INTEG PT FINALS

Skin

Largest organ (~16% body weight); protects body, maintains homeostasis, forms mucosal barriers, thickness varies (0.5–6 mm).

Epidermis

Outer protective layer; regulates fluid, temperature, and waste; made of avascular stratified squamous epithelium.

Stratum Corneum

Outermost epidermal layer of dead keratinized cells; prevents water loss; ~75% of epidermal thickness.

Stratum Lucidum

Clear thin layer in thick skin (palms, soles); lacks nuclei; contains eleidin for translucency.

Stratum Granulosum

3–4 layers of flattened cells with keratohyalin granules aiding keratin formation.

Stratum Spinosum

Several layers of polygonal cells; supports immune and nutrient exchange via intercellular bridges.

Stratum Basale

Single layer anchoring epidermis to dermis; regenerates cells and contains key specialized cells.

Keratinocytes

Produce keratin for protection and waterproofing.

Melanocytes

Produce melanin for pigmentation and UV protection.

Merkel Cells

Provide tactile sensation and touch response.

Langerhans Cells

Immunologic defense cells aiding in pathogen recognition.

Dermis

Connective tissue beneath epidermis; provides strength, elasticity, nourishment, and thermoregulation.

Stratum Papillarosum

Upper dermal layer (1/5 of dermis); loose connective tissue under epidermis; supports sensory exchange.

Stratum Reticularosum

Deeper dermal layer; dense irregular connective tissue with collagen and elastin; gives tensile strength.

Subcutaneous Tissue (Hypodermis)

Loose connective tissue with fat, blood vessels, and nerves; attaches skin to muscles, insulates, and cushions.

Skin Appendages

Derived from epidermis; include hair, nails, sweat, sebaceous, mammary, and ceruminous glands.

Hair

Keratinized filament from follicle; regulates temperature and senses touch.

Nails

Keratinized plates from stratum corneum; protect digits and aid fine movements.

Sebaceous Glands

Holocrine glands secreting sebum to lubricate skin/hair; absent on palms/soles.

Sweat Glands

Excrete sweat for thermoregulation; include eccrine (watery) and apocrine (thick, odor-producing) types.

Eccrine Glands

Open directly to skin surface; active in cooling and excretion.

Apocrine Glands

Open into hair follicles (axilla, groin); secrete thicker fluid; active post-puberty.

Mammary Glands

Modified sweat glands producing milk for infant nourishment.

Ceruminous Glands

Specialized sweat glands in ear canal; produce earwax for lubrication and protection.

Cutaneous Sensation

Skin receptors detecting touch, temperature, vibration, and pain; dense in sensitive areas (lips, palms).

Free Nerve Endings

Simple receptors under epidermis; detect pain, pressure, and light touch.

Meissner’s Corpuscles

Located in dermal papillae; detect light touch and vibration; abundant in lips, fingers, tongue.

Pacinian Corpuscles

Deep dermal/subcutaneous receptors sensing deep pressure and vibration.

Ruffini’s Corpuscles

Dermal stretch receptors detecting sustained pressure and deformation.

Krause’s End Bulbs

Cold receptors in dermis; respond to low temperatures.

Merkel’s Disks

Superficial tactile receptors; detect steady pressure and fine detail.

Muscle Spindles

Sense muscle length and contraction; regulate tone.

Golgi Tendon Organs

Sense tendon tension; prevent muscle overstrain.

Cutaneous Nerves (Scalp)

Supplied by trigeminal and cervical nerves; mainly sensory.

Cutaneous Nerves (Face)

Branches of trigeminal nerve; convey facial and oral sensation.

Burn

Injury from heat, radiation, chemicals, electricity, or friction causing tissue damage.

Thermal Burn

Most common; caused by flame, scalds, steam, or hot objects.

Chemical Burn

Due to acids/alkalis; severity depends on type, concentration, duration.

Electrical Burn

Caused by current flow; deep tissue injury; may cause arrhythmia (“iceberg” effect).

Radiation Burn

From industrial, nuclear, or therapeutic radiation exposure.

Friction Burn

Mixture of heat and abrasion; common in falls and accidents.

Inhalation Injury

Damage from smoke or toxic gas inhalation; may cause airway edema.

Minor Burn

Small, superficial injury (e.g., sunburn); heals easily.

Moderate Burn

Partial-thickness or small full-thickness; moderate severity.

Major Burn

Extensive or critical-area burns (face, hands, feet, perineum, joints); includes chemical/electrical.

First-Degree Burn

Involves epidermis only; red, dry, painful; heals 3–7 days without scar.

