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integumentaryPTA

integumentary

QuestionAnswer
The extent and severity of a burn is dependent on gender, age, duration of burn, type of burn, and affected area
Burns are most appropriately classified according to the depth of tissue destruction
Superficial Burn: involves only the outer epidermis. The involved area may be red with slight edema. Healing occurs without evidence of scarring.
Superficial Partial-Thickness Burn: involves the epidermis and the upper portion of the dermis. The involved area may be extremely painful and exhibit blisters. Healing occurs with minimal to no scarring.
Deep Partial-Thickness Burn involves complete destruction of the epidermis and the majority of the dermis. The involved area may appear to be discolored with broken blisters and edema. Damage to nerve endings may result in only moderate levels of pain. hypertrophic scars and keloids
Full-Thickness Burn complete destruction of the epidermis and dermis along with partial damage of the subcutaneous fat layer. The involved area often presents with eschar formation and minimal pain. Patients with full-thickness burns require grafts, susceptible to infection.
Subdermal Burn: the complete destruction of the epidermis, dermis, and subcutaneous tissue. Subdermal burns may involve muscle and bone and as a result often require surgical intervention.
Anterior neck burn deformity and splinting Anticipated deformity: Flexion with possible lateral flexion Splinting type: Soft collar, molded collar, Philadelphia collar
Anterior chest and axilla burn deformity and splinting Anticipated deformity: Shoulder adduction, extension, and medial rotation Splinting type: Axillary or airplane splint, shoulder abduction brace
Elbow burn deformity and splinting Anticipated deformity: Flexion and pronation Splinting type: Gutter splint, conforming splint, three-point splint, air splint
Hand and wrist burn deformity and splinting Anticipated deformity: Extension or hyperextension of the MCP joints; flexion of the IP joints; adduction and flexion of the thumb; flexion of the wrist Splinting type: Wrist splint, thumb spica splint, palmar or dorsal extension splint
Hip burn deformity and splinting Anticipated deformity: Flexion and adduction Splinting type: Anterior hip spica, abduction splint
Knee burn deformity and splinting Anticipated deformity: Flexion Splinting type: Conforming splint, three-point splint, air splint
Ankle burn deformity and splinting Anticipated deformity: Plantar flexion Splinting type: Posterior foot drop splint, posterior ankle conforming splint, anterior ankle conforming splint
Selective Debridement Selective debridement involves removing only nonviable tissues from a wound. Selective debridement is most often performed by sharp debridement, enzymatic debridement, and autolytic debridement.
Sharp Debridement requires the use of Sharps selectively remove devitalized tissues, foreign materials or debris from a wound. used for wounds with large amounts necrotic tissue; also used for cellulitis or sepsis. most expedient form of removing necrotic tissue.
Enzymatic Debridement topical application of enzymes to the surface of necrotic tissue. used on infected and non-infected wounds with necrotic tissue. used in wounds that have not responded to autolytic debridement or in conjunction. slow to establish a clean wound bed
Autolytic Debridement the body’s mechanisms to remove nonviable tissue. includes transparent films, hydrocolloids, hydrogels, and alginates results in a moist wound environment that permits rehydration of necrotic tissue and allows enzymes to digest tissue
Autolytic debridement can be used with any amount of necrotic tissue and is non-invasive pain free.caregivers can be instructed to perform autolytic debridement with relative ease; however, this type of debridement requires a longer period of time for overall wound healing and infected wounds.
Non-selective Debridement Non-selective debridement involves removing both viable and nonviable tissues from a wound. Non-selective debridement is often termed “mechanical” and is most commonly performed by wet-to-dry dressings, wound irrigation, and hydrotherapy (whirlpool).
Wet-to-dry Dressings refer to the application of a moistened gauze dressing placed in an area of necrotic tissue. The dressing is then allowed to dry completely and is later removed along with the necrotic tissue that has adhered to the gauze
Wet-to-dry dressings are most often used to debride wounds with moderate amounts of exudate and necrotic tissue. should be used sparingly on wounds with both necrotic tissue and viable tissue since granulation tissue will be traumatized in the process. Removal of dry dressings from granulation tissue causes bleeding
Wound Irrigation removes necrotic tissue from the wound bed using pressurized fluid. Pulsatile lavage is an example of wound irrigation that uses a pressured stream of irrigation solution. most desirable for wounds that are infected or have loose debris.
