Chapter 10 Tissue Healing and Wound Care Flashcards

Question

What is the largest organ of the body?

Answer 1

Provides protection and sensation, regulates fluid balance and temperature, produces vitamins and immune system components

Answer 2

Outer region - epidermis Pigment melanin Hair, nails, sebaceous glands, sweat glands Outer surface = dead epithelial cells replaced every 3-4 weeks by new cells pushed up from dermis

Answer 3

Dermis – largest portion of the skin, provides strength and structure Blood vessels, nerve endings, hair follicles, sebaceous glands and sweat glands Is beneath the epidermis Composed of dense, irregular connective tissue – characterized by a loose, multidirectional arrangement of collagen fibers Fiber arrangement = enables resistance to multidirectional loads Also forms fascia – fibrous sheets of connective tissue that surround muscles Dense, irregular connective tissue covers internal structures

Answer 4

innermost layer of skin Provides cushioning between the skin layers, muscles and bones Regulates body temperature – insulating properties

Answer 5

elasticity

Answer 6

type of collagen known as reticulin, thinner, support internal structures

Answer 7

Tendons connect muscles to bones Composed of dense, regular connective tissue that consists of tightly packed bundles of unidirectional collagen fibers Collagen fibers are arranged in a parallel pattern, enabling resistance to high, unidirectional tensile loads when the attached muscle contracts Tendons twice as strong as muscles

Answer 8

structures formed by dense, regular connective tissue Strong, flat, sheetlike tissues that attach muscles to other muscles or bones

Answer 9

highly organized structure that can Be stretched/increase in length (extensibility) Return to normal length after lengthening or shortening takes place (elasticity) Respond to a stimulus (irritability) Develop tension Endomysium – surrounds each muscle cell/fiber

Answer 10

membrane that encloses a joint Hold bones firmly in place Outer portion – fibrous and composed primarily of collagen Inner lining – synovial membrane which secretes a clear, slightly yellow liquid called synovial fluid that provides lubrication inside the articular capsule at synovial joints

Answer 11

Ligaments connect bone to bone – composed of dense, regular connective tissue that consists of tightly packed bundles of unidirectional collagen fibers Parallel collagen fibers interwoven Provide resistance to large tensile loads along the long axis of the ligament but also providing resistance to smaller tensile loads from other directions More elastin than tendons

Answer 12

Membranous sacs that contain small amounts of synovial fluids and serve to reduce friction Locations – tissues where friction develops 🡪 area between tendons and bones, tendons and skin and ligaments and bones

Answer 13

Held together by fibrous tissue Amount of movement depends on the length of the fibers uniting the bones Can absorb shock, permits little or no movement of the articulating bones Sutures – seen only in the skull, involved irregular grooves, articulating bone sheets tightly bound by fibers that are continuous with the periosteum Syndesmoses – joints joined by fibrous tissue that permit extremely limited range of motion Can be ligament or a fibrous membrane Gomphosis joint – found between tooth and the bone in its socket

Answer 14

Unite bones by either hyaline cartilage or fibrocartilage Sternocostal joints, epiphyseal plates – articulating bones are held together by a thin layer of hyaline cartilage Secondary cartilaginous – articular surfaces of the bones are covered with hyaline cartilage, is fused to an inventing pad, or plate of fibrous tissue or fibrocartilage Strong, slightly movable joints designed for strength and shock absorption Pubic symphysis, intervertebral joints, manubriosternal

Answer 15

Most common and most important Provide free movement between articulating bone surfaces Diarthrodial joints – according to their shape Plane – articulating surfaces are nearly flat (intermetatarsal, intercarpal, facet joints) Hinge – one bone surface is concave, one is convex (permit flexion/extension) Pivot – rounded or conical end of one bone rotates within a sleeve or ring composed of bone (atlantoaxial joint, radioulnar joint) Condyloid – oval articular surface of one bone fits into a reciprocal concavity of another (wrist joint) Saddle – biaxial joints, allowing greater freedom of movement Ball and socket – spherical head of one bone articulates with the socket of another

