CHAPTER 1 Flashcards
ATROPHY
DISUSE/DECREASE IN SIZE OF THE CELL
HYPERTROPHY
INCREASE IN SIZE OF CELLS
HYPERPLASIA
INCREASE NUMBER OF CELLS
HYPOPLASIA
DECREASE NUMBER OF CELLS
INVOLUTION
DECREASE NUMBER OF CELLS, BUT TO THE RETURN OF NORMAL SIZE (UTERUS AFTER PREGNANCY)
METAPLASIA
CHANGE IN CELLS (CANCER)
CLASSIFICIATION OF INFLAMMATION
ACUTE-1ST
SUBACUTE - 24-72 HRS AFTER
CHRONIC-WHEN PROCESS CONTINUES AFTER SHORT TIME (MONTHS, YEARS)
PHASES OF NORMAL WOUND HEALING
BLEEDING, INFLAMMATION, PROLIFERATION, MATURATION (REMODELING)
BLEEDING
BLOOD CLOT
INFLAMMATION
0-10 DAYS; IMMUNE SYSTEM REACTS TO INJURY; EDEMA, ERYTHEMA AND DRAINAGE CAN BE EXPECTED ; CAPILLARIES RELEASE HEALING BUILDING BLOCKS
PROLIFERATION
DAY 3 TO APPROX. DAY 20; NEW TISSUE FILLS IN THE WOUND (MYOFIBROBLASTS)
MATURATION (REMODELING)
DAY 9 UP TO 2 YEARS; REMODELING OF TISSUE
ARTERIAL WOUND
SITE-TOES, FOOT, ANKLE
EDGES-PUNCHED OUT & WELL DEFINED
APPEARANCE-COVERED W/SLOUGH & NECROTIC TISSUE
SIZE-SMALL
EXUDATE-LOW
PAIN-YES
CAN’T HEAL UNLESS BLOOD FLOW RETURNS; NO CAPILLARY REFILL TIME ON TOES OR NOT ABLE TO FEEL PULSE IN ANKLE
VENOUS WOUND
SITE-MEDIAL GAITER REGION EDGES-SLOPING & GRADUAL APPEARANCE-COVERED WITH SLOUGH SIZE-LARGE EXUDATE-HIGH PAIN-MINIMAL
LYMPHEDEMA
LYMPH SYSTEM PULLS FLUID OUT; AFTER CANCER SURGERY WHERE LYMPH NODES ARE REMOVED AND THUS THE EXTRA FLUID DOESN’T HAVE ANYWHERE ELSE TO GO
PRESSURE ULCER STAGE 1
NON BLANCHABLE ERYTHEMA; PROPER POSITIONING & TURNING CAN REPAIR; CAUSED BY LACK OF MOBILITY & MOISTURE (URINE/FECES)
PRESSURE ULCER STAGE 2
PARTIAL THICKNESS LOSS OF DERMIS PRESENTING AS A SHALLOW CRATER OR FLUID FILLED BLISTER
PRESSURE ULCER STAGE 3
FULL THICKNESS TISSUE LOSS. BONE, TENDON OR MUSCLE NOT EXPOSED (ONLY FAT LAYER)
PRESSURE ULCER STAGE 4
FULL THICKNESS TISSUE LOSS WITH EXPOSED BONE, TENDON OR MUSCLE; WILL DIE SOON; NOT MUCH YOU CAN DO
UNSTAGEABLE PRESSURE ULCER
DEPTH OF ULCER IS OBSCURED BY SLOUGH OR ESCHAR
SUSPECTED DEEP TISSUE INJURY
DTI; PURPLE OR MAROON LOCALIZED AREA OF DISCOLORED INTACT SKIN OR BLOOD FILLED BLISTER DUE TO DAMAGE OF UNDERLYING TISSUE; CAN HAPPEN BEFORE IT’S OPENED UP; CAUSE LOSS OF BLOOD FLOW WHICH CAUSES TISSUE TO DIE UNDER SKIN; LET HEAL ON IT’S OWN; DON’T OPEN IT UP; CAN BE PAINFUL
NEUROPATHIC WOUNDS
ULCERATION IS USUALLY ON WEIGHT-BEARING SURFACES OF THE FOOT, ANESTHETIC, ROUND, OVER BONY PROMINENCES. BONES DISSOLVE; WALK ON SOMETHING (LIKE A NEEDLE) & DON’T KNOW IT.
