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Integumentary > Atypical Wounds > Flashcards

Atypical Wounds Flashcards

1
Q

Other Wound Types

A

Traumatic wounds
Surgical Wounds
Abscesses
Atypical wounds

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2
Q

What are abrasions?

A

Wound caused by friction to the skin’s surface

May be superficial or partial thickness

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3
Q

Presentation of abrasions?

A

May or may not be contaminated
Mild, stinging sensation
Light to moderate bleeding
Rarely progress to be chronic wounds

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4
Q

Interventions for abrasions?

A

Irrigate thoroughly with water or saline

Whirlpool therapy may assist with removal of debris

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5
Q

Debridement for abrasions?

A

Selective or nonselective debridement

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6
Q

Dressing for clean abrasions?

A

Clean wounds: moisture-retentive dressing

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7
Q

Dressing for contaminated wounds:

A

broad-spectrum antimicrobial and gauze dressing

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8
Q

Skin tears

A

Traumatic wounds resulting from shear or friction forces that separate the epidermis from dermis
Partial-thickness wound
Age-related skin changes

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9
Q

Who is at risk for skin tears and why?

A

Age-related skin changes make elderly at increased risk for skin tears

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10
Q

Presentation for skin tears:

A

Linear tear or flap

Wound edges can readily be approximated or may have tissue defect

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11
Q

Drainage for skin tears:

A

Slight serous drainage

Bleeding- minimal to significant

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12
Q

Pain with skin tears:

A

Minimal pain

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13
Q

Skin Tear Category I

A

IA: Linear
IB: Flap

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14
Q

Skin Tear Category I Presentation

A

No tissue loss
Epidermis and dermis pulled apart
Epidermal flap covers dermis

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15
Q

Skin Tear Category II

A

IIA: Scant tissue loss
IIB: Moderate to large tissue loss

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16
Q

Skin Tear Category II Presentation

A

Partial tissue loss
= 25% epidermal loss
>25% epidermal flap loss

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17
Q

Skin Tear Category III

A

Skin tear with complete tissue loss

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18
Q

Skin Tear Category III Presentation

A

No epidermal flap

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19
Q

Surgical Wounds

Treated with Primary Closure

A

Sutures, staples, or tissue adhesives

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20
Q

Surgical Wounds

Treated with Primary Closure drainage

A

Expect minimal bleeding/drainage for first

day or so

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21
Q

Surgical Wounds

Treated with Primary Closure Healing

A

Epithelialized in 7–10 days

Keep clean and dry for 24–48 hours

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22
Q

Factors related to dehiscence

A 
Malnutrition 
Diabetes
Steroids
Smoking
Excessive tension on wound edges
Underlying infection and abscess
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23
Q

Treatment of Dehisced Surgical Wounds

A

Reduce tension at wound borders

Infection

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24
Q

Reduce tension at wound borders

A

Use of binder, Montgomery straps, compression

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25
Q

Infection

A

Antibiotics per MD, wound irrigation, debridement

Monitor for fistulas: sinus tract that connects two epithelial surfaces

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26
Q

Interventions for surgically debrided wounds:

A

Interventions directed at granulation tissue formation, wound contraction, and epithelialization
Fill Dead space

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27
Q

If there is no infection for surgically debrided wounds, dressing to use:

A

use moisture-retentive dressing

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28
Q

Amputation management

A

Manage wound
Diabetics made need advanced interventions to promote healing
Protect stump
Provide compression to shape stump

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29
Q

Stump wrapping:

A

Reduce stump edema
Promote healing
Shape stump

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30
Q

Advantages of stump wrapping:

A

Custom fit
Can adjust tightness to patient tolerance
Easily applied over wound dressing

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31
Q

Disadvantages of stump wrapping:

A

Difficult to apply correctly and with even compression

Slip, become loose

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32
Q

Stump shrinker:

A

Reduce stump edema
Promote healing
Shape stump

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33
Q

Advantages of stump shrinker:

A

Convenient
Easy for patient to apply
Variety of sizes and lengths

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34
Q

Disadvantages of stump shrinker:

A

Difficult to apply over dressing
May not compress distal stump effectively
May roll/slide on conical shaped legs

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35
Q

Rigid Removable Dressing

A 
Reduce edema
Protect residual limb
Promote wound healing
Shape residual limb
Decrease pain
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36
Q

Advantages of Rigid Removable Dressing

A

Good for fall risk patients
Can apply socks to promote shrinking
Easy to apply

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37
Q

Disadvantages of Rigid Removable Dressing

A

Added expense

Requires fitting/proper size

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38
Q

Presentation of Traumatic Wounds:

A

Highly variable
Wounds due to gunshots, motor vehicle accidents, falls, industrial accidents
Concomitant injuries such as fractures, spinal cord injuries, and head injuries may be present

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39
Q

Interventions for traumatic Wounds:

A

Contaminated or infected wounds should be irrigated and debrided
Attain warm, moist wound environment
Protect wound from further trauma

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40
Q

Bites most likely to become infected:

A

Human wounds are most likely to become infected, followed by cat bites due to microflora

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41
Q

What type of spider bites require interventions:

A

Black widow

Brown recluse

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42
Q

Black widow spider bites:

A

Patients are acutely ill within 1–3 hours of bite

Small bite surrounded by erythema with urticarial rash, stinging sensation

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43
Q

Symptoms of black widow spider bites:

A

Bite causes weakness, headache, nausea/vomiting, hyperreflexia, dyspnea, diaphoresis, HTN, tachycardia
The wound itself rarely requires wound care

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44
Q

Interventions for black widow spider bites:

A

antivenom, NSAID, muscle relaxer

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45
Q

Brown recluse spider bites:

A

Lives in enclosed spaces, active in spring
Endemic to parts of the Southeast, Southwest, and Midwest
Bites defensively – majority heal without complication in 3–5 days

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46
Q

Presentation of brown recluse spider bite:

A

edema, vasodilation, blood vessel degeneration, reddish blisters or bullae may develop
Within 24 hours, red inflammation, blue thrombosis, and white ischemia and possible necrotic center
Fever, nausea, malaise, joint pain

47
Q

Healing time for brown recluse spider bite:

A

Healing time for complicated brown recluse spider bites ranges from 5 to 17 weeks

48
Q

Brown recluse spider wound treatment:

A

Debride necrotic tissue
Moist wound healing with appropriate dressings
Avoid heat

49
Q

Brown recluse spider wound medical care:

A

Monitor for potential systemic complications
3% may require skin graft
Antibiotics if signs and symptoms of infection
Antihistamines
Steroids

50
Q

Abscesses

A

A localized collection ofpurulent material

Usually bacterial in origin

51
Q

Signs and symptoms of abscesses:

A

redness, pain, warmth, and swelling.

52
Q

How are abscesses usually addressed?

A

incision and drainage

53
Q

Treatment of abscesses:

A 
Irrigation and debridement
 Fill dead space
Systemic Antibiotics
Manage exudate
Protect surrounding skin
54
Q

Radiation:

A

Directly destroys tissue
Indirect tissue damage from free radical production
Inhibits inflammatory response and proliferative phase of healing

55
Q

What does damage from radiation depend on?

A

dose, type of radiation, location, surface area

56
Q

Patient related variables for radiation:

A

age, comorbidities, medications, nutrition, hydration, immune function

57
Q

Presentation of Radiation Fibrosis and Radiation Burns

A

Mild inflammation, slight erythema, and local edema

Dry, scaling, itchy, hyperpigmented skin

58
Q

If radiation continues, what forms?