Answer 16

Articular cartilage – glassy-smooth hyaline cartilage covers the ends of the bony surfaces, absorb compression placed on the joint protecting bone ends from being crushed No nerves or blood vessels, nourished by synovial fluid Joint cavity – unique to synovial fluid, the joint cavity is filled with synovial fluid Articular capsule – joint cavity is enclosed by a double-layered capsule External layer – tough, flexible, fibrous capsule that is continuous with periosteum of the articular bones Inner layer – synovial membrane composed of loose connective tissue, which covers all internal joint surfaces that are not hyaline cartilage Synovial membrane produces synovial fluid that lubricates the joint Synovial fluid – viscous, egg white consistency because of hyaluronic acid secreted by cells in the synovial membrane, occupies free spaces within joint capsule Thins and becomes less viscous as it warms during activity Reinforcing ligaments – synovial joints are reinforced by a number of ligaments

Answer 17

shear when the skin is scraped with sufficient force in one direction against a rough surface Greater force applied – more layers of skin are scraped away

Answer 18

repeated application of shear in one or more directions, formation of between epidermis and dermis as fluid migrates the site of injury

Answer 19

resulting from compression sustained during a blow, damage to underlying capillaries causes the accumulation of blood within the skin

Answer 20

breaks in the skin resulting from injury Incision – clean cut produced by the application of a tensile force to the skin as it is stretched along a sharp edge Laceration – irregular tear in the skin that typically results from a combination of tension and shear Avulsion – severe laceration that results in complete separation of the skin from the underlying tissue Puncture – results when a sharp, cylindrical object penetrates the skin and underlying tissues with tensile loading

Answer 21

result from a direct compressive force sustained from a heavy external blow Ecchymosis – present if the hemorrhage is superficial Blood and lymph flow into the damaged area in a diffuse or circumscribed manner, swelling occurs, which can compress muscle fibers causing pain and loss of motion Rectus femoris, vastus intermedius Complications = acute compartment syndrome, active bleeding, large hematomas First-degree: little or no restriction in ROM Second-degree: noticeable reduction in ROM Third-degree: fascia may be ruptured, swollen muscle tissue protruding

Answer 22

stretch induced caused by sudden forced lengthening over the viscoelastic limits of muscles during powerful contractions Greater CSA muscles 🡪 greater strength 🡪 produce more force and translate that force to the attached tendon Tendons stronger than muscle = musculotendinous unit almost always ruptures first (muscle CSA is smallest here) First-degree: micro tearing of the collagen fibers anywhere along the muscle/tendon/bone junction, local tenderness, no observable symptoms, no loss of function Second-degree: muscle tears greater than muscle fascicle/bundles, moderate pain, muscle weakness, loss of function Third-degree: major loss of tissue continuity, significant loss of function/movement

Answer 23

fatigue muscles absorb less energy in early stages of stretch as compared to non-fatigued muscle, increased stiffness

Answer 24

during activity, aching, firmness, dull ache to stabbing ache that increases with activity

Answer 25

several hours after unaccustomed eccentric contractions, acute inflammatory pain with stiff, weak muscles and pain at rest, usually resolves within a week

Answer 26

painful, involuntary contraction (alternating contraction/ relaxation or continued contraction) Biomechanical imbalance, muscle fatigue

Answer 27

involuntary contraction of short duration caused by a reflex action that can be biomechanically derived or initiated by a mechanical blow to a nerve/muscle

Answer 28

inflammation of a muscle’s connective tissues and inflammation of the sheaths of fascia surrounding portions of muscle, repeated body movements

Answer 29

tendon pathology, pain and swelling with tendon movement Tendinitis – lack a direct inflammatory response Tendinosis – degenerative changes result

Answer 30

inflammation of the synovial sheath surrounding a tenon and is common in hands/feet Acute – crepitus with movement, inflammation, local swelling Chronic – nodule formation in sheath

Answer 31

inflammation of peritendinous layer of thick tissue surrounding tendon

Answer 32

Long-term tendinopathy 🡪 mineral deposits 🡪 ectopic calcification

Answer 33

Accumulation of mineral deposits in muscle 🡪 myositis ossificans, in tendons = calcific tendinopathy

Answer 34

Stage 1 – pain after activity only Stage 2 – pain during activity that does not restrict performance Stage 3 – pain during activity that restricts performance Stage 4 – chronic, unremitting pain even at rest

Answer 35

Sprains – acute traumatic injury to ligaments, high tensile forces produce a stretching or tearing of tissues that compromise the ability of the ligament to stabilize the joint Tissue tearing 🡪 flow of blood and lymph to damaged area, producing swelling, increasing ROM First-degree – microtearing of collagen fibers, mild discomfort, mild point tenderness, minimal to no swelling/loss of function Second-degree – tearing of nearly half the ligament fibers, moderate loss of function, detectable joint stability, moderate pain/swelling/ecchymosis Third-degree – major loss of tissue continuity, significant loss of function, severe instability, severe pain

