Ch-41 Disorders of the Integument Flashcards
What is decubitus ulcers?
when pressure interrupts NORMAL BLOOD FLOW to skin and underlying tissues
Pressure ulcers from ____ (1) pressure, shearing forces, friction and ____ (2).
(1) unrelieved; (2) moisture
What are the risks for pressure ulcers? (5pts)
immobilization, prolonged moisture exposure, neurological disorders (spinal cord injuries), malnutrition, dehydration.
What are the 4 stages of Pressure Ulcers?
Stage 1: skin unbroken but inflamed
Stage 2: skin breaks open; site tender and painful; epidermis and dermis involved
Stage 3: below dermis fat tissue involved
Stage 4: MUSCLE, BONE, ligaments or tendons visible.
Pathophysiology of PU:
Prolonged pressure = tissue ____/ (1) will return to normal with repositioning or stimulation
Pressure continues = blocked blood flow = ____ (2) = shearing or friction = detachment of tissues = if continued ___ (3) will occur.
(1) reddens; (2) hypoxia; (3) necrosis
Tx for pressure ulcers? (4 pts)
- early detection and prevention
- fq. assessment of skin, repositioning, adequate skin care, promoting independent movement
- special beds prevent friction and eliminate excess moisture
- adequate nutrition, hydration
What is the tx required for First degree brun? What are some symptoms?
no tx required; may have nausea and vomiting
Who are the vulnerable groups for first degree burn? How long is the healing time for first degree burns?
- young and old experiencing dehydration
- Heals within 3-5 days – no scarring
What are the two types of 2nd degree burn?
Superficial partial thickness & Deep partial thickness
What is superficial partial thickness?
- fluid filled blisters – develop within minutes of injury
How long does superficial partial thickness heals? Is there scarring formation?
heals within 3-4 weeks; scarring is unusual
T or F: In superficial partial thickness, pain sensors are lost.
FALSE; Pain sensors remain intact.
What is the tx for deep partial thickness? Is there scarring formation?
tx: Graph of own skin required
Hypertrophic scarring occurs – thick raised scar
What is deep partial thickness?
- waxy white look that takes weeks to heal.
- necrotic tissue may be present —- need to be surgically removed
What are some characteristics of 3rd degree burn?
- full thickness/ dry leathery appearance
- loss of dermal elasticity
- all nerve endings have been destroyed
What is the tx for 3rd degree burn
- requires escharotomy
What is escharotomy?
cutting through burned skin to release pressure and prevent compartment syndrome
What is eschar?
dead tissue that forms over healthy skin
What are the 2 types of degree burns that are considered medical emergencies?
3rd and 4th degree burns
What does 4th degree burn requires?
skin grafting & reconstructive surgery
Surgery requires “____ __ __s” for estimation of total body surface.
Rule of 9
What are the Burns Rule of 9s?
- used to estimate percentage of body burned.
What is the % of the groin area in Burns of Rule of 9s?
1%
What are the 3 burn phases?
- Burn shock phase
- Ebb phase
- Flow phase
During burn shock phase, combination of ___ (1) hypovolemia & ____ (2) hypovolemia = massive fluid losses/ increased capillary permeability, thus fluid shift to interstitial spaces
Result: ____(3) blood volume/ ____ (4) cardiac output
Integumentary and pulmonary damage will result in loss of ability to regulate water evaporation = loss of several liters of fluid due to _____ (5) each day.
- CV
- Cellular
- Decreased
- Decreased
- Evaporation
During ebb phase, the blood shunted away from ___(1), ____(2) & ____ (3) in first ____ (4) hours.
After 24 hours, restoration begins of capillary integrity, edema begins to resolve, ____ ____ (5) phase ends.
- liver
- kidneys
- Gut
- 24
- burn shock
During flow phase, the state of HYPERmetabolic response = increased _____ (1), _____ (2) & _____(3).
Hyperglycemia also occurs with increased _____ (4) resistance and muscle loss.
This phase can last up to ___(5) years.
- catecholamines
- cortisol
- glucagon
- insulin
- two
What is the goal of burns tx?
fluid restoration and nutrition
The first ___ hours is critical for burns
24
What is required to restore fluids for burns? And what is used to monitor to prevent fluid overload?
IV required to restore fluids
Parkland formula – prevent fluid overload
Parkland formular requires __mL(1) of ____’s ____ (2) per kg of body weight per %TBSA burned. 1/2 to be given during the first __ (3) hours after injury and the rest in next ___ (4) hours = vol required in a 24-hour period.
- 4mL
- Ringer’s Lactate
- 8 hours
- 16 hours
What is a ringer’s lactate?
IV fluid for dehydration, having surgery or receiving IV meds
What are the 4 types of cold injury?
- Frostnip
- Chilblains
- Frostbite
- Flash freeze
What is frostnip?
superficial frostbite, pain increases during tissue rewarming
What is chilblains?
partial thickness frostbite; purple tone; can develop chronic vasculitis (inflammation of blood vessel.
What is frostbite?
tissue freeze; ice crystals form; whiteness of tissue; numbness with no sensation of pain; potentially irreversible.
What is flash freeze?
rapid formation of ice crystals; associated with contact with cold metals or volatile liquids
