Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MED CON III > Background, Healing, Closure, Screening/ Exam > Flashcards

Background, Healing, Closure, Screening/ Exam Flashcards

1
Q

What are the functions of the integumentary system?

A

o “Serves as a barrier to environmental threats such as bacteria, pressure, shear, friction, & moisture”
(Guide to PT Practice)

o Protection/immunity - protects against pathogens, decreases water loss

o Temperature regulation – provides insulation, related to dilation & constriction of blood vessels, sweating

o Sensation – contains various nerve endings, including for pain, light touch, etc

o Assists in VitD synthesis, indicator of VitB levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Layers of the integumentary system

A

epidermis

dermis

hypodermis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Layers of the epidermis:

A

stratum corneum

stratum lucidum

stratum granulosum

stratum spinosum

stratum basale

basement membrane

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

stratum corneum (epidermis)

A

-most superficial- primary barrier
-soft keratin-containing, dead squamous cells
-constantly sloughing or shedding
-15-20 layers of dead cells
-can indicate hydration levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

stratum lucidum (epidermis)

A

-thin, clear layer of dead skin cells
-palms of hands and soles of feet (increased tissue stress areas)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

stratum granulosum (epidermis)

A

layer that contains the transition zone for the development of keratin

-active keratin development

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Stratum spinosum (epidermis)

A

-layer containing spiky or spiny projections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

stratum basale (epidermis)

A

deepest and most continuous layer of the epidermis

1-3 layers of cells thick

regenerates the epidermis –> everything above it

contains a variety of other cells

CELLTYPES: basal cells, keratinocytes, merkel cells melanocytes,

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Basement membrane (epidermis/dermis)

A

layer that separates the epidermis and dermis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Epidermal cell types and appendages

A

o Melanocytes – produce melanin
–> found in stratum spinosum and stratum basale
o Merkel cells – mechanoreceptors for light touch sensation
–> found in stratum spinosum
o Langerhans’ cells – fight infection
–> found in stratum spinosum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Functions of the dermis

A

-thickest layer of the skin

FUNCTIONS
▪ Thermoregulation
▪ Storage of water/maintaining hydration
▪ Provides nutrients & waste removal for itself & the epidermis
▪ Houses the epidermal appendages
▪ Assists with infection control
▪ Provides sensation

-hair, nails, sweat glands, and sebaceous glands

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What does the dermis contain?

A

-blood vessels
-lymph vessels
-nerve endings
-epidermal appendages
–> hair
–> sebaceous glands: slow down growth of bacteria; secrete sebum
–> sudoriferous glands–> sweat glands
–> nails

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Regions of the dermis

A

PAPILLARY REGION
-bumpy surface that interdigitates with the epidermis, strengthens the connection
-influences the contours of the skin’s surface
-ex: fingerprints

RETICULAR REGION
- Contains collagen, elastic, & reticular fibers, providing strength, extensibility, & elasticity
- Contains the roots of the hair, sebaceous & sweat glands, receptors, nails, & blood vessels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Hypodermis characteristics:

A

-subcutaneous tissue
-attaches skin to underlying bone and muscles
-contains loose CT, adipose tissue, and elastin
-contains 50% of body fat
-provides insulation and shock absorption

-Pacinian cells (vibration, deep pressure, proprioception) and free nerve endings for cold and pressure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is a pacinian cell?

A

Pacinian corpuscles, also known as Vater-Pacini or lamellar corpuscles, are sensory receptors for vibration and deep pressure and are essential for proprioception

-found in the hypodermis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Why do we care about the integumentary system/wound care?

A

skin abnormalities–> can indicate more global disease

appearance and quality can indicate overall health

-PT can specialize in wound care

-profound effects on our patients and on the healthcare system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Risk factors for inadequate wound healing:

A

-comorbidities
-nutrition or malnutrition –> appropriate protein and calorie intake
-obesity- extra tissue gets less blood flow the further out the tissue has to go
-smoking, alcohol, and/or drug use
-sedentary or limited mobility
-impaired sensation
-risk-prone behavior

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Extrinsic factors impacting wound healing:

A

-shoes - condition and fit
-orthotics and prosthetics
-seating
-hairstyles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What kinds of health conditions can impact the integumentary system?

A

cardio - venous/arterial insufficiencies
endocrine/metabolic - DM
neuromuscular
integumentary- burns, frostbite, incisions
MSK
pulmonary
multisystem/other

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Impairments of the integumentary system:

A

de-conditioning

claudication, tissue perfusion

skin lesions, adhesions, scars

sensory integrity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Wound healing chronology:

A

1.) inflammation
-longest stage
-peaks at 1-3 days

2.) proliferation
-peaks at 10 days
-overlaps with the inflammatory phase
-Also known as angiogenesis, this phase occurs when the wound is rebuilt with new tissue made of collagen and extracellular matrix.

3.) maturation- Also known as remodeling, this phase occurs when the wound fully closes and collagen is remodeled. This phase also involves scar tissue formation.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Hemostasis process:

A

1.) vessel injury

2.) vascular spasm with infiltration of platelets - smooth muscle contraction

3.) formation of the platelet plug - Fibrinogen converts to fibrin, the fibrin threads weave and stick together over the top of the platelet plug and hold the clump in place.