Answer 36

traumatic injury that occurs when the bones that comprise a joint are forced beyond their normal position, displacement of one joint surface on another Incomplete dislocation = subluxation Extensive stretching of connective tissue 🡪 susceptible to chronic dislocations

Answer 37

arthritis attributed to the degeneration of the articular cartilage in a joint, no cause but factors predispose

Answer 38

irritation of one or more bursae, acute or chronic Swelling pronounced, point tender, warm to touch

Answer 39

Days 0-6 Redness, heat, swelling, pain, loss of function Acute – brief duration, hemodynamic activity that generates exudate (plasma-like fluid that exudes out of tissue or its capillaries, composed of protein and granular leukocytes aka WBC) Chronic – prolonged duration, presence of nongranular leukocytes and the production of scar tissue Three mechanisms: Local vasoconstriction – few seconds to 10 minutes, reduction of blood volume Platelet reaction – provokes clotting as individual cells irreversibly combine with each other and with fibrin to form a mechanical plug that occludes the wen of the ruptured blood vessel 🡪 protect from bacteria, produce mediators such as serotonin, adrenaline, noradrenaline and histamine Coagulation cascade – fibrinogen molecules converted into fibrin for clot formation Extrinsic pathway – activated by thromboplastin, released from damaged tissue Intrinsic pathway – inside blood vessels, enabled my interaction between platelets and the Hageman factor Following vasoconstriction 🡪 vasodilation by a local axon reflex Complement cascade – 20 proteins that normally circulate in the blood in the inactive form become active 🡪 attraction of neutrophils and macrophages to rid the injury of debris through phagocytosis Blood flows to injured area, cells are redistributed to periphery 🡪 adhere to endothelial lining 🡪 diapedesis Cells and basophils release histamine to promote vasodilation Increase BF to region causes swelling – blood from broken vessels, damaged tissues forms a hematoma + necrotic tissue = zone of primary injury 1 hour post-injury – swelling or edema occurs as vascular walls become more permeable, increased pressure within the vessels forces a plasma exudate out into interstitial tissues Returns to normal state after 20-30 mins Severe trauma 🡪 prolonged state

Answer 40

vasodilator, increases permeability

Answer 41

Increases vessel permeability, stimulates nerve endings to cause pain

Answer 42

Days 3-21 Involves repair and regeneration of injured tissue Development of new blood vessels, fibrous tissue formation, generation of new epithelial tissue and wound contraction Hematoma diminishes = growth of new tissue Skin 🡪 new skin tissue, soft tissue 🡪 scar tissue Fibroblasts produce a supportive network of types I and III collagen Type III collagen – rapidly form cross-links that contribute to stabilization at the wound site New vessel formation Platelet response and hypoxic wound environment stimulates angiogenesis Epithelial cells migrate from the periphery toward the center of the wound to enact reepithelialization

Answer 43

Up to 1+ year Fibroblasts activity decreases and habitual loading produces increased organization of the extracellular matrix A return to normal histochemical activity allows for reduced vascularity and water content Types I and III collagen continue to proliferate, replacing immature collagen precursor and resulting in contracture of the wound Scar tissue formation results in decreased size and flexibility of the involved tissues Remodeling causes collagen fiber alignment along lines of habitual stress, with tensile strength increasing up to 2 years post-injury

Answer 44

Attract cells to the wound, stimulate proliferation and direct the deposition of the extracellular matrix

Answer 45

first two stages of healing Activates macrophages, stimulates fibroblasts to secrete types I and III collagen

Answer 46

stimulates angiogenesis, accelerates collagen deposition

Answer 47

facilitate development of granulation tissue, regulate angiogenesis, promotes epidermal regrowth

Answer 48

Wash hands Apply gloves Apply direct pressure to the wound with sterile gauze or a non-stick material Cleanse the wound and the area around the wound (at least twice the size of the wound) with normal saline or potable tap water Dress and bandage the wound site securely for continued activity Creams and ointments may or may not be used with occlusive dressings Change dressings as necessary and look for signs of infection Maintain a moist wound environment for optimal healing

Answer 49

Latex gloves and other protective equipment should be worn Exposure to infectious materials – wash and disinfect hands immediately Large spills – disinfect prior to removal or spill and after Disinfect all horizontal surfaces, scrub Disinfect with cleaning solution 1:10 to 1:100 solution (bleach to water) Washed with detergent and water for 25 minutes at a minimum of 71 degrees C or 160F

Answer 50

Apply crushed ice packs for 30 mins directly to the skin Elevate body part above level of the heart (10-12 in) Remove ice, apply compression, continue elevation Reapply crushed ice every 2 hours Wear compression wrap throughout the night?

