Conditions test 2 Skin disorders

Superficial

(1st degree) - involves only the epidermal layer of skin - redness & pain & some edema (no blisters)

Partial thickness

(2nd degree) - involves dermis

Superficial partial thickness

(type of 2nd degree) - red, blistering, wet, painful, heals on own in 7-21 days

Deep partial thickness

(type of 2nd degree) - red, white, elastic, possible impaired sensation, heals in 21-31 days, may convert to full thickness due to infection

Full thickness

3rd degree - extends to subcutaneous layer - can be charred black, cherry red, waxy, with thinned-walled blisters-pain free at time of burn-healing time varies-will leave a scar-contracture risk

TBSA

total body surface area

Rule of nine

Estimation methods of TBSA - divides body surface into areas representing 9% or multiples of 9% convenient & rapid though less accurate with children

Lund & Browder

Estimation methods of TBSA - more accurate in children because it modifies the percentages according to age

Restrictive defects

presence of a tight, circumferential, restrictive eschar on the chest, neck, or abdomen causes difficulty with inspiration and expiration

Signs of respiratory distress

• presence of facial burns

• singed nasal hair &/or darkened oral mucosa

• hoarse voice

• cough

• drooling

• stridor (high pitched wheezing)

• tachypnea (fast breathing)

• hypoxia (low O2 in tissues, blue purple skin)

Burn shock

inability of circulation to meet the needs of tissues for oxygen & nutrient & the removal of the metabolites - likely in people with burns of 20% TBSA

Hypermetabolic response

triggered by release of stress hormones - body needs more calories - results in need for additional nutritional support via nasogastric feedings

Body temp regulation

loss of skin and fluid loss increase cooling of skin - deep 2nd degree & 3rd degree burns lose sweat glands that wont be replaces - burn patients spend more energy keeping body temperature up & need to be aware of humid, hot situations

Acute phase

1st phase of burn tx - first 72 hrs post injury; primary focus=medical management & survival

Surgical + postoperative phase

2nd phase of burn tx - prevention of wound infection, sepsis, & septic shock

Rehabilitation

3rd phase of burn tx - (postgrafting) - includes in & out patient - longest, most vigorous phase; primary focus = wound maturation

Hansen’s disease

chronic bacterial disease cause by the M. leprae virus affecting skin, peripheral nerves, and upper airways - also known as leprosy

Cardinal signs of Hansen’s

• localized skin lesions - can be raised or flat, lighter than normal skin color or pigment, sensory loss in lesion of touch, heat, or pain, non-healing

• Thickened peripheral nerves - numbness or absent sensation in hands, arms, feet, & legs

• muscle weakness

• demonstrated acid-fact bacilli in lesion

OT treatment for Hansen’s

• MDT (multi-drug therapy)

• ROM, splinting, strengthening, skin, hand, foot, and eye care, rest, positioning, edema management, muscle re-education, ADL

Scleroderma

Group of rare diseases that involve hardening and tightening of the skin and connective tissue; Caused by an overproduction and accumulation of collagen as a result of the risk factors of immune system problems, genetics, and environmental triggers

Affected areas of Scleroderma

• skin

• digits (fingers and toes) *Raynaud’s disease

• digestive system

• organs

Symptoms of Sclerderma

CREST

• Calcinosis - calcium deposits in skin

• Raynaud’s phenomenon - spasms of blood vessels in response to cold or stress

• Esophageal dysfunction - acid reflux or decreased motility

• Sclerodactyly - thickening and tightening of skin in fingers and hands

• Telangiectasias - dilation of capillaries causing red marks on skin surface

OT treatment of Scleroderm

• medications - steroids, blood pressure meds, antibiotics, pain meds

• OT/PT to manage pain, improve strength and mobility

• surgery - finger amputations, lung transplants

• splinting

• hand therapy