Integumentary Conditions PDF

CCPT311 Name...

CCPT311 Name Section Title During evaluation, there are different inspection that may Integumentary Conditions warn patient for integumentary condition. Usually they have complaints that can be addressed by PT that mimic other conditions. Possible causes of skin lesions include hereditary factors, physical trauma, systemic origin, burns, dehisced surgical wounds, neoplasm, reaction to radiotherapy, contact with infective organisms, reaction to radiation, contact with injurious agents, and reaction to allergen. S/Sx of skin disorder can be pruritus, urticaria, rash, blisters, xerosis, unusual spots; moles; nodules; and cysts, edema, and changes in appearance of nails and skin pigmentation, turgor, and texture. Patient may be needed to be referred to other practitioners, if pt is not within the scope of PT Practice. _______________________________________________ Pruritus (itching) is the MC manifestation and most commonly caused by Xerosis (dryness of the skin). Based on aging physiology, the sweat glands decrease in number and may atrophy leaving the skin unlubricated causing dryness. It can be underlying systemic disease with degeneric itching. It is seen in chronically ill or elderly population. To assess for itching, you can observe the skin for scratch marks made by the nails. Marking may not have wounds but have scratch marks. You can ask the patient and develop Hx of the scratches to determine if there is underlying systemic condition. _______________________________________________ Urticaria (hives) are Vascular reaction to the skin marked by the appearance of smooth, slightly elevated patched (wheals). They are seen in allergic responses and is only transient (acute). They do not last for 2 days. It has chronic form (but needs to last for 3 weeks to months or years). Anti-histamine is used for allergic reactions. Signs and Symptoms of Skin Disease Histamine is produced by Mast cells located at the Pruritus (itching) muscles to produce vasodilation. When you have allergic -​ MC manifestation response, the skin becomes erythematous, skin elevates -​ MC Cause: Xerosis d/t excess fluid build up. Smooth, slightly elevated patches in the skin. Ask patient for allergies, last episode for allergy, and triggering factors. Modalities may cause allergic episode for the patient. As we grow old, we become less sensitive to allergies. At approximately 50% of muscles reduce in number as we age. _______________________________________________ Rash is a Generalized term for an eruption on the skin. Most often on the face, trunk, axilla, and groin; often Urticaria (Hives) accompanied by itching. -​ Vascular reaction to the skin marked by the appearance of smooth, slightly elevated patched If Pt complaints of rash, document the appearance of the (wheals) rash. Thai can be caused by allergic reaction, skin exposure, chemical or medical irritants or systemic in nature. Butterfly rash = Systemic Lupus Erythematous (SLE) Heat Rash = Due to heat _______________________________________________ Determine if there is Elevation. If there is no elevation, determine the Size; if there is elevation, determine if it is Solid or not Rash With size, if it is 5cm, it is Patch -​ Generalized term for an eruption on the skin -​ Most often on the face, trunk, axilla, and groin If Elevated wound is solid, determine if there is Pus or if it is Transient. -​ Often accompanied by itching If there is Pus, then it is Pustule. If there is no pus, determine the size; if it is 1cm, then it is a Bullae If it is Transient then it is a Wheal. If it is not transient, determine its Depth; if it is deep, then it is a Nodule. RA can develop into nodules which affect extra-articular joints. If the depth is Superficial, then if it is 1cm, then it is a Plaque. _______________________________________________ Blister is Vesicle or bulla. Fluid-containing elevated lesions of the skin with clear watery or bloody contents Yellow-Green Color = Pustule Correlated with Burn, Dermatitis, and Herpes Simplex _______________________________________________ Blister Eczema and Dermatitis is used interchangeably to -​ Vesicle or bulla describe a group of disorders -​ Fluid-containing elevated lesions of the skin with clear watery or bloody contents These are Superficial inflammation of the skin caused by irritant exposure, allergic sensitization (delayed Common Skin Disorders hypersensitivity) or genetically determined idiopathic Eczema and Dermatitis factors. S/Sx seen at the superficial layer of the skin. -​ Used interchangeably to describe a group of disorders -​ Superficial inflammation of the skin caused by irritant exposure, allergic sensitization (delayed Causative Factors: Allergic dermatitis, irritant dermatitis, hypersensitivity) or genetically determined idiopathic factors seborrheic dermatitis, nummular eczema, AD, stasis dermatitis. -​ Allergic dermatitis, irritant dermatitis, seborrheic dermatitis, nummular eczema, AD, stasis _______________________________________________ dermatitis Acute Dermatitis – Extensive erosions with serous 3 Stages of Eczema/Dermatitis exudate or by intensely pruritic, erythematois papules, and 3 Stages of Eczema/Dermatitis vesicles on a background of erythema. 1.​ Acute Dermatitis Papules = Small ( Weakness Secondary Raynaud’s This is an autoimmune mechanism but can be drug -​ Caused by an underlying disease, condition, or other factor induced, virus triggered, or caused by other condition. Both -​ This type of Raynaud’s is often called Raynaud’s Phenomenon sides would manifest symmetrical Sx. Poliomyositis and Dermatomyositis Polymyositis vs Dermatomyositis -​ MC idiopathic inflammatory disease of muscles Poliomyositis (poly = multiple) -​ Diffuse, inflammatory myopathies -​ Insidious proximal muscle weakness -​ Symmetric weakness of striated muscle -​ Symmetrical -​ Primarily the proximal muscles of the shoulder and pelvic girdles, neck, and pharynx -​ Muscle tenderness/ discomfort -​ C/C: Fatigue (functional losses) > Weakness -​ Loss DTR -​ Cardiac involvement and Pulmonary diseases (progressive pulmonary fibrosis) Dermatomyositis -​ Purplish rash appears on eyelids (heliotrope Poliomyositis erythema) -​ Insidious proximal muscle weakness -​ Rash may progress to the anterior neck, upper -​ Symmetrical chest and back, shoulder, and arms, and nail -​ Muscle tenderness/ discomfort beds -​ Gottron papules* -​ Loss DTR Rule out UMNL and LMNL Dermatomyositis LMNL- affectation of connection of peripheral area coming -​ Purplish rash appears on eyelids (heliotrope erythema) from the nerve supply to the neuromuscular junction. ​ -​ Rash may progress to the anterior neck, upper chest and back, shoulder, and arms, and nail beds -​ Gottron papules* Since muscles are weak, the reflex arc will be affected. Afferent → Central connection → Efferent response Heliotrope Erythema / Heliotropic Rash Gottron Papules Gottron’s Papule is non-elevating (