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PT 670 Integument
| Question | Answer |
|---|---|
| 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 |
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