Background, Healing, Closure, Screening/ Exam Flashcards

Question

Cellular response in inflammatory phase of wound healing:

Answer 1

PMNs (polymorphonuclear neutrophils) - scavengers that kill bacteria and cleans wound Macrophages - direct the repair process, assist with killing bacteria and cleaning wound, secretes growth factors Mast cells - secretes enzymes and inflammatory mediators

Answer 2

Timeline: begins around 48 hours, for weeks Processes: -angiogenesis (neovascularization)- capillaries form buds and grow -granulation tissue formation- temporary latticework of vascularized CT to fill wound; eventually replaced by scar tissue; healthy, new tissue -wound contraction- myofibroblasts drive this process, pulling wound edges together --> more for full thickness wounds, slower in circular wounds -epithelialization - keratinocytes at wound margins and epidermal appendages begin to multiply and migrate --> closed barrier of wound ** unable to migrate over nonviable tissue

Answer 3

-Epithelial cells migrate across the new tissue to form a barrier between the wound and the environment -Basal epithelial cells at wound margin --> multiply in horizontal direction --> epithelial cells move toward and fill the edges of the wound and form a layer of cells --> flatten (mobilize) and migrate into the open wound -Basal cells behind margin undergo vertical growth (differentiation)

Answer 4

-new collagen is formed -old collagen broken down -Collagen fibers from immature Type III to mature Type I AND reorient along the lines of stress -rosy, pink scar--> more pale with remodeling -sensation, oils, sweat may be different after wound -tissue never returns to same as it was before wound -Timeline: Remodeling can continue for up to 2 years following wound closure, with the greatest change in the first 6-12 months -Increase tensile strength over time, but never back to baseline (only 80%)

Answer 5

clean, straight line, edges well approximated with sutures, rapid healing, usually best cosmetic outcome

Answer 6

larger wounds with tissue loss, edges not approximated, heals from the inside out, granulation tissue fills in the wound, longer healing time, larger scars -wound left open and allowed to heal spontaneously/ fill -contaminated/infected wounds -increased scarring **wound care PT more directly invovled

Answer 7

delay is typically 3-5 days before injury is sutured, used to manage infected or unhealthy wounds, larger scar -delayed primary closure -good for contaminated/infected initially wounds

Answer 8

oAbsence of inflammation oChronic inflammation oHypogranulation oNon-advancing wound edge (epibole) oHypergranulation oHypertrophic scaring oKeloids oContractures oDehiscence

Answer 9

◦ Mechanism of onset ◦ Time since onset ◦ Wound location ◦ Wound dimensions ◦ Wound temperature ◦ Wound hydration ◦ Necrotic tissue and/or foreign bodies ◦ Infection

Answer 10

circulation sensation mechanical stress

Answer 11

◦ Nutrition/hydration ◦ Diabetes ◦ Peripheral Vascular Disease (PVD) ◦ Gastroesophageal Reflux Disease (GERD) ◦ Collagen disease ◦ End Stage Renal Disease (ESRD) ◦ Immunosuppression ◦ Aging ◦ Medications ◦ Social/health habits ◦ Functional status & activity level ◦ Infection ◦ Paresthesia ◦ Perfusion ◦ Incontinence

Answer 12

Blanchable: reddened area that turns pale under applied light pressure.--> GOOD Non-blanchable: an area of redness that does not blanch under applied light pressure.--> more significant tissue involvement

Answer 13

cyanosis- lack of oxygen perfusion purple: deep tissue injury red: infection, inflammation, cellulitis, dermatitis, erythema, stage 1 pressure injury, 1st degree burn

Answer 14

CELLULITIS: (fat and shiny) DERMATITIS: raised bumps, red

Answer 15

white: -reynaud's --> keep in mind how this looks different in different skin colors black: -necrotic tissue: eschar, gangrene Yellow: jaundice: liver issues

Answer 16

-varies with wound type -indicates what's happening beneath the skin -changes --> may indicate infection -helps determine which tests are indicated -signs of integument disease

Answer 17

o Defined as excess fluid in the interstitial tissue o Can be multi-factorial in cause o Impedes healing regardless of etiology o Extent and type of edema helps identify wound etiology.

