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PTH 608 Gen Med II > Exam 2 - wounds > Flashcards

Exam 2 - wounds Flashcards

1
Q

epidermis

A
  • outer layer of skin
  • avascular
  • regenerates every 4-6 weeks
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2
Q

Dermis

A

-has 2 layers (papillary = thin, vascular next to epidermis)
(reticular = deep layer containing skin appendages)
-*repairs via scar formation

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3
Q

subcutaneous tissue

A
  • adipose and connective tissue

- contains major blood vessels, nerves, and lymphatic vessels.

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4
Q

LE ulcers increase amputation risk by?

A

6x

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5
Q

what are 6 functions of the skin?

A
  • protection
  • maintain fluid status
  • thermoregulation
  • produce vit D
  • sensation
  • psychosocial
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6
Q

Inflammatory phase of healing

A
  • first phase
  • lasts 4-6 days
  • characterized by: neutrophils(most), macrophages, and lymphocytes
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7
Q

what are the cardinal signs of inflammation? (5)

A
  • calor (warm)
  • rubor (redness)
  • tumor (swelling)
  • dolor (pain)
  • loss of function
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8
Q

Proliferative phase of healing

A
  • ~4 to 3-6weeks

- characterized by: granulation tissue formation, wound contraction, and epithelialization

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9
Q

Angiogenesis

A
  • formation of new blood vessels

- happens in proliferative phase with granulation tissue formation

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10
Q

Maturation phase of healing

A
  • can last 1-2 years
  • balance between collagen synthesis and lysis.
  • remodeling and reorganization (tension theory)
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11
Q

Hypertrophic scar

A

raised but within area of normal tissue

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12
Q

keloid scar

A

extends beyond border of wound

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13
Q

most neutrophils during what phase?

A

inflammatory

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14
Q

most macrophages during what phase?

A

inflammatory

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15
Q

most fibroblasts during what phase?

A

proliferation

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16
Q

most lymphocytes during what phase?

A

proliferation

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17
Q

Primary intention

A

wound edges approximated (surgical), minimal proliferative phase

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18
Q

Secondary intention

A
  • wound edges left open and healing occurs by formation of granulation tissue contraction, and epithelization
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19
Q

tertiary intention

A

wound left open temporarily before surgical closure

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20
Q

Dehiscence

A

a wound closed by primary intention that later opens up again

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21
Q

intrinsic factors affecting wound healing

A
  • age
  • chronic disease (DM, CAD,PVD, cancer)
  • perfusion and oxygenation
  • immunosuppression
  • sensation (SCI, DM neuropathy)
  • stress
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22
Q

extrinsic factors affecting wound healing

A
  • meds
  • nutrition
  • smoking and EtOH
  • infection
  • mechanical stress
  • **tissue moisture
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23
Q

Lab values and delayed healing: Prealbumin, albumin, hemoglobin, hematocrit, WBC, BUN:Creatinine

A
  • Prealbumin less than 16 mg/dl
  • Albumin less than 3.5 mg/dl
  • Hemoglobin less than 12 g/dl
  • Hematocrit less than 33%
  • WBC less than 1800/mm3
  • BUN/Creatinine over 10:1
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24
Q

contamination def

A

-presence of bacteria in wound surface

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25
Q

colonization def

A

replication bacteria present in wound but without tissue response

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26
Q

Critical colonization def

A

bacteria delay or stop healing of the wound without presence of classical symptoms and signs of infection

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27
Q

infection def

A

bacterial burden overwhelms the immune response of the patient, wound is unable to heal, have symptoms of infection

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28
Q

what are the signs of infection?

A
  • Inflammatory signs (rubber, dolor, tumor, color)
  • purulent drainage/pus
  • foul odor
  • tissue induration
  • fever, tachycardia
  • WBC > 10,000/mm^3
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29
Q

osteomyelitis

A

-inflammation of bone caused by infecting organism, lead to progressive destruction of bone and necrosis

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30
Q

Necrotizing fasciitis

A
  • flesh eating bacteria
  • rapid spreading
  • very high mortality rates
31
Q

Tissue involved: superficial wound

A
  • epidermis

- sunburn, stage 1 pressure ulcer, abrasion

32
Q

Tissue involved: Partial-thickness

A
  • epidermis, dermis

- skin tear, abrasions, tape damage, blisters, stage II pressure ulcer

33
Q

Tissue involved: Full-thickness

A
  • epidermis and dermis

- donor sites, venous ulcers, full-thickness burns, stage III pressure ulcers

34
Q

Tissue involved: Subcutaneous tissue wounds

A
  • additional classification level for full-thickness extending beyond subcutaneous tissue
  • surgical wounds, stage IV pressure ulcer
35
Q

Pressure ulcers: Stage 1 and 2

A

Stage 1 = intact skin, non-blanchable redness usually over bone

stage 2 = may have intact or open blister

36
Q

Pressure ulcer stage 3

A
  • subQ fat may be visible

- may include undermining and tunneling

37
Q

Pressure ulcer stage 4

A
  • exposed bone, tendon, or muscle
  • often includes undermining and tunneling
  • osteomyelitis is a possibility
38
Q

unstageable pressure ulcer

A
  • full thickness tissue loss in which the base of ulcer is covered by slough and or eschar
  • hard to determine stage without debridement
39
Q

