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TRI 4 - Integ > Exam 1 content > Flashcards

Exam 1 content Flashcards

1
Q

What are the two layers of the skin

A

Epidermis - Avascular superficial area we see

Dermis - vascular deep layer

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2
Q

What are the 5 functions of the skin

A 
Protection
Sensation
Fluid maintenance
Immunity
Thermoregulation
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3
Q

What are the 5 layers of the Epidermis from deep to superficial and what is significant about each layer

A

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

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4
Q

What is the significance of Melanocytes and where are they located

A

Give skin pigment

Located between Basale and spinosum

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5
Q

Describe the dermis

A

Vasculature near basement membrane
Binds epidermis to subcutaneous tissue
Contains Encapsulated nerves

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6
Q

What do Meissner’s and Pacinian corpuscles do and where are they located

A

Meissner’s - light touch
Pacinian - Deep pressure and vibration
Both are located in the Dermis

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7
Q

Describe Erosion

A

Epidermal skin loss only
Redness, minimal to no bleeding
Ex. first degree burns

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8
Q

Describe Partial thickness wounds

A

Loss of epidermis and dermis
Bleeding
Ex. 2nd degree burns, skin tears

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9
Q

Describe full thickness wounds

A

Loss of epidermis, dermis and hypodermis
Exposure of bone, ligaments, ,muscle
Surgical incisions, wounds

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10
Q

What are the 4 stages of the healing response

A

Hemostasis
inflammation
Proliferation
Remodeling

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11
Q

Describe Hemostasis

A

less than 1 hour
Clot formation
Inflammation and edema

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12
Q

Describe Inflammation

A

1hr - 4 days
Vasodilation, angiogenesis, autolytic debridement
Increased body temp, rubor, tumor, dolor, calor

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13
Q

Describe proliferation

A

4-12 days
collagen synthesis, granulation tissue formation
Beefy red granulation tissue, re-epithelialization after granulation

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14
Q

Describe Remodeling

A

Wound closure
Increased tensile strength
Collagen replacement
Blanching

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15
Q

How strong are wounds after they heal

A

80% pre injury strength

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16
Q

What is recidivism

A

re-tear of a wound due to a decrease in original tensile strength

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17
Q

Describe Primary wound response

A

Minimal loss of tissue and good approximation
Rapid healing
No scab
Resolves in 2 weeks

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18
Q

Describe secondary wound response

A

Usual wound healing for non-surgical wounds

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19
Q

Describe Tertiar wound response

A 
Delayed primary healing
Debris or pathogens in the wound
Granulation occurs
Inflammatory response
Closed surgically once deemed free of pathogens
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20
Q

What makes up the extracellular matrix

A

Collagen
Elastin
Proteoglycans
Adhesive Glycoproteins

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21
Q

What is the most common type of chronic wounds

A

Venous insufficiency ulcers

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22
Q

What causes chronic wounds and how long do they take to heal

A

Foreign debris
Pathogen
Disease
Months to years to close

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23
Q

What are some impeding factors to wound healing

A 
Infection
Medications
Comorbidities
Cancer / radiation
Autoimmune disorders
Stress
Modifiable factors
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24
Q

What is the normal value and consequence of increased and decreased levels of WBC

A

N - 4.5 - 11
In - wound fails to progress
Dec - decreased immune response

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25
Q

What is the normal value and consequence of increased and decreased levels of hemoglobin

A

Normal - 12-18
In - wound fails to progress
Dec - wound fails to progress / pale appearance

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26
Q

What is the normal value and consequence of increased and decreased levels of Hematocrit

A

N - 36-50%
In - sign of thrombi / emboli
Dec - wound fails to progress / pale

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27
Q

What is the normal value and consequence of increased and decreased levels of Prothrombin

A

N - 2.5 seconds
In - bleeds easily
Dec - increased clotting

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28
Q

What is the normal value and consequence of increased and decreased levels of HbA1C

A

N - <5.7

In - delayed wound healing

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29
Q

What is the normal value and consequence of increased and decreased levels of Glucose

A

Normal < 100mg/dl

In - delayed wound healing

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30
Q

What do Red, Yellow and Black wounds mean

A

Red - Clean, healing, granulating
Yellow - Possible infection, need to be cleaned, possible necrotic tissue
Black - Is necrotic and needs healing

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31
Q

What are the Wagner ulcer grades

A 
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
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32
Q

Describe tunneling

A

Between two wounds

May be tunnel with no exit

33
Q

Describe eschar

A

Nonviable Necrotic tissue
Black or brown in appearance
Varies in texture

34
Q

Describe Slough

A

Non-viable subcutaneous tissue
Result of autolytic debridement
Soft and yellow

35
Q

What is granulation tissue comprised of

A

Capillaries and ECM

36
Q

Describe hyper granulation tissue

A

Abnormal healing

unable to heal as edges are not able to approximate due to excess granulation

37
Q

Describe the terms for amount of drainage

A 
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
38
Q

Describe the terms for types of drainage

A 
Serous - clear
Sanguineous - bloody
Serosanguinous - pinkish
Purulent - thick pus, may have smell, yellow
Infected - Malodorous
39
Q

