Skin Disorders

Mon/Wed

Skin Function

1st line of protection/defense, virtually impermeable to toxins/bacteria/liquid solutions (when intact), protects against trauma, regulates body temp, secretes waste, and houses sensory nerves (tactile/thermal).

Layers of the Skin

epidermis, dermis, and subcutaneous.

Epidermis Layer

outer (regenerates approximately 2 weeks).

Dermis Layer

2nd (produces collagen/elastin) and houses nerves/vascular supply.

Subcutaneous Layer

3rd (fat, insulate/temp reg) and houses nerve/vascular supply.

Cyanosis

decrease in blood supply that causes bluing of the skin.

Necrosis

decrease in blood supply that causes deadening of the skin.

Assessing Skin

focus on pressure prone areas, note integrity (color, texture, moisture) and area/size (uni/bilateral, use anatomical landmarks).

Pressure Prone Areas

coccyx, sacrum, olecranon process, and ischial tuberosities (sit bones).

Decubitus Ulcers (Pressure Sores)

localized areas of necrosis (common over bony areas), common in patients w/ suppressed immunity, innervation, vascularization, or immobility.

Decubitus Ulcers (Pressure Sores) Signs

shiny reddened area, dark/bruising, blister/ulcer, and foul smelling.

Decubitus Ulcers (Pressure Sores) Diagnosis

physical exam or culture.

Decubitus Ulcers (Pressure Sores) Treatment

relieve pressure, skin care, debridement, antibiotics, dressing changes, and wound vac.

Decubitus Ulcers (Pressure Sores) Considerations

early mobilization, ROM, positioning, skin checks, splinting, whirlpool, and frequent shower/ADLs.

Burns

long recovery, highly specialized area of practice, team approach essential.

Burn Signs

exposure/reaction to thermal or chemical agent, blistering skin, pain, and typically follows accident/trauma.

Burn Diagnosis

physical exam, classified by rule of nines or Lund/Browder chart, and % of body and degree.

Burn Treatment

fight infection, fluids (replace and edema management), wound care, pain management, prevent 2’ issues, and skin grafting.

Burn Considerations

ROM, splinting, mobility, positioning, garments, scar management, skin care, psychosocial, and family/pt ed support.

Surgical Incision Considerations

location (safety implications) pain, scar tissue, necessary for healing, forms on all wounds, influenced by age and quantity of scar deposited, and scar massage/mobilization.

Scar Massage/Mobilization Reasoning

modify and remodel scar, preserves soft tissue mobility which allows tissues to glide and controlled tension on scar facilitates remodeling.

Gliding with Scar Management/Mobilization

scar resembles state of tissues before injury.

Without Gliding with Scar Management/Mobilization

scar is fixed on or adheres to surrounding structures.

Scar Massage/Mobilization How To

gentle to firm massage of the scarred area with a thick ointment, followed with active movement so tendons glide against softened scar, may use vibration to area (small, low intensity), and active exercise with facilitation techniques/exercise against resistance/functional activity should follow vibration.

Scar Massage/Mobilization Time Frame

may be started 4 weeks after the injury.

Scar Massage/Mobilization OTA/OTR Role

can be carried out by OTA under close supervision of OTR.

PAMs

paraffin, hot packs, fluid therapy followed by stretching and contraindicated if decreased sensation or if swelling persists.

Documentation

assessment/observation and other considerations.

Current Skin Concern to Document

measurements of current area, location, and description of skin appearance.

Other Considerations to Document

previous skin concerns, cognitive status, sensory impairment/awareness, contractures or deformities, nutrition status, mobility status, pain, level of alertness, friction, shear, and pressure.

Debridement

medical procedure that involves the removal of dead, damaged, or infected tissue.

Skin Grafting in Kids

means that they have to endure many surgeries since the skin graft does not stretch when they grow.