A

bullae formation and fibrinous exudate with increased pain

59
Q

Radiation fibrosis:

A

late tissue injury
Skin is dry, discolored, hairless, atrophied, fibrotic, and inelastic
Skin appears translucent

60
Q

Grade 1 skin reaction to radiation:

A

faint erythema
epilation
dry desquamation
decreased sweating response

61
Q

Grade 2 skin reaction to radiation:

A

bright erythema
tenderness to palpation
moderate edema
moist desquamation

62
Q

Grade 3 skin reaction to radiation:

A

moist desquamation with pitting edema

63
Q

Grade 4 skin reaction to radiation:

A

ulceration or necrosis

64
Q

Radiation Fibrosis and Radiation Burns interventions:

A 
Protection from mechanical forces (shear, friction, and pressure)
Avoid adhesives
Decrease bathing frequency and pat skin dry
Avoid superficial heat and ice
Avoid heavy detergents or perfumes
Amorphous hydrogel to soothe skin
Moisturizing ointment
Oatmeal baths or topical steroids
65
Q

Atypical wounds

A 
Pyoderma Gangrenosum
Cancerous lesions
Psoriasis
Discoid lesions
Fungal infections
Hydradenitis Supurativa
Yeast infections
Peau d’orange
66
Q

Pyoderma Gangrenosum

A

Noninfectious, progressive necrotizing skin condition, uncommon, destructive inflammatory disease of unknown etiology.

67
Q

Onset of Pyoderma Gangrenosum

A

50% have a systemic inflammatory condition
25% insidious
25% after trauma or surgery

68
Q

Differential diagnoses for Pyoderma Gangrenosum:

A

Cancer, vasculitis, adverse drug reaction, spider bite, chronic venous insufficiency

69
Q

Presentation of Pyoderma Gangrenosum

A

Begins as small, painful papule, vesicle, or pustule on lower extremities and trunk
Progresses to full-thickness ulcerations
Irregular borders , Inflammed with gray or purple hue
Undermining

70
Q

Wound bed and drainage of Pyoderma Gangrenosum

A

Indurated, boggy, necrotic base
Purulent and hemorrhagic exudates
Erythematous due to inflammation
Wound bed covered with eschar or slough

71
Q

How does Pyoderma Gangrenosum heal?

A

Heals with irregular cribriform scars

72
Q

Treatment of Pyoderma Gangrenosum?

A

Requires immunosuppressive therapy
Severe pain (burning/searing)
May have fever, malaise, or myalgia

73
Q

Suspect Pyoderma Gangrenosum if:

A

Positive wound cultures without response to antibiotics

Wound not responding to standard care for presumed wound etiology

74
Q

Interventions for Pyoderma Gangrenosum

A 
Immunosuppressive agents – cyclosporin
Corticosteroids – systemic, topical locally injected
Gentle, limited debridement
Topical antimicrobials
Gauze or moisture-retentive dressings
Elevation and compression
Negative pressure therapy, HBO may help
75
Q

Keratoacanthoma

A

Non-malignant
Fast growing
Resembles Squamous cell carcinoma

76
Q

Psoriasis

A

a chronic, autoimmune disease that appears on the skin

77
Q

Five types of psoriasis:

A

plaque, guttate, inverse, pustular and erythrodermic

78
Q

Most common form of psoriasis and presentation:

A

plaque psoriasis

appears as raised, red patches or lesions covered with a silvery white buildup of dead skin cells, called scale

79
Q

Lupus Erythematosus

A

photosensitive, plaques on hands, may have occasional leg ulcers, scalp lesions in discoid, vasculitis, bullous lesion

80
Q

Candida Albicans

A

yeast infection

red pinpoint papules, part of normal flora, occur in areas of moisture, diabetes, with use of antibiotics

81
Q

Treatment of Candida Albicans

A

miconazole or other “zoles”, use powder for moisture control

82
Q

Hydradenitis Supurativa

A

Clusters of abscesses typical located in the axilla or groin
Heriditary component
Autoimmune characterisits
Weeping, purulent drainage