COMPLICATIONS TO DELAY HEALING
CHRONIC INFLAMMATION (INFECTION); COMPROMISED IMMUNE SYSTEM; CIRCULATORY CONDITIONS (TOO MUCH H2O OUTSIDE CAUSES OSMOSIS); REINJURY; SMOKING; LOW IRON COUNT, LOCATION OF THE WOUND; INFECTIONS, AGE, NUTRITIONAL STATUS, MEDICATIONS, INTERFERENCE BY PATIENT, TEMPERATURE
HEALING BY 1ST INTENTION
FROM BED OF WOUND UP; HEALS INSIDE TO OUTSIDE; CLEAR/CLEAN MARGINS
HEALING BY 2ND INTENTION
SIDES INTO MIDDLE (LARGER WOUND); HAS A LOSS OF SKIN OR LOSS OF TISSUE (INCLUDES VENOUS STASIS ULCERS & PRESSURE ULCERS); TAKES LONGER
AUTOLYTIC
DRESSING ON WOUND & ENCOURAGE BODY TO CLEAR IT OUT (NATURAL PROCESS)
CHEMICAL/ENZYMATIC
CREAMS TO HELP CLEAN IT OUT
BIOSURGERY
MEDICAL MAGGOTS IN GAUZE TO CLEAN IT OUT-THEY ONLY EAT DEAD TISSUE
PTA & WOUND PATIENT
IDENTIFY WOUNDS, CHECK SKIN, NOTICE CHANGES (NOTIFY PT); PATIENT EDUCATION & PROBLEM SOLVING
3 GRADES OF LIGAMENT/TENDON STRAIN
GRADE 1-MICROTRAUMA LESS THAN 25%
GRADE 2-25-99%
GRADE 3-100% TEAR
PHASES OF HEALING -LIGAMENT/TENDON
INFLAMMATION-0-10 DAYS; BLOOD; SWELLING
PROLIFERATION;4-8 WEEKS; FIBROBLASTS CREATING DENSE IRREGULAR TISSUE
MATURATION; UP TO 1 YEAR; SHRINKS & BECOMES DENSE REGULAR TISSUE
PHASES IN BONE HEALING
INFLAMMATION-HEMATOMA FORMATION
PROLIFERATION-FIBROCARTILAGINOUS CALLUS FORMATION & BONY CALLUS FORMATION
MATURATION-BONY CALLUS FORMATION & BONE REMODELING
BONE HEALING INFO
- BONE HEALS THICKER (HARDER TO BREAK IN SAME PLACE
- 6 WEEKS TO HEAL IN HEALTHY PERSON
- BONY CALLUS FORMS ABOUT WEEK 4
- IF BONE EDGES ARE FURTHER APART OR IT’S NOT SPLINTED WELL OR NONUNION/MALUNION WILL DELAY HEALING & WILL TAKE LONGER THAN 6 WEEKS
BONE FRACTURES ARE DESCRIBED & CLASSIFIED ACCORDING TO:
TYPE; COMMUNICATION OR NONCOMMUNICATION WITH EXTERNAL ENVIRONMENT; ANATOMIC LOCATION
TYPES OF FRACTURES
AVULSION-MOST COMMON ACL
COMMINUTED-CRUSHED
GREENSTICK-MOSTLY IN CHILDREN (1/2 BEND & 1/2 BREAK)
IMPACTED-BONE CRUSHED INTO ITSELF (AKA BUCKLE FRACTURE)
INTERARTICULAR-INTO JOINT
LONGITUDINAL-ALONG DIAPHYSIS OF BONE
OBLIQUE-ANGLED
SPIRAL-SPIRAL UP SHAFT OF BONE
TRANSVERSE-FORCE, STRAIGHT ACROSS (PARTIAL FRACTURE)