What is ecchymosis

A

Bruising

40
Q

What are the various types of odors

A

Pseudomonas - sweet odor, corn tortilla
Malignancy - various odors
Wet gangrene - foul odor

41
Q

What is PAD

A

Peripheral arterial disease
Arterial insufficiency
Slowing of blood flow

42
Q

What is claudication

A

Heavy legs

Cramping pain during exertion that dissipates at rest

43
Q

What are the first three Arterial wound risk factors

A

Arterio / atherosclerosis
Smoking
Obesity

44
Q

What are the second three Arterial wound risk factors

A

DM
HTN
Hypercholesterolemia

45
Q

What are the final two Arterial wound risk factors

A

Family history

Nutrition

46
Q

What are some non invasive screening tools for arterial insufficiency

A

ABI
Angiography
CT
Rubor of dependency test

47
Q

Describe the ABI

A

Ratio of ankle systolic pressure to brachial systolic pressure

48
Q

Describe ABI interpretation and implications

A

< .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

49
Q

Describe the rubor of dependency test

A

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

50
Q

Describe the characteristics of an arterial insufficiency wound

A 
Round small with smooth borders
Looks like hole punch
Pink periwound
Hair loss
Muscle atrophy
51
Q

How do you treat Arterial insufficiency wounds

A

PRAFO boots
Heel cushions
Pressure relief
Clean / sterile bandaging

52
Q

What are some surgical options for arterial insufficiency wounds

A

Revascularization surgery
Endovascular interventions
Surgical debridement

53
Q

Describe some factors of normal Venous flow

A

Valves prevent retrograde flow

Skeletal muscle pump helps to return blood to the heart

54
Q

Describe the presentation of venous insufficiency wounds

A 
Above the malleolus
insidious onset
Uneven edges, shallow little eschar
Moderate to copious serous, purulent drainage
Minimal pain
55
Q

How do you treat a venous insufficiency wound

A

Compression

but not when there is extreme arterial insufficiency or heart failure

56
Q

Describe the 4 layers of compression wrapping

A

1 - soft for body protection
2 - elastic layer
3 - long stretch layer
4 - self adhering bandage

57
Q

How often is a compression wrap to be changed

A

Every 3-7 days

58
Q

What populations experience pressure injuries the most

A

SCI
Acute pediatric
Cardiovascular
Neonatal

59
Q

What is the cost of managing a full thickness pressure ulcer

A

70,000

60
Q

What are the proposed pathophysiology’s associated with pressure injuries

A

Ischemia
Impaired lymphatic flow
Impaired reperfusion
Deformation of tissue

61
Q

Describe the timeline of pressure injuries

A

30 mins - local hyperemia
2-6 hours - ischemia
6 hours - necrosis
2 weeks - Ulceration

62
Q

Describe the stage classification system of pressure injuries

A

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

63
Q

Describe a deep tissue injury

A

Nonblanchable deep red, maroon or purple discoloration

64
Q

What are some risk factors for pressure injuries

A

Immobility
Inactivity
Sensory loss
Shear / friction force

65
Q

What are some interventions for pressure injuries

A

PRAFO’s
Pressure redistribution support surfaces
Care for moisture prone areas

66
Q

Describe the Braden scale

A

Sunscales of sense, moisture, activity, mobility, nutiotion, friction and shear
Low scores are bad

67
Q

Describe the Norton scale

A

> 17/20 = low risk

68
Q

What are the advantages of debridement

A

Removal of dead, damaged or devitalized tissue
Encourages wound healing process
reduces chronic inflammation by removing necrotic tissue
Promotes keratinocyte growth

69
Q

What are the first 3 contraindications to debridement

A

ABI of .4or lower
Dry gangrenous wounds
Elevated temperature

70
Q

What are the second 3 contraindications to debridement

A

Cellulitis
Wound failure to progress
Visible exposure of bone tendon or prosthetic device

71
Q

What are the last 2 contraindications to debridement

A

Extreme abscesses or extreme undermining

Stable eschar in arterial insufficiency or diabetes

72
Q

Describe the types of debridement

A 
Biological agents - maggots
Autolytic - natural healing
Enzymatic - chemicals
Mechanical - outside force
Sharp - scalpels
73
Q

Describe autolytic debridement

A

Cleansing
More rapid
Slow

74
Q

Describe enzymatic breeding

A

Apply enzyme 1-2 times per day
Selective
Costly

75
Q

Describe mechanical debridement

A

Ultrasound is an example
Decreased bacteria
Painful, nonselective

76
Q

Describe Sharp debridement

A

Most rapid form
selective and speeds
Painful

77
Q

How do you treat excess bleeding

A

Pressure for 5 - 10 minutes
Elevation
Topical agents

78
Q

Define desiccation

A

Dry

79
Q

Describe an Unna boot

A

Compression dressing

TRI 4 - Integ (2 decks)

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