83
Q

Tinea Cruris

A

jock itch

a common skin infection that is caused by a type of fungus called tinea

84
Q

Common places for fungus in tinea cruris:

A

warm, moist areas of the body and as a result, infection can affect the genitals, inner thighs, and buttocks. Infections occur more frequently in the summer or in warm, wet climates

85
Q

Impetigo

A

Superficial skin infection, strep or staph aureus lesion may form roofed bullae. Treat with Mupirocin 2% ointment or cream & oral antibiotics

86
Q

Cellulitis

A

Infection of the dermis and sub cutaneous tissue causes erythema, edema, and pain, usually caused by skin disruption

87
Q

Treatment of cellulitis:

A

elevation, antibiotics to fight skin flora.

88
Q

Erysipelas

A

Acute inflammatory form of cellulitis involving lymphatic streaking, more superficial, clearly demarcated with skin break as portal of entry

89
Q

Symptoms with Erysipelas

A

Fever, chills, anorexia, vomitting, typically strep- treat with oral antibiotics

90
Q

Actinc Keratosis

A

Pre-cursor to squamous cell CA, sun-exposure, cresting/pigmentation

91
Q

Basal Cell Carcinoma

A

most common cutaneous CA, slow growing, locally destructive, common after 40 & with fair skin

92
Q

Squamous cell Carcinoma

A

arising from keratinocytes, second most common (20% of all primary malignancies) metastatic, related to burns, radiation, osteomyelitis, and chronic infections

93
Q

A

A

Asymmetry

94
Q

B

A

Border

95
Q

C

A

Color

96
Q

D

A

Diameter

97
Q

E

A

Evolving

98
Q

Hepes Zoster

A

Involves single dermatome, varicella virus gaining entry to nerve with chicken pox, tender with hyperesthesias in dermatome, pain/itching, fever, may cause lasting neuralgia, skin eruptions

99
Q

Vasculitis

A

inflammation and destruction of blood vessels, purpura causing burning, usually below knee

100
Q

What is hypersensitivity vasculitis associated with?

A

infection or chemical/drug exposure, blood vessels walls are attacked by immune system, become inflamed and seep blood

101
Q

Scleroderma

A

Excessive fibroblasts/collagen, Raynaud’s, treat with ultraviolet A

102
Q

CREST

A 
Calcinosis
Raynauds
Esophageal dysfunction
Sclerodactyly
Telanglectasias
103
Q

Calcinosis

A

calcium deposits in the skin

104
Q

Sclerodactyly

A

thickening and tightening of the skin on the finger and hands

105
Q

Telanglectasias

A

dilation of the capillaries causing red marks on surface of the skin

106
Q

Necrobiosis Lipoidica

A

Inflammatory condition, collagen degeneration associated with diabetes, lesions slow, along anterior tibial ridge

107
Q

Cholesterol Emboli

A

recent surgery or anticoagulation, “blue toe syndrome

108
Q

When does Cholesterol Emboli occur?

A

cholesterolfrom plaques are dislodged and travel through the blood stream, becoming lodged in small vessels

109
Q

Karposi’s Sarcoma

A

Malignant tumor of lymph and epithelial cells linked to Herpes & HIV, radiation/chemo

110
Q

STAR classification 1a

A

a skin tear where the edges can be realigned to the normal anatomical positions and the skin flap color is not pale, dusky or darkened.

111
Q

STAR classification 1b

A

a skin tear where the edges can be realigned to the normal anatomical position and the skin flap color is pale, dusky or darkened

112
Q

STAR classification 2a

A

a skin tear where the edges cannot be realigned to the normal anatomical position and the skin or flap color is not pale, dusky or darkened

113
Q

STAR classification 2b

A

a skin tear where the edges cannot be realigned to the normal anatomical position and the skin flap color is pale, dusky or darkened

114
Q

STAR classification 3

A

a skin tear where the skin flap is completely absent

Integumentary (18 decks)

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