STRESS FRACTURE-REPETITIVE STRESS (MICROTRAUMAS OVER TIME) MOST COMMON - CALCANEAL (BAREFOOT RUNNING)
CLASSIFICATION BY COMMUNICATION
OPEN FRACTURE: FROM WITHIN TO WITHOUT (BONE BREAKS SKIN) OR FROM WITHOUT TO WITHIN (KNIFE TO BONE)
CLOSED FRACTURE: NO SKIN BROKEN
FRACTURE DESCRIBED & CLASSIFIED ACCORDING TO:
APPEARANCE, POSITION & ALIGNMENT OF THE FRAGMENTS; CLASSIC NAMES; STABLE (ENDS NOT MOVING, INCOMPLETE, PERIOSTEUM INTACT) OR UNSTABLE (LOOSE, NEET TO BE CASTED, NON WEIGHT BEARING)
STABLE FRACTURES
OCCUR WHEN A PIECE OF THE PERIOSTEUM IS INTACT ACROSS THE FRACTURES; EXTERNAL OR INTERNAL FIXATION HAS RENDERED THE FRAGMENTS STATIONARY (COULD USE BOTH IF IT’S REALLY BAD)
UNSTABLE FRACTURES
GROSSLY DISPLACED; POOR FIXATION
CLINICAL MANIFESTATIONS OF A BROKEN BONE - WHAT ARE WE LOOKING FOR…
IMMEDIATE LOCALIZED PAIN; DECREASE FUNCTION; INABILITY TO BEAR WEIGHT OR USE AFFECTED PART; GUARDING (HOLDING CLOSE TO BODY); MAY OR MAY NOT SEE OBVIOUS BONE DEFORMITY
REPARATIVE PROCESS OF SELF-HEALING (UNION) OCCURS IN THE FOLLOWING STAGES:
- FRACTURE HEMATOMA (D/T BLEEDING, EDEMA)
- GRANULATION TISSUE-OSTEOID (3-14 DAYS POST INJURY
- CALLUS FORMATION (MINERALS DEPOSITED IN OSTEOID)
- OSSIFICATION (3 WKS-6 MTHS)
- CONSOLIDATION (DISTANCE BETWEEN FRAGMENTS DECREASES-CLOSES)
- REMODELING (UNION COMPLETED; REMODELS TO ORIGINAL SHAPE, STRENGTH)
CLOSED REDUCTION
NONSURGICAL, MANUAL REALIGNMENT (MORE SIMPLE FRACTURES)
OPEN REDUCTION
CORRECTION OF BONE ALIGNMENT THROUGH A SURGICAL INCISION (MORE CRAZY FRACTURES)
TRACTION
- APPLICATION OF PULLING FORCE TO ATTAIN REALIGNMENT (SKIN TRACTION 48-72 HRS; SKELETAL TRACTION LONGER PERIODS)
- APPLICATION OF A PULLING FORCE TO AN INJURED PART OF THE BODY WHILE COUNTERTRACTION PULLS IN THE OPP DIRECTION.
EXTERNAL FIXATION OF FRACTURE IMMOBILIZATION
METALLIC DEVICE COMPOSED OF PINS THAT ARE INSERTED INTO THE BONE AND ATTACHED TO EXTERNAL RODS
PROTECT FROM INFECTION-CLEANING AREA WHERE ROD TRAVELS OUT TO IN
INTERNAL FIXATION OF FRACTURE IMMOBILIZATION
- PINS, PLATES, INTRAMEDULLARY RODS & SCREWS
* SURGICALLY INSERTED AT THE TIME OF REALIGNMENT
PURPOSE OF TRACTION
PREVENT/REDUCE MUSCLE SPASM
IMMOBILIZATION
REDUCTION
TREAT A PATHOLOGIC CONDITION
