Exam 1 content Flashcards
What are the two layers of the skin
Epidermis - Avascular superficial area we see
Dermis - vascular deep layer
What are the 5 functions of the skin
Protection Sensation Fluid maintenance Immunity Thermoregulation
What are the 5 layers of the Epidermis from deep to superficial and what is significant about each layer
Stratum Basale - where skin cells are born
Stratum Spinosum - thickest layer, protects against shear forces and friction
Stratum Granulosum - prevents water loss with lipids
Stratum Lucidum - thick environmental protection
Stratum Corneum - old dead cells on the periphery
What is the significance of Melanocytes and where are they located
Give skin pigment
Located between Basale and spinosum
Describe the dermis
Vasculature near basement membrane
Binds epidermis to subcutaneous tissue
Contains Encapsulated nerves
What do Meissner’s and Pacinian corpuscles do and where are they located
Meissner’s - light touch
Pacinian - Deep pressure and vibration
Both are located in the Dermis
Describe Erosion
Epidermal skin loss only
Redness, minimal to no bleeding
Ex. first degree burns
Describe Partial thickness wounds
Loss of epidermis and dermis
Bleeding
Ex. 2nd degree burns, skin tears
Describe full thickness wounds
Loss of epidermis, dermis and hypodermis
Exposure of bone, ligaments, ,muscle
Surgical incisions, wounds
What are the 4 stages of the healing response
Hemostasis
inflammation
Proliferation
Remodeling
Describe Hemostasis
less than 1 hour
Clot formation
Inflammation and edema
Describe Inflammation
1hr - 4 days
Vasodilation, angiogenesis, autolytic debridement
Increased body temp, rubor, tumor, dolor, calor
Describe proliferation
4-12 days
collagen synthesis, granulation tissue formation
Beefy red granulation tissue, re-epithelialization after granulation
Describe Remodeling
Wound closure
Increased tensile strength
Collagen replacement
Blanching
How strong are wounds after they heal
80% pre injury strength
What is recidivism
re-tear of a wound due to a decrease in original tensile strength
Describe Primary wound response
Minimal loss of tissue and good approximation
Rapid healing
No scab
Resolves in 2 weeks
Describe secondary wound response
Usual wound healing for non-surgical wounds
Describe Tertiar wound response
Delayed primary healing Debris or pathogens in the wound Granulation occurs Inflammatory response Closed surgically once deemed free of pathogens
What makes up the extracellular matrix
Collagen
Elastin
Proteoglycans
Adhesive Glycoproteins
What is the most common type of chronic wounds
Venous insufficiency ulcers
What causes chronic wounds and how long do they take to heal
Foreign debris
Pathogen
Disease
Months to years to close
What are some impeding factors to wound healing
Infection Medications Comorbidities Cancer / radiation Autoimmune disorders Stress Modifiable factors
What is the normal value and consequence of increased and decreased levels of WBC
N - 4.5 - 11
In - wound fails to progress
Dec - decreased immune response
What is the normal value and consequence of increased and decreased levels of hemoglobin
Normal - 12-18
In - wound fails to progress
Dec - wound fails to progress / pale appearance
What is the normal value and consequence of increased and decreased levels of Hematocrit
N - 36-50%
In - sign of thrombi / emboli
Dec - wound fails to progress / pale
What is the normal value and consequence of increased and decreased levels of Prothrombin
N - 2.5 seconds
In - bleeds easily
Dec - increased clotting
What is the normal value and consequence of increased and decreased levels of HbA1C
N - <5.7
In - delayed wound healing
What is the normal value and consequence of increased and decreased levels of Glucose
Normal < 100mg/dl
In - delayed wound healing
What do Red, Yellow and Black wounds mean
Red - Clean, healing, granulating
Yellow - Possible infection, need to be cleaned, possible necrotic tissue
Black - Is necrotic and needs healing
What are the Wagner ulcer grades
0 - Pre-ulcerative lesions 1 - Superficial ulcer 2 - may expose underlying tissue 3 - Infection of the bone 4 - Gangrene of digit 5 - gangrene of entire foot
Describe tunneling
Between two wounds
May be tunnel with no exit
Describe eschar
Nonviable Necrotic tissue
Black or brown in appearance
Varies in texture
Describe Slough
Non-viable subcutaneous tissue
Result of autolytic debridement
Soft and yellow
What is granulation tissue comprised of
Capillaries and ECM
Describe hyper granulation tissue
Abnormal healing
unable to heal as edges are not able to approximate due to excess granulation
Describe the terms for amount of drainage
Scant - Small remnant of drainage Minimal - 25% dressing covered Moderate - 50% dressing covered Heavy - 100% covered Copious - Multiple layers covered Strike through - drainage visible through last layer
Describe the terms for types of drainage