4.) the coagulation- fibrin filaments, red blood cells, and white blood cells the blood clot it formed ; fibrin strands secure the platelets and RBCs, effectively plugging the break (clot)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Infection control in the integumentary system:

A
  1. bacteria and other pathogens enter wound
  2. platelets from blood release blood clotting proteins at wound site
  3. Mast cells secrete factors that mediate vasodilation and vascular constriction. Delivery of blood, plasma, and cells to injured area increases
  4. Neutrophils secrete factors that kill and degrade pathogens
  5. Neutrophils and macrophages remove pathogens by phagocytosis
  6. Macrophages secrete hormones called cytokines that attract immune system cells to the site and activate cells involved in tissue repair
  7. inflammatory response contributes until the foreign material is eliminated and the wound is repaired
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Inflammatory phase of wound healing:

A

o Requires a vascular & cellular response from living tissue
o Assists in controlling the bleeding & combating infection
o Sets the stage for further healing by signaling the cells for repair & regeneration

Characteristics: erythema, edema, tenderness, pain

Function: remove debris, start healing cascade and prepare wound for regeneration

Timeline: begins at injury and lasts a few days
-1: injured blood vessel walls allow transudate to leak into the interstitial space (local edema) –> helps with fluid leakage
-2: local blood vessels constrict for several minutes to reduce blood loss
-3: platelets aggregate at the injury site, become active and start sticking together

◦ Activated platelets release chemicals like cytokines (proteins), growth factors (for cell growth,
differentiation, metabolism), & chemotactic agents (attract cells for wound repair)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Cellular response in inflammatory phase of wound healing:

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Proliferative phase of wound healing

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Epitheliaziation process of wound healing

A

-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)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Remodeling phase of wound healing

A

-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%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Primary intention wound closure:

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Secondary intention wound closure:

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Tertiary intention wound closure:

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are some examples of abnormal wound healing?

A

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

33
Q

What types of characteristics should you note in a wound?

A

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

34
Q

local factors that affect wound healing:

A

circulation
sensation
mechanical stress

35
Q

Systemic factors that impact wound healing:

A

◦ 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

36
Q

Blanchable vs non-blanchable:

A

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

37
Q

Cyanosis vs Purple color vs red

A

cyanosis- lack of oxygen perfusion

purple: deep tissue injury

red: infection, inflammation, cellulitis, dermatitis, erythema, stage 1 pressure injury, 1st degree burn

38
Q

Cellulitis appearance vs dermatitis

A

CELLULITIS: (fat and shiny)

DERMATITIS: raised bumps, red

39
Q

Skin observations in color:

A

white:
-reynaud’s –> keep in mind how this looks different in different skin colors

black:
-necrotic tissue: eschar, gangrene

Yellow: jaundice: liver issues

40
Q

Characteristics of skin color and texture:

A

-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

41
Q

what is edema?

A

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.

42
Q

Localized edema:

A

-infection
-inflammatory response in the immediate wound area

43
Q

Unilateral edema

A

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

44
Q

Bilateral edema could indicate what?

A

you could be suspicious of a condition that is more systemic

45
Q

How do we grade pitting edema?

A

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

46
Q

What is induration (edema)

A

skin that looks like an orange peel

extreme edema; chronic

hard and firm

47
Q

Signs of acute inflammation:

A

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

48
Q

Signs of infection:

A

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

49
Q

Wound cultures:

A

-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

50
Q

Ways to manage infection:

A

-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)

51
Q

INFLAMMATION VS INFECTION

A

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

52
Q

Two ways to diagnose wounds:

A

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

53
Q

Questions to ask about wound itself:

A

-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?

54
Q

Questions about patient:

A

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.

55
Q

Objective Measures to include in wound exam:

A

-dimens./extensions
-tissue type
-staging
-wound bed color
-drainage
-wound edges

-check surrounding tissue
-temperature

-edema

-circulation

-circumferential measurements

-sensory integrity

56
Q

Taking dimensions of a wound: (head to toe method)

A

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

57
Q

Clock method:

A

-used for tunneling and undermining

58
Q

Methods for taking dimensions:

A

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

59
Q

How to take total body surface area- burns:

A

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

60
Q

What are the types of subcutaneous extensions ?

A

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

61
Q

Abrasion

A

-rubbed/scraped skin
-usually not much bleeding

EX: road rash

62
Q

Avulsion

A

-partial or complete tearing away of skin/tissue
-bleeds heavily and
rapidly

MOI: accident, crush accident, explosion, gunshot

63
Q

Puncture

A

small hole caused by pointy object

may not bleed much, can damage organs

MOI: nail, bullet, needle

64
Q

Laceration

A

Deep cut or tearing of skin

rapid and extensive bleeding possible

MOI: knives, tools, machinery

65
Q

Why do we need to determine tissue type?

A

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

66
Q

Granulation tissue:

A

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

67
Q

What is a split thickness skin graft?

A

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

68
Q

Slough

A

-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

69
Q

Necrotic tissue

A

composed of dead cells and fibrin

may be dray and hard or soft, rubbery, leathery

-may be dry gangrene or wet gangrene

70
Q

what is gangrene?

A

-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

71
Q

What does muscle look like when unhealthy?

A

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

painful when exposed

72
Q

Appearance of tendons:

A

-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

73
Q

Appearance of bone: normal and abnormal

A

NORMAL: tan, milky, white in color; shiny

NECROTIC: dark brown, soften, appear moth-eaten
–> must be debrided if necrotic

-covered with periosteum when healthy

74
Q

Appearance of adipose tissue: normal and abnormal

A

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

75
Q

Classification of skin loss:

A

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

76
Q

Staging of pressure injuries:

A

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

77
Q

What is a deep tissue pressure injury?

A

-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

78
Q
A

MED CON III (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions