Chapter 41 - Disorders Of Integument Flashcards
Pressure ulcers are from
Unrelieved pressure, shearing forces, friction and moisture
Decubitus ulcers
When pressure interrupts normal blood flow to skin and underlying tissues
Risks for ulcer formation
-immobilization
-prolonged moisture exposure
-neurological disorder (spinal cord)
-malnutrition or dehydration
Prolonged pressure =
Tissue reddens and will return to normal with repositioning or stimulation
If pressure continues and blocks blood flow =
Hypoxia = shearing or friction and detachment of tissues = inc risk of necrosis
Stage 1 pressure ulcer
Skin unbroken but inflamed, can still prevent ulcerations with repositioning
Stage 2 pressure ulcer
Skin breaks open or wears away, site is tender and painful, epidermis and dermis are involved
Stage 3 pressure ulcer
Below dermis, fat tissue involved
Stage 4 pressure ulcer
Muscle bone ligaments or tendons visible
TX for pressure ulcer
-early detection and prevention
-frequent assessment, repositioning, promoting independent movement
-special beds to prevent friction and eliminate moisture
-nutrition and hydration
First degree burn
No TX needed
-some minor nausea and vomiting
-heals within 3-5 days, no scarring
Who is vulnerable to a first degree burn
Young and old, experiencing dehydration
Second degree burn: superficial partial thickness
Fluid filled blisters, that develop within minutes of injury
-pain sensors remain intact
-wound heals 3-4 weeks, scarring is unusual
Second degree burn: deep partial thickness
Waxy white look that takes weeks to heal
-necrotic tissue may be present and will need to be surgically removed
-graph of own skin required
-hypertrophic scarring (thick and raised)
Third degree burn
Full thickness causing a dry leathery appearance
-loss of derma elasticity
-required escharotomy
-Eschar
-all nerve endings destroyed
escharotomy
Cutting through burned skin to release pressure and prevent compartment syndrome
Eschar
Dead tissue that forms over healthy skin
Fourth degree burn
Requires skin grafting or reconstructive surgery
-surgery requires rule of 9’s f
Which burns are considered medical emergencies?
Three and four
Burn rule of 9’s
Used to estimate percentage of body burned
-all the parts of the body are 9%, except for groin area which is 1%
Burn shock phase
Combination of CV hypovelmia and cellular hypovolemia causes massive fluid loss and increased capillary permeability so fluid shifts to interstitial spaces
Result of burn shock phase
Decreased blood volume, decreased cardiac output
Integumentary and pulmonary damage will result in (burn shock phase)
Loss of ability to regulate water evaporation = loss of several litres of fluid due to evaporation each day
Ebb phase
Blood is shunted away from liver, kidney and gut in the first 24 hours
-after that, there begins resortation of capillary integrity, and edema begins to resolve (end of burn shock phase)
Flow phase
State of hyper metabolic response = inc catchecholamines, cortisol, glucagon
-hyperglycaemia with inc insulin resistance and muscle loss
-can last up to two years
Goal of TX for burns
Fluid resuscitation and nutrition
The first ___ hours in a burn injury is critical
24
TX for burns
-IV to restore fluids (monitor to prevent fluid overload)
-parkland formula
-ringers lactate
Parkland formula
4mL of ringers lactate per kilogram of body weight per %TBA burned
-one half to be given during first 8 hours after injury and rest in next 16 hours = volume required in 24 hour period
Ringers lactate
IV fluid for dehydration, having surgery or reciting IV medications
Frostnip
Superficial frostbite, pain inc during tissue rewarding
Chillblains
Partial thickness frostbite
-purple tone
-can develop vasculitis (inflammation of bv)
Frostbite
Tissues freeze
-ice crystals form
-whiteness of tissue
-numbness with no pain
-potentially reversible
Flash freeze
Rapid formation of ice crystals, associated with contact with cold metals or volatile liquids
