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PT 670 Integument

Define Integument pertaining to or composed of skin; protective covering
What is Integumentary Integrity? 1. health of the skin 2. ability to serve as a barrier to the environment against parasites and bacteria
The purpose of integumentary test and measures is... Assess the effects of a wide variety of problems that result in skin and subcutaneous changes
Integument changes occur due to ... 1. pressure 2. venous and arterial problems 3. ulcers 4. burns and other traumas 5. number of other diseases
General determinations during the integumentary exam (3) 1. Determine the baseline 2. Determine the rate of healing/ non-healing 3. Determine the presence of edema/swelling/effusion
Define edema accumulation of an excessive amount of watery fluid in cells, tissues or serous cavities (extravascular and interstitial tissue)
Define swelling clinical manifestation of edema
Define Effusion escape of fluid from blood vessels or the lymphatics into tissue or cavity (i.e. knee sprain)
The general integumentary examination assists in what? 1. identifying circulatory problems 2. locating the presence of adhesion formation 3. determine the location of primary pain/problem
What change of the integument might indicate a circulatory problem? altered temperature of an extremity
Define eccymosis bruise
Define inspection visual evaluation of the skin
Palpation is used to test tissue ___________ integrity
What are some changes in tissue integrity that can be detected? 1. Temperature 2. Moisture 3. Elasticity
The evidence of sweating can indicate what? peripheral circulatory efficiency, SNS activity, or the influence of the ambient environment
What can you visually see on the integument? discoloration, presence of hair, swelling
Testing the elasticity test what? Amount of drag or resistance to movement
What tactile examination techniques could be used to test elasticity? Use of fingers vs skin roll to assess the amount of motion in all directions
Where should you begin palpation? around the site of complaint
What places are important to know where you are, and what you are palpating? bondy landmarks such as ligaments, capsule, joint, muscle, tendon
What determines the depth of palpation? based on structures
What is the problem with palpating too heavy? initially you may miss information from more superficial structures
The written descrition of impairments is located where? Objective/ Examination section
The list of impairments is documented where? the considered where? 1. Assessment/ Evaluation 2. considered in the Clinical Impression
Examples of impairments 1. pain 2. decrease ROM 3. decrease strength 4. impaired balance 5. alteration in joint mobility 6. swelling 7. decrease in sensation
Specific impairments related to altered skin integrity. Circumferential/diameter measure Areas of infection Areas of recent healing Smell (if applicable) Size/color of eschar (scab) Amount/color of drainage
Specific skin impairments post trauma/immobilization Presence of atrophy Shiny/hairless skin Areas of eccymosis (indicate color, size and location )
What should you document about scars and incisions? Dimension of the incision/scar Location of the incision/scar Presence of sutures/staples/steri-strips (list number) Presence of drainage: color/amount (area of non-healing: dimension and healing) Presence of keloid/adhesion formation
what is a keloid scar? hypertrophic scar, larger than normal (African american have a higher rate of formation)
Written description of specific impairments Increased diaphoresis (sweating/clammy skin) Increased warmth Coolness (location and dimension)
Define myofascial. Pertaining to the sheet of fibrous tissue (connective tissue) that envelopes the body beneath the skin; also encloses muscles and muscle groups, and separates their several layers or groups
Myofascial Impairments hypomobility Postural Imbalance swelling/ edema altered skin integrity
Hypomobility is usually secondary to... immobilization/ inflammation
Postural imbalance is a causes a continuous cycle of what? poor posture affects fascia with increase restriction which promotes the propagation of poor posture
Altered skin integrity could be due to... scar formation poor tissue nutrition
What palpation techniques could be used to test myofascia? layer palpation and skin rolls
What is recorded in Written documentation of integrity of soft tissue (myofascial tissue) Size and location of muscle spasm and trigger points
Define muscle spasm Increased muscle tension and shortness, which cannot be released voluntarily and which prevents lengthening of the muscles involved
Do muscle spasms respond to stretching? yes
Latent trigger point is a focus of hyperirritability in the muscle or its associated fascia clinically only painful if palpated
What are active trigger points? hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers causing muscular pain
Pain from an active trigger point will or will not radiate? radiate
The pattern of pain of an active trigger point is specific to what? muscle
Name the characteristics of trigger points Tender spots in muscles Decreased muscle stretch preventing the lengthening of muscle Referred pain with palpation Specific autonomic phenomena
Trigger points focal tenderness is always... present and reproducable
What does a trigger point prent like in palpation? Palpable taut band in muscle passing through the TP; muscle tissue in the vicinity feels dense to palpation
What can be elicited by pressure to the trigger point twitch response
What will reproduce referred pain or increase the pain? limitations? Gentle sustained pressure on the TP (10+ sec) Passive or active ROM increases pain Strong contraction of muscle against resistance increases pain Direction and location of skin roll is limited Altered muscle/tendon/ligament integrity
Myofascial Exam findings are best documented on what? body chart
Examples of interventions Soft tissue mobilization (STM)/myofascial release (MFR) (Targets superficial and deep layers) Swedish massage Trigger point release
Systematic and scientific manipulation of tissues effects what? nervous, respiratory, musculoskeletal, circulatory systems
What are the mechanical effects of soft tissue mobilization Assists in venous flow of blood Encourages lymphatic flow Reduce certain types of edema Produce gentle stretching of tissue Reduce subcutaneous scar tissue
Why does lymphatic flow need to increase? due to increased pooling secondary to swelling, and massage redirects lymph in any direction
What are the metabolic effects of soft tissue massage? Increase capillary dilation secondary to increase circulation decrease pain psychological PROLONGED EFFECTS Increased RBC Increased platelets Increased urine output Limited but definite increased O2 Increased nitrogen excretion
WHat is the neurological mechanism for decreased pain? Gate Control Theory of Pain: the stimulation of large cutaneous fibers/receptors block pain, thus increased tactile stimulation will block pain
What is the autonomic effect of soft tissue massage? ADVERSE Increase in sweating, nausea, dizziness
Contraindications of soft tissue massage? Thrombophlebitis Infection Open wound New scar tissue Edema secondary to kidney, heart, lymph obstruction Fx site Acute injury (hemorrhage)
What is the progression of soft tissue massage? Superficial to deep tissues
What is the applicaiton process of soft tissue massage? Fingers, knuckles, elbows, palmar surfaces of hands and forearms
What other techniques coordinate with soft tissue massage? Tissue elongation: muscle energy technique, stretching, PNF Joint mobilization Ther Ex Modalities
What is used to decrease friction Cold cream Massage cream/lotion Mineral oil Baby oil Cocoa butter and vitamin E oil Bee’s wax
Important things to remember about patient position Ensure relaxation Use of elevation for edema Body part should be exposed Use pillows for support Appropriately drape the patient
Important things to remember for physical therapists postion Proper body mechanics Table height to increase comfort Wide BOS Weight shift vs UE movement helps decrease fatigue
what is recorded in the objective section Should include patient position, treatment technique, time frame, supplies used
what information is put in the assessment section Interpret patient’s response to treatment
What information is put in the Plan section Any changes in treatment plan
Created by: 696592119



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