Hydrotherapy debridement whirlpool tank with agitation directed toward a wound. process results in the softening and loosening of adherent necrotic tissue. be aware of the side effects of hydrotherapy: dependent positioning of the LE, drop in blood pressure, and maceration
Hydrocolloids dressings consist of gel-forming polymers such as gelatin, pectin, and carboxymethylcellulose with a strong film or foam adhesive backing. The dressings vary in permeability, thickness, and transparency
Hydrocolloids absorb exudate by swelling into a gel-like mass and vary from being occlusive to semipermeable. The dressing does not attach to the actual wound itself and is instead anchored to intact skin surrounding the wound.
Hydrocolloids Indications partial and full-thickness wounds. The dressings can be used effectively with granular or necrotic wounds.
Hydrocolloids Advantages • Provides a moist environment for wound healing • Enables autolytic debridement • Offers protection from microbial contamination • Provides moderate absorption • Does not require a secondary dressing • Provides a waterproof surface
Hydrocolloids Disadvantages • May traumatize surrounding intact skin upon removal • May tend to roll in areas of excessive friction • Cannot be used on infected wounds
Hydrogels Hydrogels consist of varying amounts of water and varying amounts of gel-forming materials such as glycerin. The dressings are available in sheet form or amorphous form.
Hydrogels Indications superficial and partial-thickness wounds (e.g., abrasions, blisters, pressure ulcers) that have minimal drainage. Rather than absorb drainage, hydrogels are moisture retentive.
Hydrogels Advantages • Provides a moist environment for wound healing • Enables autolytic debridement • May reduce pressure and diminish pain • Can be used as a coupling agent for ultrasound • Minimally adheres to wound
Hydrogels Disadvantages • Potential for dressings to dehydrate • Cannot be used on wounds with significant drainage • Typically requires a secondary dressing
Foam Dressings are composed of hydrophilic polyurethane base. The dressings are hydrophilic at the wound contact surface and are hydrophobic on the outer surface. The dressings allow exudates to be absorbed into the foam through the hydrophilic layer
Foam Dressings are most commonly available in sheets or pads with varying degrees of thickness. Semipermeable foam dressings are produced in adhesive and non-adhesive forms. Non-adhesive forms require a secondary dressing.
Foam Dressings Indications used to provide protection over partial and full-thickness wounds with varying levels of exudate. They can also be used as secondary dressings over amorphous hydrogels.
Foam Dressings Advantages • Provides a moist environment for wound healing • Available in adhesive and non-adhesive forms • Provides prophylactic protection and cushioning • Encourages autolytic debridement • Provides moderate absorption
Foam Dressings Disadvantages • May tend to roll in areas of excessive friction • Adhesive form may traumatize periwound area upon removal • Lack of transparency makes inspection of wound difficult
Transparent Film thin membranes made from transparent polyurethane with water-resistant adhesives permeable to vapor and oxygen, but are mostly impermeable to bacteria and water. elastic, conform to a variety of body contours, easy visual inspection they are transparent.
Transparent Film Indications superficial wounds (scalds, abrasions, lacerations) or partial-thickness wounds with minimal drainage.
Transparent Film Advantages • Provides a moist environment for wound healing • Enables autolytic debridement • Allows visualization of the wound • Resistant to shearing and frictional forces • Cost-effective over time
Transparent Film Disadvantages • Excessive accumulation of exudates can result in periwound maceration • Adhesive may traumatize periwound area upon removal • Cannot be used on infected wounds
Gauze manufactured from yarn or thread and are the most readily available dressing used in an inpatient environment come in many shapes and sizes Impregnated gauze is a variation of woven gauze with materials such as petrolatum zinc or antimicrobials added
Gauze Indications Gauze dressings are commonly used on infected or non-infected wounds of any size. The dressings can be used for wet-to-wet, wet-to-moist or wet-to-dry debridement.
