema, increases blood flow, and removes infectious material |
| what is hyperbaric oxygen therapy | pt reaches 100% oxygen in a chamber with a raised atmospheric pressure, this reverses hypoxia by oversaturating oxygen in blood |
| what is Pulsatile lavage | squeezable bottle with suction to remove wound debris |
| when is a whirlpool indicated in wound care | ulcers with a lot of exudate, slough and necrotic tissue |
| what is wound debridement | removal of necrotic or infected tissue which decreases bacteria and improves wound healing |
| what is an unna boot | a pliable nonstretchable dressing impregnated with ointment |
| what types of e-stim can you use on a wound | direct current with continuous waveform, HVPC, MENS, alternating biphasic current |
| lift don't ______ | drag |
| is it best to use a transfer board in w/c transfers | yes minimize shear and friction forces |
| what is a hydrocolloid | adhesive waters that interact with wound fluid to form a gel over it |
| is a hydrocolloid semiocculsive or occlusive | both |
| what types of wounds would a hydrocolloid be good for | partial-thickness, mild-exudate, supports autolytic debridement of necrotic tissue |
| what is a hydrogel | water or glycerine based gel, insoluble in water |
| what types of wounds would a hyrdrogel be good for | partial to full-thickness, wound with necrosis, radiation burns |
| what is a foam | semipermeable membrane |
| what are the 2 types of foam | hydrophilic or hydrophobic |
| what types of wounds would a foam be good for | partial to full-thickness w/ min-mod exudate, as a 2nd layer, |
| what is an alginate | soft, absorbent which is derived from seaweed, form a viscous hydrophilic gel |
| what types of wounds would an alginate be good for | mod-large amts of exudate, exudate and necrotic wounds, wounds that need packing, infected/noninfected exudating wounds |
| gauze can be used for what 3 techniques | wet to dry, continuous dry, continous moist |
| what types of wounds would a gauze be good for | exudative wounds, wounds with dead space or tunneling, wounds with both necrotic and exudate |
| when should surgical debridement be used | cellulitis, immunocompromised pts, where an infection threatens the pts life |
Created by:
dcohen
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