lec_9 health and wealth.pptx kmu dpt 3rd semster

3rd semstr biochemstry

1. Health and Wellness Integumentary System

2. Lifespan Changes The integumentary system contains the largest organ of the body, the skin. This system also includes subcutaneous tissues (responsible for storing energy and absorbing trauma), the nails, the hair, and the structures immediately under the superficial skin layer (dermis). Barrier against infection and injury, the skin helps to regulate body temperature, removes waste products from the body, protects internal structures (to some extent) from ultraviolet (UV) radiation, and produces vit.D , an essential nutrient for maintaining normal blood levels of calcium and phosphorus needed to form and maintain strong bones.

3. A healthy full-term baby is born with extra fat and increased skin elasticity. Changes in the skin become more apparent during puberty when hormones influence sexual changes in hair and fat distribution and, in some cases, increased secretion from sebaceous glands. With aging and exposure to UV radiation, toxins, and other damaging agents, the skin tends to lose its elasticity, its vascularity , its thickness, its strength, and its thermoregulation properties.

4. In older adults, the overall function of the skin is compromised with the graying of hair and the physiological changes underlying changes in physical appearance, including tissue dehydration and impaired wound healing. Primary practice includes health education about maintaining skin hydration as well as avoiding the various risk factors leading to premature aging and pathology.

5. INtegumentary Pathology Amputation, congestive heart failure, diabetes, malnutrition, neuromuscular dysfunction, obesity, peripheral nerve involvement, spinal cord dysfunction, and vascular disease. Any clients with impairments limiting levels of activity, reducing sensation, or causing edema, inflammation, pain, or ischemia are at increased risk for integumentary problems and should be monitored carefully by the physical therapist.

6. Physical therapists are fortunate in their practices to have the time to complete a comprehensive and thorough examination of their clients. A comprehensive examination and assessment of the patient includes identification of secondary complications related to chronic pathology, such as loss of integumentary integrity. Suspected risk to integumentary integrity should lead the physical therapist to three vital areas of skin care education: risk reduction for skin cancers, avoidance of pressure sores or wound development, and medication side effects with integumentary manifestations.

7. In 'addition, physical therapists can help clients prevent losses of skin elasticity and range of motion by encouraging passive and active movement, a healthy diet (including adequate hydration), and protection from irritants and infections affecting the skin's integrity. As integumentary conditions become more severe, the client becomes more vulnerable to complications resulting from exposure of underlying tissue. Physical therapists can play a key role in primary, secondary, and tertiary preventive care of clients

8. Skin Cancer One growing concern is the risk of skin cancer. The incidence of skin cancer is greater than the incidence of breast, lung, prostate, colorectal, and kidney cancers combined. The ABCDE rule of skin cancer helps to identify any abnormal skin lesions that are suspect and includes the following: "A" represents asymmetry in the lesions ( ie , one half of the lesions is unlike other half). "B" represents borders that are irregular or poorly circumscribed. "C” represents color variation in the lesions (melanomas tend to have color variations that include tan, brown, black, white, red, and blue). "D" represents diameter greater than 6 mm (the size of a pencil eraser) since cancerous skin lesions tend to grow. "E" represents elevation since normal skin lesions tend to be flat and raised lesions may represent abnormal growth.

9. The American Cancer Society recommends a thor­ough skin exam every 3 years between the ages of 20 and 40, every year age 40 or older, and monthly skin self-exams, most easily performed after a bath or shower. A thorough screening demands that the entire surface of the body be palpated and inspected in good light. The onset and duration of each symptom should be recorded, together with a description of the lesion and any subsequent changes.

10. Primary prevention includes educating individuals about monthly checks as well as the need to use a full-length mirror and brightly lit room to examine the entire body, including: The scalp, inside the mouth, between the toes, and the bottoms of the feet Individuals at an increased risk for melanoma are those with fair complexions; excessive exposure to UV radiation from the sun or occupational exposure to coal, tar, pitch, creosote, arsenic compounds, and radium; or human immunodeficiency virus (HIV).