Gauze Advantages • Readily available, cost-effective dressings • Can be used alone or in combination with other dressings or topical agents • Can modify number of layers to accommodate for changing wound status • Can be used on infected or uninfected wounds
Gauze Disadvantages • Has a tendency to adhere to wound bed • Highly permeable and therefore requires frequent dressing changes (prolonged use decreases cost effectiveness) • Increased infection rate compared to occlusive dressings
Alginates consist of calcium salt of alginic acid that is extracted from seaweed. Alginates are highly permeable and non-occlusive and they require a secondary dressing. based on interaction of calcium ions in the dressing and the sodium ions in wound exudate.
Alginates Indications Alginates are typically used on partial and full-thickness draining wounds such as pressure wounds or venous insufficiency ulcers. Alginates are often used on infected wounds due to the likelihood of excessive drainage.
Alginates Advantages • High absorptive capacity • Enables autolytic debridement • Offers protection from microbial contamination • Can be used on infected or uninfected wounds • Non-adhering to wound
Alginates Disadvantages • May require frequent dressing changes based on level of exudate • Requires a secondary dressing • Cannot be used on wounds with an exposed tendon, joint capsule or bone
Full-Thickness Burn • Burn causes immediate cellular and tissue death and subsequent vascular destruction
Pressure Ulcer • Unrelieved pressure deprives the tissues of oxygen which causes ischemia, subsequent cell death, and tissue necrosis
Full-Thickness Burn • Eschar forms from necrotic cells and creates a dry and hard layer that requires debridement • Absent sensation and pain due to destruction of free nerve endings, however, there may be pain from adjacent areas that experience partial-thickness burns
Pressure Ulcer • Impaired cognition, poor nutrition, altered sensation, incontinence, decreased lean body mass, and infection contribute to the development of a pressure ulcer
Integumentary System largest organ consisting of the dermal and epidermal layers, hair follicles, nails, sebaceous glands, sweat glands. The dermis is vascularized, is characterized as elastic, flexible, and tough. The epidermis, avascular is the outer layer
Bony Prominences Associated with Pressure Injuries : Supine Occiput, spine of the scapula, inferior angle of scapula, vertebral spinous processes, medial epicondyle of humerus, posterior iliac crest, sacrum, coccyx, heel
Bony Prominences Associated with Pressure Injuries: Prone Forehead, anterior portion of acromion process, anterior head of humerus, sternum, anterior superior iliac spine, patella, dorsum of foot
Bony Prominences Associated with Pressure Injuries: Sidelying Ears, lateral portion of acromion process, lateral head of humerus, lateral epicondyle of humerus, greater trochanter, head of fibula, lateral malleolus, medial malleolus
Bony Prominences Associated with Pressure Injuries: Sitting (Chair): Spine of the scapula, vertebral spinous processes, ischial tuberosities
Pressure Ulcer Staging: Stage I An observable pressure related alteration of intact skin whose indicators as compared to an adjacent or opposite area on the body may include changes in skin color, skin temperature, skin stiffness or sensation.
Pressure Ulcer Staging: Stage II A partial-thickness skin loss that involves the epidermis and/or dermis. The ulcer is superficial and presents clinically as an abrasion, a blister or a shallow crater.
Pressure Ulcer Staging: Stage III A full-thickness skin loss that involves damage or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining adjacent tissue.
Pressure Ulcer Staging: Stage IV A full-thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone or supporting structures (e.g., tendon, joint capsule).
Red-Yellow-Black System description and goals Red D-Pink granulation tissue G-Protect wound; maintain moist environment
Red-Yellow-Black System description and goals yellow D-Moist yellow slough G-Debride necrotic tissue; absorb drainage
Red-Yellow-Black System description and goals Black D- Black, thick eschar firmly adhered G-Debride necrotic tissue
Rule of Nines: Head and neck 9%
Rule of Nines: Anterior trunk 18%
Rule of Nines: Posterior trunk: 18%
Rule of Nines : Bilateral posterior arm, forearm, and hand 9%
Rule of Nines: Genital region 1%
Rule of Nines: Bilateral anterior leg and foot 18%
Rule of Nines: Bilateral posterior leg and foot 18%
Rule of Nines: Bilateral anterior arm, forearm, and hand 9%
Arterial insufficiency ulcers Wounds resulting from arterial insufficiency occur secondary to ischemia from inadequate circulation of oxygenated blood often due to complicating factors such as atherosclerosis.
