Integumentry

Dermatitis Bacterial
Impetigo Cellulitis Abscess
Def Itching Superficial Skin Inflammatn of Cellular or Cavity with
Redness Infection Connective tissue in or close to •
Skin Lesions skin
Cause Allergic :- Staphylococcus Staphylococcus Staphylococcus
• Harsh Soap, Chemicals, Streptococcus Streptococcus Typically
Adhesive tape
Actinic :- Commonly after Injection Drug Commonly after
• Photosensitivity, reactn to use. injection drug use
Sunlight, UV
Atopic :-
• Unknown assoc with
Allergic , Hereiditary,
Psychological
Stages Acute :- Small Pus filled Poorly defined , Wide spread Cavity
/Signs • Rash - Red Oozing,Crusting Vesicles • Pus
• Extensive erosion, This fluid dries to Skin :- • Surrounded
• Exudate form a thick, honey- • Hot , by
colored crust. • Red,
• Pruritic Vesicles inflammatn
Subacute :- • Edematous
Not usually painfull
• Erythematous skin but itches (No Eruptions//VESICLES,
• Scales Neither filled with Pus)
• Scattered Plaques
Chronic :-
• Thickened Skin
• Skin marking after
scratching
• Fibrotic papules & Nodules
• Post inflammatory
Pigmentatn Elderly, Diabetes,
• Relapsing Commonly in 2-6 yrs. Wounds,Malnutrition
NO fever child Steroid Therapy
Preca PT modalities :- Contagious Contagious Precautions Contagious
u/CI • UV at less intensity Staph :- Contact If Untreated :- Precautions
• precautions • Gangrene
Distancing people • Abscess
Hand hygiene • Sepsis

Medic Topical, Systemic therapy Antibiotics Healing by

al Hydration • Draining

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 Lubrication of skin • Incising the
abscess
PT Elevation of part
Cool Wet dressings

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 Viral
Herpes Simplex Herpes 2 Herpes Zoster// Shingles Warts
Def Common Cause of Spinal or Cranial Dermatome affected Benign

Cause HSV virus Sexual Contact • Varicella oster virus (Chicken pox) Human Pappiloma Virus
remains dormant • Remained dormant for years (HPV)
in the MUCOSAL
secretions >>
Spreads thru cut
• Kissing
• Toothbru
sh
• Utensils
Stages/Si Signs • Vesicular Along dermatome Locations
gns • Itching Genital • Pain Tingling (1st) Skin
Soreness Eruption • Red papules (2nd) • Dorsum of Hands
Later • Vesicles (last) • Fingers around
Appearance nails
• Vesicular • Fever chills malaise, GI prob Appearance
Eruptn • CN symps (3,5 ) • flesh colored,
on Skin Post herpetic neuralgic pain :- • look like
Locations • Intractable , lasting for mnths to cauliflower tops-
• Around yrs. Rough bumps
MOUTH • Remains only on half of body (No • raised or flat
Common cross)
ly NO Symptoms of pain or
itch
Precau/CI Oral To oral In New borns Contagious to individuals who had not Direct Contact
• May cause have Chicken pox Transmission
Meningoe
ncephalitis Heat , US :- Inc severity
• Can be
fatal
Medical Antiviral Acids
Systemic corticosteroids Electrodessiction
Slow progression Curettage
PT Cryotherapy
http://www.antiherpes.com/archive/herpeszosterh
erpessimplexvirus.asp
DD HSV 1 vs 2 Simplex Vs Zoster
HSV 1 :- Around Mouth
HSV 2 :- Around genitals • Around • Around
Mouth , Dermatom

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 genitals • Don’t cross
• Cross the one half of
half of body
body • Does not
• Spreads spread if
Quickly had
Chicken
Pox

Fungal Parasitic
Ring Worm//Tinea Corporis Athlete’s foot//Tinea Scabies- LICE
Pedis
Def Fungal infectn Fungal infect of foot Mites Burrow Eggs into skin
Cause
Stages/Sig Appearance Typically • Inflammation Locations :-
ns • Ring shaped patches • Betwn Toes • Itching Worse at • Head (hairs)
with Vesicles or night :-genitals, • body
scales suprapubic, Skin • Genital area
• RED Raise border erosion,
with CLEAR CENTER • Possible pruritis Appearance
Signs • Bite marks,
• Itchy • redness,
Locations • nits (eggs)
• Areas:-Hair,Skin, Signs :-
Nails • Itchng All day
Precau/CI Direct contact transmission Direct contact
(Person to person, Animal To person) Person to person

Medical Topical //oral Antifungal Antifungal cream Sabicide

Eg :- griseofulvin If untreated :-
• Cellulitis,
• bacterial infect

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Examination Pruritis Urticaria Rash Xeroderma