11. Examination Skin examination should be performed regularly during physical therapy visits. Most skin cancers develop mainly on areas of skin exposed to direct sunlight, including the scalp, face, lips, ears, neck, chest, arms and hands, and on the legs in women. They can also develop on unexposed , areas, such as the palms, the spaces between toes, and the genital area. A cancerous skin lesion can appear suddenly, or it can develop slowly. Secondary prevention includes reducing risk factors that can cause a recurrence of malignant skin lesions, including sun protection, self examination, and early diagnosis of potential malignant melanoma, basal cell carcinoma, and squamous cell carcinoma—common forms of skin cancer.

12. Basal cell or squamous cell carcinomas, the most common of skin cancers, 4 are likely to present in one of the following ways: as an open sore that bleeds, oozes, or crusts and is present for more than 3 weeks; as an irritated red patch that may itch or hurt; as a growth with a rolled border and central indentation; as a shiny bump or nodule; or as a scarlike area. Sudden or continuous enlargement of a lesion; surface changes such as bleeding, crusting, erosion, oozing, or scaling, changes in the sur­rounding skin such as redness, swelling, or satellite pigmentation; changes in sensation such as itching, tenderness, or pain; changes in consistency such as softening or friability; and the development of a new pigmented lesion, particularly in clients older than 40 years of age.

13. Pressure Sores Physical therapists are vital members of health care teams when treating clients at risk for skin breakdown, including clients with periods of immobility, prolonged pressure on bony prominences, poor nutrition, incontinence of bowel and/or bladder, lowered mental alertness, history of pressure sore or open wound, or lack of sensation. Healthy People 2010 defines "persons at risk" as persons with a disability.

14. The Agency for Health Care Policy and Research (AHCPR; now the Agency for Healthcare Research and Quality) recommended the Braden Scale and the Norton Scale as appropriate tools for assessing a patient's risk for pressure ulcers. The Braden Scale, presents a risk assessment incorporating six subscales: (1) sensory perception, (2) skin moisture, (3) activity, (4) mobility, (5) nutritional status, (6) friction and shear factors.

15. Attention Complications such as endocarditis (heart infection), heterotopic bone formation (bone formation in soft tissue), maggot infestation, osteomyelitis (bone infection), bacteremia (blood infection), fistulas (abnormal openings between organs), septic arthritis (infection of inflamed joints), develomement of sinus tracts or abscess, and systemic complications of topical treatment, such as iodine toxicity and hearing loss after topical neomycin and systemic gentamicin , are not uncommon and can result from poor hygiene and exposure to infectious agents.

16. Health Education for Skin Care keeping nails trimmed, avoiding scratching the skin, and bathing in non fragranced warm water, rather than hot water. The Lower Extremity Amputation Prevention (LEAP) organization advo­cates routine and frequent screening of skin for risk factors associated with diabetes. These include prominence of metatarsal heads, dry skin, callus formation, unable to perceive 10 g force (5.07 Simmes -Weinstein filament), and finally, decreased thermal and vibration sensation, which tends to dry the skin. Also, avoidance of allergens and skin irritants such as fabric softeners, perfumed soaps, and household cleansers should be emphasized.

17. For those engaged in aquatic activities, bathing is essential following swimming for removing drying pool chemicals. Protection from the sun can be achieved by avoiding peak sunshine (10:00 am to 4:00 pm) and limiting unnecessary sun exposure through protective clothing and maintained sunscreen. Over-the-counter topical ointments (such as topical steroids) can be used to manage minor skin irritations and to reduce skin infections when there is skin injury; however, any client presenting with chronic skin inflammation, pruritus , or suspicious skin lesions should be more thoroughly examined by a dermatologist.

18. Side Effects of Medications The most com­mon medications encountered in the management of many acute conditions include analgesics, anti-inflammatory agents, and muscle relaxants. Physical therapists should be aware of adverse drug reactions associated with these medications.

19. Cutaneous drug reactions are the most common adverse responses to drugs, though not the only adverse reaction. Urticaria (itchy, swollen, red bumps or patches on the skin) is the most common reaction; however, there are many different types of drug reactions, and some are life threatening. Aspirin and nonsteroidal anti-inflammatory drugs (NSAIDs) can cause angioedema (swelling beneath the skin) and urticaria . NSAIDs can cause common cutaneous reactions, such as pruritus (itching), Morbilliform rash (rash appearing like measles), urticaria , and photo-sensitivity. Urticaria is most frequent in salicylate -sensitive patients. Other skin reactions are unusual, although purpura ( bruiselike coloration) and cutaneous vasculitis (an allergic inflammatory reaction of vessels)