Answer 18

-infection -inflammatory response in the immediate wound area

Answer 19

-DVT -venous insufficiency -IV fluid going to incorrect place -had surgery that affected the lymphatic system

Answer 20

you could be suspicious of a condition that is more systemic

Answer 21

Trace- 1+ < 2mm and barely perceptible Mild - 2+ Moderate - 3+ Severe- 4+ > 7mm and > 30 seconds Based on amount of depression and time before skin rebound

Answer 22

skin that looks like an orange peel extreme edema; chronic hard and firm

Answer 23

◦ Rubor – redness ◦ Fumor – swelling ◦ Calsor – heat ◦ Dolor – pain ◦ Functio laesa – loss of function

Answer 24

odor pain -throbbing palpation - pain systemic changes wound cultures -streaking: sepsis -more drainage from the wound--> infection ** all of the signs of inflammation but more extreme

Answer 25

-gold standard for tissue biopsy -swab cultures: find number & type of bacteria present --> bacteria types: aerobic (common most wounds) and anaerobic (deep, tunneling wounds, wounds with undermining or sinus tracts, wounds occluded with thick layers of topical agents) -fluid aspiration: must have enough fluid to sample, middle ground between biopsy and swab

Answer 26

-antibiotics -antibacterials (e.g., Bacitracin, Bactroban, Silvadene, Neosporin) -antifungals (e.g., Mycostatin, Lotrimin) -antiseptics (e.g., acetic acid, Hibiclens, Dakin's solution, hydrogen peroxide, Betadine)

Answer 27

INFLAMMATION -slight edema -local temp inc. -mild amount drainage, thin, clear fluid -well defined erythema near wound edges -pain proportionate to wound INFECTION -significant edema -broad temp increase, hot to touch, fever, malaise -large to copious drainage, prurulent or clear, thin or thick -broad, streaking redness, blistering clear or blood filled -severe pain, no position of comfort, change or disproportionate

Answer 28

1.) by tissue involvement - local care -superficial/erosion -partial or full thickness 2.) by etiology - systemic care -arterial wound -venous wound -neuropathic wound -pressure injury -atypical

Answer 29

-any precipitating event associated with the onset of the wound? -other signs/symptoms? (fever, itching, pain) -what alleviates the pain/makes worse? -what have you tried for treatment? -is wound getting better or worse?

Answer 30

PMH Current meds Allergies Nutritional Status Alcohol, tobacco, drug habits Physical Activity Level? AD required for functional activities? Other social history that may be pertinent- religious beliefs, culture, etc.

Answer 31

-dimens./extensions -tissue type -staging -wound bed color -drainage -wound edges -check surrounding tissue -temperature -edema -circulation -circumferential measurements -sensory integrity

Answer 32

Length (cm) x width (cm) x depth (cm) ** always use a decimal point ** length: head to toe **width: 9 to 3 EX: tunneling at 3 o'clock, 1 and 7 length

Answer 33

-used for tunneling and undermining

Answer 34

perpendicular clock volumetric - measure how much saline it takes to fill the wound tracing-clear film, draw on with permanent marker, gives you an idea of the size of the wound and compare how that is changing photography- use grid method to determine the size of the wound --> ex: "" squares in this direction --> keep image a consistent distance away from the wound

Answer 35

rule of 9s -head and neck: 9 percent -anterior trunk (chest and abdomen): 18 percent -posterior trunk (back and buttocks: 18 upper extremities: 18- each arm front and back lower extremities: 36 percent: each leg 9 percent front and back genitalia and perineum: 1 percent