Signs Itching (NOT PUS) Skin patches :- Local Redness Excessive dry skin
• Smooth Itching +
red Eruption on skin Shedding of
elevated Epithelium
Hives
Rash
Common in Hyperthyroidism Allergic response • Inflammatn Thyroid Deficiency
Diabetes • Drugs • Skin dz Diabetes
Drug • Infection • Chronic
hypersensitivity Alcoholism
• Vasomotor
Disturbance
• Pyrexia
• Medications

Colour Cause Seen in Skin Temp

Cherry Red CO Poisioning
Cyanosis Lack of O2 in HB • Lung prob Abn Hot Hyperthyroidism
Bluish Grayish , • CHF Fever
Slate coloured • Venous Excess salt intake
Discolouratn obstruction
Pallor Lack of • Anemia Abn Cold Hypothyroid
colour//White • Internal Poor circulation
Paleness Haemmorha Vasomotor spasm
ge Obstructn
Yellow Inc Billirbin • Jaundice Moist Skin Fever
Eyes, lips, Sclera • Liver Dz Hyperhidrosis Pneumonic Crisis
Drugs

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 Inc Carotene intake Hot drinks
• Yellow Exc
colour
palms ,
Soles face

Liver spots Aging Dry Skin Hypothyroidism

Brownish Yellow Uterine Hypohydrosis Dehydratn
Liver Malignancy Icthyosis
Preg
Brown Venous Cold sweat Fear
(Haemosiderin) insufficiency Anxiety
Depression
AIDS

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M/M PT
Emergency Care Immersion in Cold Immersion in Debridement :- Excisionof Loose Charred
water Hydroth dead skin
If :- Tank Wet removal of dressing
• Les than Half of ROM exc
bdy burn Early mobi

Cold Compress Precaut :- Antiinfectn are used for infect

Cover burn with Sterile control
bandage or clean cloth

No Ointment or Cream

Medical M/m Asepsis & Wound Care Sharp Excision of eschar with sterilized equips
• Removal of Debridement
Charred
clothing
• Wound
Cleansing Autolytic Autolytic dressing + Enymes for scar removal
Debridement
Antibacterial Medic

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 (even without drssing Rehab ROM Exc :-
applied_ Open dressng) • DBE,Chest expansion, Ambu to
prevent Pneumonia
_Silver nitrate (Only on • Combine with Medicatn Dosage,
Surface organisms) Hydroth.
Applied with Wet Edema Control :-
dresng • Elev of Extremeity,AROM
Freq dressing chang • Elastic control
Post grafting Precau :-
_Silver sulfadiazine • Discont AROM , PROM for 3-5 days
_Sulfamylon//mafenide Reduce Scar formatn:-
acetate :- (Penetrates • Deep Frictn Massage
thru eschar)
For Hypertrophic & Keloid Scar Prev :-
Occlusive dressing Following BURN, EDEMA,
(Closed tech) Initially :-Pressure garments (23 hr /day for
6-12 mnths)

Last Option :- Surgery

(Compression wraps & Occlusive dressing
has no impact on hypertrophic scarring)

Strength , Endurance , ADL Progres

Positioning & Splinting

:
Ant Neck :-
Monitor ABG, Serum electrolyte Ant Neck Flxn Hyperextnsn
Urinary output
Vitals
Shldr Add Abd
GI func :- Provide IR Er
nutritional support Flxn
Positn with
Firm Plastic
Cervical
ORthosis

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Pain relief Morphine Sulfate
Prev Of infectn Tetanus Prophylaxis
Antibiotics
Isolatn , Sterile tech
Fluid Replacement th. Prevent shock
Surgery
Graft Autograft :- Pt own skin
Allograft :-
• Other person
Skin
Xenograft :-
• Other species
skin(Pig)
Biosynthesis Graft :-
• Collagen +
Synthetics
Cultured Skin
• Labgrown Pt’s
own skin
Split thickness :-
• Epid + Up Derm
Full Thickness :-
• Epid + Dermis

Z plasty Surgical Resection of

Scar in Z shape to
• lengthen the
burn scar

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 Mechanism Physiology Benefits
Vaccum • Open cell Foam Constricts Wound
aasisted dressing is • Drawa wound edges together Treats wound by
closure placed on wound Prevents edema by Negative pressure
• Subatm inside wound
Pressure(125 • pulling out exudates
mmhg) below Prevents infection spread :-
ambient • Remove infectious material along with
pressure is exudate
applied thru ext Inc blood flow to wound :-
device • These removal allows wound to get
sufficient blood and healing
Strength of healing
• Cell are stretched >>>> becomes more
metabolically active and stronger healing
Hyperbaric O2 • Pt breathes • Hyper Oxygenation Prevents tissue hypoxia CI
Therapy 100% O2 in a and facilitates healing with inc O2 Pneumothorax
sealed full Body Neoplastic medications
Chamber
• 2-2.5 Absolute
atmospheric
pressure