Serous - clear Sanguineous - bloody Serosanguinous - pinkish Purulent - thick pus, may have smell, yellow Infected - Malodorous
What is ecchymosis
Bruising
What are the various types of odors
Pseudomonas - sweet odor, corn tortilla
Malignancy - various odors
Wet gangrene - foul odor
What is PAD
Peripheral arterial disease
Arterial insufficiency
Slowing of blood flow
What is claudication
Heavy legs
Cramping pain during exertion that dissipates at rest
What are the first three Arterial wound risk factors
Arterio / atherosclerosis
Smoking
Obesity
What are the second three Arterial wound risk factors
DM
HTN
Hypercholesterolemia
What are the final two Arterial wound risk factors
Family history
Nutrition
What are some non invasive screening tools for arterial insufficiency
ABI
Angiography
CT
Rubor of dependency test
Describe the ABI
Ratio of ankle systolic pressure to brachial systolic pressure
Describe ABI interpretation and implications
< .49 - Severe occlusion - (Compression contraindicated)
.5 - .79 - Moderate Occlusion (Compression no greater than 23-30)
.8 - .9 - Mild occlusion (Compression no greater than 30-40)
.91 - .99 - Borderline occlusion
1 - 1.4 - Normal
> 1.4 - abnormal
Describe the rubor of dependency test
Elevate limbs to 30 off table in supine
Sit patient up with legs dangling
Abnormal - Bright red
- Dilation of arteries attempting to repurfuse the extremity
Describe the characteristics of an arterial insufficiency wound
Round small with smooth borders Looks like hole punch Pink periwound Hair loss Muscle atrophy
How do you treat Arterial insufficiency wounds
PRAFO boots
Heel cushions
Pressure relief
Clean / sterile bandaging
What are some surgical options for arterial insufficiency wounds
Revascularization surgery
Endovascular interventions
Surgical debridement
Describe some factors of normal Venous flow
Valves prevent retrograde flow
Skeletal muscle pump helps to return blood to the heart
Describe the presentation of venous insufficiency wounds
Above the malleolus insidious onset Uneven edges, shallow little eschar Moderate to copious serous, purulent drainage Minimal pain
How do you treat a venous insufficiency wound
Compression
but not when there is extreme arterial insufficiency or heart failure
Describe the 4 layers of compression wrapping
1 - soft for body protection
2 - elastic layer
3 - long stretch layer
4 - self adhering bandage
How often is a compression wrap to be changed
Every 3-7 days
What populations experience pressure injuries the most
SCI
Acute pediatric
Cardiovascular
Neonatal
What is the cost of managing a full thickness pressure ulcer
70,000
What are the proposed pathophysiology’s associated with pressure injuries
Ischemia
Impaired lymphatic flow
Impaired reperfusion
Deformation of tissue
Describe the timeline of pressure injuries
30 mins - local hyperemia
2-6 hours - ischemia
6 hours - necrosis
2 weeks - Ulceration
Describe the stage classification system of pressure injuries
1 - nonblanchable erythema of skin
2 - partial thickness loss with exposed dermis
3 - full thickness loss, fat may be visible, necrotic tissue means automatic classification
4 - exposure of deep structures
Unstageable - obscured full thickness loss, covered with slough or eschar
Describe a deep tissue injury
Nonblanchable deep red, maroon or purple discoloration
What are some risk factors for pressure injuries
Immobility
Inactivity
Sensory loss
Shear / friction force
What are some interventions for pressure injuries
PRAFO’s
Pressure redistribution support surfaces
Care for moisture prone areas
Describe the Braden scale
Sunscales of sense, moisture, activity, mobility, nutiotion, friction and shear
Low scores are bad
Describe the Norton scale
> 17/20 = low risk
What are the advantages of debridement
Removal of dead, damaged or devitalized tissue
Encourages wound healing process
reduces chronic inflammation by removing necrotic tissue
Promotes keratinocyte growth
What are the first 3 contraindications to debridement
ABI of .4or lower
Dry gangrenous wounds
Elevated temperature
What are the second 3 contraindications to debridement
Cellulitis
Wound failure to progress
Visible exposure of bone tendon or prosthetic device
What are the last 2 contraindications to debridement
Extreme abscesses or extreme undermining
Stable eschar in arterial insufficiency or diabetes
Describe the types of debridement
Biological agents - maggots Autolytic - natural healing Enzymatic - chemicals Mechanical - outside force Sharp - scalpels
Describe autolytic debridement
Cleansing
More rapid
Slow
Describe enzymatic breeding
Apply enzyme 1-2 times per day
Selective
Costly
Describe mechanical debridement
Ultrasound is an example
Decreased bacteria
Painful, nonselective
Describe Sharp debridement
Most rapid form
selective and speeds
Painful
How do you treat excess bleeding
Pressure for 5 - 10 minutes
Elevation
Topical agents
Define desiccation
Dry
Describe an Unna boot
Compression dressing