Answer 51

Calcium carbonate, calcium phosphate, collagen and water Minerals make up 60-70% bone weight – provide stiffness and strength in resisting compression Collagen – degree of flexibility and strength in resisting tension Epiphyseal plates – cartilaginous disks near the ends of long bones Longitudinal bone growth takes place on the diaphysis side of the plates, during adolescence the plate disappears and the bone fuses Bones continue to grow in diameter throughout most of a person’s lifespan Internal layer of periosteum builds new, concentric layers of bone tissue on top of existing ones Form new bone tissue = osteoblasts Resorb bone = osteoclasts Bone tissue = cortical or cancellous Cortical = stiffer, greater stress but less strain Cancellous = spongier, more strain before injury

Answer 52

Simple – bone breaks cleanly but ends do not break the skin Compound (open) – bone ends penetrate through soft tissue and skin Depressed – occurs more frequently on flat bones when the broken portion is driven inward Transverse – break occurs in a straight line across the bone Comminuted – bone fragments into several pieces Oblique – break occurs diagonally when torsion occurs on one end while the other is fixed Epiphyseal – separation involves epiphysis of the bone Spiral – jagged bone ends are S-shaped when excessive torsion is applied to a fixed bone Greenstick – bone breaks incompletely Avulsion – bone fragment is pulled off by an attached tendon or ligament Impacted – bone is impacted or driven into another piece of bone

Answer 53

Type I: A complete separation of the epiphysis from the metaphysis with no fracture to the bone Type II: A separation of the epiphysis and a small portion of the metaphysis Type III: a fracture of the epiphysis Type IV: a fracture of a part of the epiphysis and metaphysis Type V: a compression of the epiphysis without fracture, resulting in a compromised epiphyseal function

Answer 54

disruption of blood supply to epiphysis, associated tissue necrosis and deformation of epiphysis

Answer 55

Acute inflammatory phase = 4 days – vasodilation, edema formation, histochemical changes Repair and regeneration – osteoclasts resorb damaged bone tissues and osteoblasts build new bones Fractured ends – callus formed – weak immature bone tissue that strengthens with time Maturation and remodeling – osteoblast activity on concave side of fracture, osteoclast on convex side

Answer 56

Posterior branches of spinal nerves – afferent (sensory) nerves that transmit information from sensory receptors in the skin, tendons, ligaments and muscles to CNS Anterior branches of spinal nerves – efferent (motor) nerves that transmit control signals to the muscles Heavily vascularized, encased in myelin sheath – protects and insulates fibers, increases speed of transmission

Answer 57

Tensile or compressive forces Tensile – occur during severe, high-speed accidents Nerve roots on SC not protected by connective tissue – susceptible to tensile injury Tensile injuries Grade I – Neurapraxia, localized conduction block that causes temporary loss of sensation and/or motor function from selective demyelination of the axon sheath without true axonal disruption, recovery within days to weeks Grade II – axonotmesis, produce significant motor and mild sensory deficits that last at least 2 weeks, disrupts axon and myelin sheath Grade III – neurotmesis, motor and sensory deficits persist up to 1 year, surgical intervention

Answer 58

Hypoesthesia – reduction in sensation Paresthesia – numbing, tingling or prickling Neuralgia – chronic pain along nerve’s course Nerve healing – completely severed = healing doesn’t occur Surgically repaired and random regrowth of nerve – neuroma

Answer 59

Mild: Ice, electrical stimulation, US, NSAID, protective padding or bracing Moderate to severe: neural flossing, correct posture, strengthen

Answer 60

originates in the skin, MSK system

Answer 61

diffuse or referred pain from organs

Answer 62

no physical cause but pain felt

Answer 63

pain sensation

Answer 64

pain initiated by mechanosensitive receptors

Answer 65

pain persists because of activation of chemo sensitive nociceptors

Answer 66

small, slow transmission, unmyelinated, dull

Answer 67

larger, faster thinly myelinated

Answer 68

block neural receptors that transmit pain