Wound Removal of When to do

Cleansing • initially and
• loose cellular • at each dressing
debris How :-
• Metab waste • Normal Saline 0.5-0.9%
• Bacteria • For Ulcers & Non toxic wounds
• Topical agents Cleansing topical agents
that retard • Topical agents that reduce surface pressure
healing Solution Used :-
• Povidone iodine

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 • Sodium Hypocholrite
• Acetic acid
• Daikins
• Hydrogen peroxide
Delievery System :-

Min Mech force used

a) Gauze cloth or sponge cleansing
Irrigation System :-
• Loosens wound debris and removes it by
suction
• 4-15 PSI pressure
Hydrotherapy Whirlpool
• Ulcers with large exudate Slough , necrotic
tissue

Wound Debridement
Wound Dressing
Edema Leg elev exc Compression Therapy :-
Management Ankle pumps • Compressn wraps :- Elastic or tubular
• Paste bandages :- Unna boot
• Compression stocking :- Jobst
• Compression pump therapy
Electric Stim for HVPC For Wound Care :- Pressure relieveing
wound healing • Cont waveform • Prevent friction devices :-
with DC • Turning & then drawing sheet Water bed
• Lifting body part not dragging Foam
• Alt biphasic Gel bed
current Over friction sites ,Use of
• Corn starch, Dynamic PRD :-
• Lubricants • Changing fluid
• Thin film dfessng pressure of
• Hydrocolloid mattresses
Avoid Restrictive clothing :-
Tight fitting shoes, socks, splints Rough textures hard • Changing air
fasteners pressure

Avoid Maceration :-
• Avoid moisture &
• temp elev
where skin contacts surface

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venous ulcer Enzymatic A wet-to-dry dressing is ( mechanical A whirlpool is
Dressng debridement is debridement) and is used to (mechanical
• effective only if • remove necrotic tissue. debridement)
and requires there is
an absorbent necrotic tissue intervention and is used
dressing. present in the for
wound bed. • wound cleansing
and
• debridement.

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 Indications CI
Autolytic • Natural Solubaizatn of necrotic • Non Infected Immunosuppressed Pts
Debride Debridement tissue by Wounds • (organ Transplant,
ment • Maintained under • Phagocytic cells • On Anticoagulant Chemotherapy,
Moisture retentive • Proteolytic & Th. Or (cancer , radiotherapy, Aids)
Occlusive or Collagenolytic radiatn, drugs) Dry Gangrene
Semiocclusive Enzymes • All Necrotic
dressing Pr in Tissues Wounds in Dry Ischemic Wounds
medically stable • (Severe Arterial
• Pt who cant tolerate Ulcers)
other forms of
debridement
Enzymati Chemical Debridement Solubaliatn of necrotic • All Moist Necrotic • Clean Granulated
c tissue by Applying Wounds wounds
Debride • topical Prep of • Eschar after cross • Ischemic Wounds
ment • Proteolytic & hatching (Unless adequate
Collagenolytic • Pt who cant tolerate Vascular status is
enzymes other forms of determined)
debridement • Dry Gangrene
Proteolytic Enzymes :-
• Removes Slough
or Eschar

Collagenolytic Enymes
:-
• Digest
Denatured
collagen in
Necrotic Tissue
Mech Removes Foreign Material Non Selective Wounds with • Clean Granulated
Debride & devitalized & debridement • Moist Necrotic wounds
ment contaminated Tissue tissue or
By • Foreign Material
• Wt to dry gauze Present
• Dextranomers

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 • Pulsatile lavage
with suction or
whirlpool
Precautions :- May remove
healthy tissue as well

Sharp Selective Debridement Scalpel, Scissors, Sticks Scoring or Excision of Clean Wounds
Debreide That selectively removes Leathery eschar Advancing cellulitis &
ment only Necrotic Tissue Sepsis
Excision of moist necrotic
Little or No Bleeding in Tissue Infection threatens
Viable tissue individuals life

Pt on Anticoagulant or has
Coagulapathy (mans Dec
Platlet >>> Cancer therapy
Heparin, Warfarin etc.)
Surgical Selective Removes most or all Advancing cellulitis & Sepsis • CardioPul Dz or
Performed by Physician or necrotic tissue diabetes
Surgeon (Scalpel or other Immunosuppressed Pts • Severe spasticity
utensils) Some health tissue too • (organ Transplant, • Caant tolerate
One time operative Chemotherapy, surgery
procedure Anaesthesia :- radiotherapy, Aids) • Short life
Co of bleeding n pain Infection threatens expectancy
individuals life :- • Quality of life cant
Perofmred in a separate • May be spreading to be improved
room vital organs or deep