Venous insufficiency ulcers Wounds resulting from venous insufficiency occur secondary to inadequate functioning of the venous system resulting in inadequate circulation and eventual tissue damage and ulceration.
Pressure ulcers sustained or prolonged pressure at levels greater than the level of capillary pressure. Factors contributing to pressure ulcers include shear, moisture, heat, friction, medication, muscle atrophy, malnutrition, and debilitating medical conditions.
Neuropathic ulcers secondary complication associated with a combination of ischemia and neuropathy. Most often neuropathic ulcers are associated with diabetes. Neuropathic ulcers are frequently found on the plantar surface of the foot, often beneath the metatarsal heads
Neuropathic ulcers located The wound is typically well defined by a prominent callus rim. has good granulation tissue and no drainage. No pain due to altered sensation. Pedal pulses absent. The distal limb appear shiny, cool to touch. The periwound skin appears dry or cracked
Arterial Ulcers vs Venous Ulcers: Location A: Lower one-third of leg, toes, web spaces (distal toes, dorsal foot, lateral malleolus) V: Proximal to the medial malleolus
Arterial Ulcers vs Venous Ulcers: Appearance A:Smooth edges, well defined; lack granulation tissue; tend to be deep V: Irregular shape; shallow
Arterial Ulcers vs Venous Ulcers: Pain A: Severe V: Mild to moderate
Arterial Ulcers vs Venous Ulcers: Pedal Pulses A: Diminished or absent V: Normal
Arterial Ulcers vs Venous Ulcers: Edema A: Normal V: Increased
Arterial Ulcers vs Venous Ulcers: Skin Temperature A: Decreased V: Normal
Arterial Ulcers vs Venous Ulcers: Tissue Changes A: Thin and shiny; hair loss; yellow nails V:Flaking, dry skin; brownish discoloration
Arterial Ulcers vs Venous Ulcers: Miscellaneous A: Leg elevation increases pain V:Leg elevation lessens pain
Factors Influencing Wound Healing: Age A decreased metabolism in older adults tends to decrease the overall rate of wound healing.
Factors Influencing Wound Healing: Illness Compromised medical status such as cardiovascular disease may significantly delay healing. This often results secondary to diminished oxygen and nutrients at the cellular level.
Factors Influencing Wound Healing: Infection An infected wound will impact essential activity associated with wound healing including fibroblast activity, collagen synthesis, and phagocytosis.
Factors Influencing Wound Healing: Lifestyle Regular physical activity results in increased circulation that enhances wound healing. Lifestyle choices such as smoking negatively impacts wound healing by limiting the blood’s oxygen carrying capacity
Factors Influencing Wound Healing: Medication can negatively impact wound healing. Medications in this category include steroids, anti-inflammatory drugs, heparin, antineoplastic agents, and oral contraceptives. physiologic effects delayed collagen synthesis, reduced blood, decreased strength of CT
Abrasion a wound that occurs from the scraping away of the surface layers of the skin, often as a result of trauma.
Contusion an injury in which the skin is not broken. The injury is characterized by pain, swelling, and discoloration.
Hematoma swelling or mass of blood localized in an organ, space or tissue, usually caused by a break in a blood vessel.
Laceration a wound or irregular tear of tissues that is often associated with trauma.
Penetrating wound a wound that enters into the interior of an organ or cavity.
Puncture made by a sharp pointed instrument or object by penetrating through the skin into underlying tissues.
Ulcer lesion on the surface of the skin or the surface of a mucous membrane, produced by the sloughing of inflammatory, necrotic tissue.
Created by: pjleblanc