Classification system: RED

A

-clean, healing, granulation

40
Q

Classification system: YELLOW

A

possible infection, needs cleaning, necrotic

41
Q

Classification system: BLACK

A

-needs cleaning, necrotic

42
Q

Arterial insufficiency (pain, position, presentation, periwound, pulses)

A
  • Pain: (+) with elevation. Severe (ischemic pain)
  • Locations: distally
  • presentation: Dry, pale (no blood flow)
  • Periwound: dry, hairless, shiny
  • Pulse: Absent
43
Q

Arterial insufficiency tests and measures

A

-pulses (absent)
-ABI
-Venous filling time
Capillary refill test
Rubor of dependency

44
Q

Venous insufficiency (pain, position, presentation, periwound, pulses)

A
  • Pain: (+) in dependent position. Mild
  • locations: medial malleolus
  • presentation: Wet
  • periwound: LE edema, hemociterin staining
  • pulses: possibly, depends
45
Q

Venous insufficiency tests and measures

A
  • ABI
  • venous filling time
  • circumferential measurements or volumetric
  • edema scale
46
Q

Diabetic neuropathy (pain, position, presentation, periwound, pulses)

A
  • pain: none
  • position: WBing area (feet)
  • presentation: irregular, depends on cause (deep)
  • periwound: calus material, charcot foot
  • pulses: possible, depends on presence of PAD
47
Q

Diabetic neuropathy tests and measures

A
  • ABI
  • sensory integrity
  • wagner classification system
48
Q

Wagner classification system

A
  • only for diabetic wounds
  • 0-5 grades.
  • 0 = no open lesion, may have deformity
  • 5 = gangrene of entire foot.
49
Q

ABI used for

A
  • Arterial
  • venous
  • diabetic wounds
50
Q

Capillary refill test used for

A

-arterial

51
Q

Rumor of dependency used for

A

-arterial

52
Q

venous filling used for

A

arterial and venous

53
Q

pitting edema test used for

A

venous

54
Q

circumferential measurements/volume used for

A

venous

55
Q

sensory integrity test used for

A

diabetic wound

56
Q

Pressure ulcers

A
  • occur from inside out
  • over bony prominence
  • classified by NPUAP at eval only

-pressure (~30 mmHg capillary close), shearing, friction, equipment

57
Q

Wound measurement parameter: MEASURE

A 
M = measure. Length, width, depth, area
E = exudate: Amount, quality
A = appearance: wound bed, tissue type, and amount
S = suffering: pain levels
U = undermining: present/absent
R = re-eval: monitor all parameters on a regular basis 
E = edge: condition of wound edge and surrounding skin
58
Q

First degree burn

A
  • most superficial layer (stratum corneum)
  • sunburn
  • 2-3 days
59
Q

2nd degree vs 3rd degree burn

A
  • 2nd is most or all of epidermis
  • 3rd degree is full thickness destroying epi and dermis

-hair test: pull hair. resistance = 2nd. no resistance means 3rd.

60
Q

Rules of Nines

A
  • head and neck (including front and back) =9
  • each arm = 9 (18)
  • front of trunk = 18
  • back of trunk = 18
  • each leg = 18 (36)
  • perineum = 1%
61
Q

best neutralizer for chemical burns

A

water

62
Q

open treatment dressing method

A

burn is exposed and covered with topical agent without a dressing

  • easy to examine, delay sepsis, easy care, control temp, early PT
  • cons: discomfort, delayed eschar separation, non transportability, added linen requirement, aesthetically appalling
63
Q

closed treatment dressing method

A
  • cover all burn with bulky dressing, either wet or dry and leaving them on 1-3 days
  • pros: comfort, transportability, absorption of secretions, acceleration debridement, aesthetic consideration
  • cons: hyperthermia, promotion of sepsis, difficult examination, odorous dressings, delayed PT
64
Q

Heterograft

A

-tissue from different species

65
Q

Homograft

A

-tissue from same species, different person

66
Q

Autograft

A

tissue from self

67
Q

donor site

A

-location from which graft was taken

68
Q

burns: positioning and splinting

A

position immediately

-splint when ROM decrease is evidenced

69
Q

Contraindication to exercise after burns

A
  • immediately after autograft or long hospital homograft
  • donor site should be immobile 24-48 hours
  • all usual contraindication (fractures, vitals, etc.)
70
Q

frostbite 1st degree

A
  • hyperemia
  • slight pain 4-5 days
  • possible desquamation
71
Q

frostbite 2nd degree

A
  • blisters
  • eschar to desquamation
  • painful 10-12 days
72
Q

3rd degree frostbite

A

-nerve damage
2-3 months
necrosis

73
Q

4th degree frostbite

A
  • extensie gangrene
  • severe
  • —-blahhhhh

PTH 608 Gen Med II (6 decks)

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