Exam 2 - wounds Flashcards
1
Q
epidermis
A
- outer layer of skin
- avascular
- regenerates every 4-6 weeks
2
Q
Dermis
A
-has 2 layers (papillary = thin, vascular next to epidermis)
(reticular = deep layer containing skin appendages)
-*repairs via scar formation
3
Q
subcutaneous tissue
A
- adipose and connective tissue
- contains major blood vessels, nerves, and lymphatic vessels.
4
Q
LE ulcers increase amputation risk by?
A
6x
5
Q
what are 6 functions of the skin?
A
- protection
- maintain fluid status
- thermoregulation
- produce vit D
- sensation
- psychosocial
6
Q
Inflammatory phase of healing
A
- first phase
- lasts 4-6 days
- characterized by: neutrophils(most), macrophages, and lymphocytes
7
Q
what are the cardinal signs of inflammation? (5)
A
- calor (warm)
- rubor (redness)
- tumor (swelling)
- dolor (pain)
- loss of function
8
Q
Proliferative phase of healing
A
- ~4 to 3-6weeks
- characterized by: granulation tissue formation, wound contraction, and epithelialization
9
Q
Angiogenesis
A
- formation of new blood vessels
- happens in proliferative phase with granulation tissue formation
10
Q
Maturation phase of healing
A
- can last 1-2 years
- balance between collagen synthesis and lysis.
- remodeling and reorganization (tension theory)
11
Q
Hypertrophic scar
A
raised but within area of normal tissue
12
Q
keloid scar
A
extends beyond border of wound
13
Q
most neutrophils during what phase?
A
inflammatory
14
Q
most macrophages during what phase?
A
inflammatory
15
Q
most fibroblasts during what phase?
A
proliferation
16
Q
most lymphocytes during what phase?
A
proliferation
17
Q
Primary intention
A
wound edges approximated (surgical), minimal proliferative phase
18
Q
Secondary intention
A
- wound edges left open and healing occurs by formation of granulation tissue contraction, and epithelization
19
Q
tertiary intention
A
wound left open temporarily before surgical closure
20
Q
Dehiscence
A
a wound closed by primary intention that later opens up again
21
Q
intrinsic factors affecting wound healing
A
- age
- chronic disease (DM, CAD,PVD, cancer)
- perfusion and oxygenation
- immunosuppression
- sensation (SCI, DM neuropathy)
- stress
22
Q
extrinsic factors affecting wound healing
A
- meds
- nutrition
- smoking and EtOH
- infection
- mechanical stress
- **tissue moisture
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
24
Q
contamination def
A
-presence of bacteria in wound surface
25
colonization def
replication bacteria present in wound but without tissue response
26
Critical colonization def
bacteria delay or stop healing of the wound without presence of classical symptoms and signs of infection
27
infection def
bacterial burden overwhelms the immune response of the patient, wound is unable to heal, have symptoms of infection
28
what are the signs of infection?
- Inflammatory signs (rubber, dolor, tumor, color)
- purulent drainage/pus
- foul odor
- tissue induration
- fever, tachycardia
- WBC > 10,000/mm^3
29
osteomyelitis
-inflammation of bone caused by infecting organism, lead to progressive destruction of bone and necrosis
30
Necrotizing fasciitis
- flesh eating bacteria
- rapid spreading
- very high mortality rates
31
Tissue involved: superficial wound
- epidermis
| - sunburn, stage 1 pressure ulcer, abrasion
32
Tissue involved: Partial-thickness
- epidermis, dermis
| - skin tear, abrasions, tape damage, blisters, stage II pressure ulcer
33
Tissue involved: Full-thickness
- epidermis and dermis
| - donor sites, venous ulcers, full-thickness burns, stage III pressure ulcers
34
Tissue involved: Subcutaneous tissue wounds
- additional classification level for full-thickness extending beyond subcutaneous tissue
- surgical wounds, stage IV pressure ulcer
35
Pressure ulcers: Stage 1 and 2
Stage 1 = intact skin, non-blanchable redness usually over bone
stage 2 = may have intact or open blister
36
Pressure ulcer stage 3
- subQ fat may be visible
| - may include undermining and tunneling
37
Pressure ulcer stage 4
- exposed bone, tendon, or muscle
- often includes undermining and tunneling
- osteomyelitis is a possibility
38
unstageable pressure ulcer
- full thickness tissue loss in which the base of ulcer is covered by slough and or eschar
- hard to determine stage without debridement
39
Classification system: RED
-clean, healing, granulation
40
Classification system: YELLOW
possible infection, needs cleaning, necrotic
41
Classification system: BLACK
-needs cleaning, necrotic
42
Arterial insufficiency (pain, position, presentation, periwound, pulses)
- Pain: (+) with elevation. Severe (ischemic pain)
- Locations: distally
- presentation: Dry, pale (no blood flow)
- Periwound: dry, hairless, shiny
- Pulse: Absent
43
Arterial insufficiency tests and measures
-pulses (absent)
-ABI
-Venous filling time
Capillary refill test
Rubor of dependency
44
Venous insufficiency (pain, position, presentation, periwound, pulses)
- Pain: (+) in dependent position. Mild
- locations: medial malleolus
- presentation: Wet
- periwound: LE edema, hemociterin staining
- pulses: possibly, depends
45
Venous insufficiency tests and measures
- ABI
- venous filling time
- circumferential measurements or volumetric
- edema scale
46
Diabetic neuropathy (pain, position, presentation, periwound, pulses)
- 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
Diabetic neuropathy tests and measures
- ABI
- sensory integrity
- wagner classification system
48
Wagner classification system
- only for diabetic wounds
- 0-5 grades.
- 0 = no open lesion, may have deformity
- 5 = gangrene of entire foot.
49
ABI used for
- Arterial
- venous
- diabetic wounds
50
Capillary refill test used for
-arterial
51
Rumor of dependency used for
-arterial
52
venous filling used for
arterial and venous
53
pitting edema test used for
venous
54
circumferential measurements/volume used for
venous
55
sensory integrity test used for
diabetic wound
56
Pressure ulcers
- occur from inside out
- over bony prominence
- classified by NPUAP at eval only
-pressure (~30 mmHg capillary close), shearing, friction, equipment
57
Wound measurement parameter: MEASURE
```
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
First degree burn
- most superficial layer (stratum corneum)
- sunburn
- 2-3 days
59
2nd degree vs 3rd degree burn
- 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
Rules of Nines
- 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
best neutralizer for chemical burns
water
62
open treatment dressing method
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
closed treatment dressing method
- 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
Heterograft
-tissue from different species
65
Homograft
-tissue from same species, different person
66
Autograft
tissue from self
67
donor site
-location from which graft was taken
68
burns: positioning and splinting
position immediately
| -splint when ROM decrease is evidenced
69
Contraindication to exercise after burns
- immediately after autograft or long hospital homograft
- donor site should be immobile 24-48 hours
- all usual contraindication (fractures, vitals, etc.)
70
frostbite 1st degree
- hyperemia
- slight pain 4-5 days
- possible desquamation
71
frostbite 2nd degree
- blisters
- eschar to desquamation
- painful 10-12 days
72
3rd degree frostbite
-nerve damage
2-3 months
necrosis
73
4th degree frostbite
- extensie gangrene
- severe
- ----blahhhhh