Answer 36

tunneling/sinus tract - narrow passage of tissue destruction within wound or separation of fascial planes -into wound bed undermining - destruction of CT between dermis and subcut. tissue -extends under the intact skin along the periphery of a wound fistula - tunneling that connects with a body cavity --> ** refer immediately!! MEAUSREMENTS: -ex: tunnel at 7 oclock and measures 3 cm (depth) -undermining at 11 oclock to 2 oclcock

Answer 37

-rubbed/scraped skin -usually not much bleeding EX: road rash

Answer 38

-partial or complete tearing away of skin/tissue -bleeds heavily and rapidly MOI: accident, crush accident, explosion, gunshot

Answer 39

small hole caused by pointy object may not bleed much, can damage organs MOI: nail, bullet, needle

Answer 40

Deep cut or tearing of skin rapid and extensive bleeding possible MOI: knives, tools, machinery

Answer 41

-find out healing phase -provide data for measuring outcomes -determine optimal treatment plan for primary and secondary dressings -indicate other disease processes

Answer 42

red, beefy -caused by angiogenesis -made of new capillaries and ECM -varies in color from anemic --> bright red -necessary for secondary intention wound closure or split thickness skin graft **Carefully protected in good wound management

Answer 43

A split-thickness skin graft (STSG), by definition, refers to a graft that contains the epidermis and a portion of the dermis, which is in contrast to a full-thickness skin graft (FTSG) which consists of the epidermis and entire dermis

Answer 44

-type of NECROTIC tissue -softer, lighter necrotic debris -by-product of autolysis -usually beneath eschar -more common in inflammatory phase of healing -soft and mushy, sometimes hard to grasp with forceps ; different from CT that is adhered to dermis **this needs to be removed for healing

Answer 45

composed of dead cells and fibrin may be dray and hard or soft, rubbery, leathery -may be dry gangrene or wet gangrene

Answer 46

-tissue death due to interrupted blood supply -type of necrosis DRY -Dry gangrene can result from conditions that reduce or block arterial blood flow such as diabetes, arteriosclerosis, and tobacco addiction as well as from trauma, frostbite, or injury. WET -Wet gangrene can result from the same causes as dry gangrene but always includes infection. In some cases of wet gangrene, the initial cause is considered to be the infection. ** INFECTION

Answer 47

brownish-gray or black when devitalized (rich blood supply) painful when exposed

Answer 48

-shiny and stringy when healthy -dull and dry, leathery when devitalized -covered with fibrous sheath of CT containing synovial fluid or fatty fluid (paratenon) -may see movement of tendon with movement of patient

Answer 49

NORMAL: tan, milky, white in color; shiny NECROTIC: dark brown, soften, appear moth-eaten --> must be debrided if necrotic -covered with periosteum when healthy

Answer 50

purpose: -stores fat, provides energy, cushioning, insulation -stores fat soluble vitamins like A,D, E, and K NORMAL: shiny, yellow-white globules when healthy DEVITALIZED: shriveled and dry ** frequent source of abscess formation

Answer 51

erosion- loss of epidermis partial thickness- loss of epidermis and part of dermis full thickness- loss of all of the epidermis, dermis, into subcutaneous tissue

Answer 52

STAGE 1 -no opening of wound -NOT blanchable STAGE 2 -opened wound -shallow -outer layer of skin affected -partial thickness STAGE 3 -full thickness wound -tunneling and undermining is possible -cannot see ms., tendon, or bone STAGE 4 -tunneling and undermining is possible -slough and eschar possible -full thickness -CAN see ms., tendon, or bone UNSTAGEABLE: cannot see the bottom of the wound --> could be covered by eschar

Answer 53

-not enough adequate blood supply -likely to open to stage 3 and 4 pressure injury -can look like a blood blister -NOT blanchable -DARK, purple in color -ultrasound may be good intervention -very common in falls at home

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Background, Healing, Closure, Screening/ Exam Flashcards

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