Second-Degree Burn

Partial-thickness; red, blistered, painful; heals 1–3 weeks, minimal scarring.

Third-Degree (Deep Partial) Burn

Involves deep dermis; white/red, less painful, sluggish blanching; heals in 3–9 weeks, scarring likely.

Full-Thickness Burn

All skin layers destroyed; leathery, insensate; requires grafting; may form keloid or eschar.

Fourth-Degree Burn

Extends into muscle/bone; charred appearance; severe tissue loss.

Keloid

Raised scar extending beyond original wound margins.

Eschar

Thick, leathery necrotic tissue; can restrict movement or breathing.

Rule of Nines

Estimates burn TBSA: head 9%, each arm 9%, trunk front/back 18% each, leg 18%, genitals 1%.

Lund–Browder Chart

Pediatric burn chart adjusting % by age and body proportion.

Palmar Method

Patient’s palm = ~1% TBSA; for scattered burns.

TBSA Importance

Guides fluid therapy, severity grading, and transfer decisions.

Burn Assessment

Includes history, extent, depth, pain, vitals, and function.

Pain Scales

VAS, NRS, Wong-Baker (children), FLACC (infants).

Functional Assessment

Burn-specific scales (FIM, BSHS-B, VSS) evaluate movement and independence.

Pediatric Burn

Thinner skin → deeper burns; risk of hypothermia, fluid loss; assess for abuse.

Geriatric Burn

Less elastic skin → deeper burns; comorbidities delay healing; high infection risk.

Acute Phase (Burn Rehab)

Initial stabilization, wound protection, airway, early PT.

Sub-Acute (Rehab) Phase

Restore mobility, manage pain, edema, scars.

Long-Term Phase

Correct contractures, surgeries, reintegration.

Positioning & Splinting

Prevent contractures, protect grafts.

Early Mobilization

Maintain ROM and circulation.

tite

click tite (bonus) taena naulit eh

Psychosocial Support

Address anxiety, PTSD, and body image.

Inhalation Red Flag

Facial burns, soot, hoarseness → airway emergency.

Circumferential Eschar

May cut circulation → needs escharotomy.

Electrical Burn Risk

Cardiac arrhythmia, deep necrosis → monitor heart.

Chemical Burn Care

Immediate copious irrigation, note agent and duration.

Decubitus Ulcer

Local skin/tissue damage from pressure, often over bony areas.

Braden Scale

Risk tool with 6 factors: sensory, moisture, activity, mobility, nutrition, friction/shear.

Pressure Cause

Prolonged load compresses capillaries → ischemia → necrosis.

Shear Injury

Tissue sliding causes deep damage; leads to Stage 3–4 ulcers.

Friction Injury

Skin rubbing → superficial epidermal damage.

Moisture Risk

Maceration from urine, sweat, or exudate increases risk.

Intrinsic Risk Factors

Immobility, sensory loss, malnutrition, comorbidities (diabetes, vascular disease).

Stage 1 Pressure Ulcer

Intact red non-blanchable skin.

Stage 2 Ulcer

Partial-thickness skin loss; pink bed or blister.

Stage 3 Ulcer

Full-thickness loss with visible fat, no exposed bone/muscle.

Stage 4 Ulcer

Full-thickness with exposed bone/tendon; possible slough/eschar.

Unstageable Ulcer

Covered by slough/eschar; depth unknown.

Deep Tissue Injury

Maroon/purple intact skin; indicates deep necrosis.

Mucosal Pressure Injury

On mucous membranes (GI/GU); caused by devices.

PUSH Tool

Measures wound healing: area, exudate, and tissue type (score 0–17).

Inflammatory Phase (0–3 days)

Vasodilation, clotting, WBC clean-up.

Proliferation Phase (3 days–3 weeks)

New capillaries, fibroblasts, epithelial migration.

Maturation Phase (3 weeks–2 years)

Collagen remodels; 80% strength regained.

Debridement

Removal of necrotic tissue (autolytic, enzymatic, mechanical, sharp).

NPWT (Vacuum Therapy)

Negative pressure removes exudate, improves perfusion.

HBOT (Hyperbaric O2)

Increases oxygenation, aids chronic wound healing.

Split-Thickness Graft

Epidermis + part dermis; covers large wounds.

Full-Thickness Graft

Epidermis + dermis; durable and cosmetic.

Autograft

Self-donor graft; no rejection.

Allograft

Cadaver donor graft.

Xenograft

Animal donor (e.g., pig).

Bioengineered Skin

Lab-grown substitute for large or chronic wounds.

Wound Care

Clinical process promoting healing, infection prevention, and functional restoration through assessment, debridement, and dressing.