Preliminary Procedure :-
Clean wounds for
surgical wound closure
line

Indications Adv Disadv Considerations

Transparent films Stage 1 & 2 Press ulcer Visual Wound eval Non Absorptive (0%) Give 1-2 inch Wound
2* Dressing in some Minimize friction margin around bed.
situations • At wound by Not forFragile
Autolytic Debridement rubbing surrounding skin :- Shave surrounding hairs
Skin Donor site • Due to
Cover for Hydrophillic Autolytic Debridement elasticity can Avoid in :-

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 poweder & Hydrogel Permeable to tear it off • Infection
• Water vapor , • Copious drainage
O2 & Co2 Or • Tracts
Impermeable to • infected
• ext fluid & wounds
Bacteria
• Channeling or
Wrinkling occurs

Hydrocolloid • Protectn of • Moist wound May soften or Yellow pus colourd with
Partial env change shape with Odor exudate on removal
Adhesive Wafers Thickness • Non adhesive to heat or Friction • Normal during
containing Wound wound removal of
Hydroactive • Autolytic • Support Melted dressing dressing
Absorptive particles debridement of Autolytic material Allow 1-1 (1/2) inch
that interact with • Necrosis or Debridement • (Odor and margin around wound bed
wound fluid to form slough • Waterproof yellow
a Gelatinous • Wounds with drainage on Taping edges will prevent
mild exudate removal) curling
• mass over Not for Wounds Freq of Change :-
the wound with Depends on amt of
bed • Exposed exudate
bone or
Available in past tendon Change
form (Can be used as • Sinus tracts 3-7 days as needed with
a filler for shallow • Infection leakage
cavity) • Fragile
surrounding
skin

Dressing edges may

curl
• Elastic
Hydrogel • Partial & Full • Fill dead space Most require 2* TO prevent maceration
thickness • Rehydrate dry Dressing • Use skin barrier
Water or glycerine wounds wound bed wipe on
based gel • Wounds with • Promote May Macerate surrounding Intact
necrosis 7 autolytic around skin (Extra skin
Available in Slough debridement fluid)
• Gel form • Burns with Change
impregnated Tissue Amorphous form :- May dry out & then • 8-48 hrs
in gauze damaged by • For infection & adhere to skin (Less

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 • Solid sheets radiation Not sheet form fluid)
• Amorphous (Promotes
Gels Pseudomonas &
yeats)
Sheet form :-
• PartialThickness
Ulcers
Exudate :-
• Mild to
moderate
Foam Partial & Fulll thickness • Insulate Wounds Non adherents To prevent maceration
Wound • Provides padding • Require 2* • Skin sealed to
Semipermeable • Most are non dressing Protect intact
memb Exudate :- adherent surrounding skin
• Mild to Not for Change :-
Vary in absorptn moderate • Dry eschar • 8-48
Thickness 2* Dressng • Wounds
• for wounds with No
that need exudate
addtnl
Absorptn
Alginates Absorptn :- • Absorps 20 times • Need 2* Change :-
• Mod to large higher than their dressing • 8 hrs – 2-3 days
• Soft non exudate wt (Transparent
absorbent Wounds type :- film or gauze
• Cotton like • Infected + Non • Support pad)
fluffy infected debridement in
• Reacts with • Exudate + exudate • Can dry
wound Necrosis presence wound bed
exudate to
form
hydrophilic
gel mass over
wound area

Gauze Wounds Wounds :- • Delayed Tight packing :-

• Made of • Dead space • Can be used on healing if Compromise bld flow &
synthetic • tunneling infecteGood used delays healing >>> So pack
Fiber • Sinus tracts mech improperly loosely into wounds
• Permeable • Exudative debridement if • Pain on
• Absorptive Wounds properly used remova For filling :-
• May be used • Exudate + • Needs 2* • Use cont roll of

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 wet moist Necrosis • Cost effective dressng gauze , Easy
alcohol Wet to dry filler for deep removal
petroleum :-Mech debride of wounds Macerate :-
jelly • necrotic tissue • If too wet
& slough • Used with
Cont dry :- topicals Wide mesh :- For
Impegnated :- Filled Heavy exudating debridement
with medicine wounds
Fine mesh :- For
Standard :- Non Cont moist :- Protection
impregnated Protectn of clean
wounds Protect surrounding skin
Autolytic debridement :-
of slough or eschar • With moisture
barrier ointment
or skin sealant as
needed

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