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Integumentary > Exam I > Flashcards

Exam I Flashcards

1
Q

what are the main functions of the skin? (5)

A

(1) protection
(2) sensation
(3) maintenance of fluid
(4) immunity
(5) thermoregulation

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2
Q

what are the two layers of the skin? are they vascular or avascular?

A

(1) epidermis (superficial layer): avascular

(2) dermis (deep layer): vascular

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3
Q

what are the 5 layers of the epidermis from deepest to most superficial?

A

(1) stratum basale
(2) stratum spinosum
(3) stratum granulosum
(4) stratum lucidum
(5) stratum corneum

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4
Q

what layer of the epidermis helps withstand friction and shear forces?

A

stratum spinosum

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5
Q

what is the thickest layer of the epidermis?

A

stratum spinosum

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6
Q

what layer of the epidermis helps prevent water loss?

A

stratum granulosum

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7
Q

what layer of the epidermis helps prevent damage from the environment?

A

stratum lucidum

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8
Q

what is the role of melanocytes?

A

give skin its pigment

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9
Q

what is the role of Langerhans cells?

A

provide an immune response

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10
Q

what is the function of Merkel cells?

A

function as mechanoreceptors to detect light touch tactile sensations

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11
Q

why is lubrication and hydration of the stratum corneum important?

A

it’s vital to inhibit water loss

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12
Q

what are the 2 layers of the dermis?

A

(1) papillary dermis (superficial)

2) reticular dermis (deeper

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13
Q

what are the functions of fibroblasts in the dermis? (2)

A

(1) generate collagen (mainly Type 1)

(2) generate elastin

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14
Q

what is the function of Meissner’s corpuscles?

A

detect light touch

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15
Q

what is the function of Pacinian corpuscles?

A

detect deep pressure and vibration sensations

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16
Q

what are the 3 types of skin loss? what is associated with each?

A

(1) erosion: epidermal loss only (1st degree burns; minimal or no bleeding)
(2) partial thickness wounds: loss of epidermis and dermis (2nd degree burns, skin tears)
(3) full thickness wounds: loss of epidermis, dermis, and hypodermis (exposure of bone, tendon; surgical incisions)

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17
Q

what are the 4 phases of skin healing?

A

(1) hemostasis
(2) inflammation
(3) proliferation
(4) remodeling

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18
Q

what is involved with the hemostasis phase of healing? how long does this phase last?

A

(1) platelet aggregation; stop the bleeding and begin scab formation Clot Form
(2) lasts less than an hour

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19
Q

what is involved with the inflammatory phase of healing? how long does this phase last?

A

(1) increased circulation to site and debridement begins; breakdown of dead tissue via phagocytes
(2) 1 hour - 4 days

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20
Q

what is involved with the proliferation phase of healing? how long does this phase last?

A

(1) formation of new extracellular matrix; new tissue being laid
(2) 4-12 days

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21
Q

what is involved with the remodeling phase of healing?

A

wound closure; collagen replacement (from type III to type I) to increase tensile strength

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22
Q

how strong is the scar tissue laid down during the remodeling phase of healing?

A

80% tensile strength of the original skin, which may take up to 2 years to achieve

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23
Q

what is recidivism?

A

recurrence of wounds within the injured area due to a decrease in original tensile strength

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24
Q

what are the 3 different classifications of wound response?

A

(1) primary intention
(2) secondary intention
(3) delayed primary intention (tertiary)

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25
Q

what is associated with a primary intention wound response?

A

(1) wounds typically seen after surgery
(2) heal uneventfully, without scaring
(3) bacteria and pathogen free
(4) resolves within about 2 weeks

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26
Q

what is associated with a delayed primary intention (tertiary) wound response?

A

(1) suspected debris or pathogens in the wound
(2) increased inflammatory response
(3) resulting granuloma

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27
Q

what is associated with a secondary intention wound response?

A

(1) progress through the stages of wound healing from inflammatory phase, granulation formation and re-epithelialization
(2) myofibrils present for 10-21 days to assist wound closure

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28
Q

why is it important for patients to eat protein for healing?

A

majority of drainage that leaves the wound is comprised of protein and the extracellular matrix is comprised of such proteins that allow for the structural integrity of the skin

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29
Q

how long do chronic wounds take to close?

A

months to years

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30
Q

what usually causes chronic wounds? (3)

A

(1) debris in the wound
(2) pathogen occupants
(3) disease (diabetes, circulatory disorders)

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31
Q

what is the most common cause of chronic wounds?

A

venous insufficient ulcers

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32
Q

what are factors that impede healing? (7)

A

(1) infection
(2) medications
(3) comorbidities
(4) cancer/Radiation
(5) autoimmune disorders
(6) stress
(7) modifiable behaviors/
lack of sleep

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33
Q

what are some comorbidities that impede healing? (4)

A

(1) diabetes
(2) arterial insufficiency
(3) chronic edema
(4) cardiac diseases

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34
Q

how does diabetes cause delayed healing?

A

due to the effects of increased glucose levels on leukocyte function

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35
Q

what is a large indicator of healing ability?

A

cardiac function (the better cardiac function the better ability for the body to heal)

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36
Q

how does stress cause delayed healing?

A

hormones released when stressed such as, epinephrine and NE result in decreased response to injury

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37
Q

what are normal WBC levels?

A

Normal: 4,500 - 11,000 per microliter of blood

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38
Q

what are normal hemoglobin levels?

A

Normal: 12-18 g/dL

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39
Q

what are normal HCT levels?

A

Normal: 36-50%

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40
Q

what are normal INR (PT-INR) levels?

A

Normal: 2.50 seconds

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41
Q

what are normal A1C% levels?

A

Normal: <= 5.7%

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42
Q

what are normal average glucose levels?

A

Normal: <100 mg/dL

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43
Q

what does each color indicate using Marion Laboratories Classification System?

A

(1) red: wound is clean, healing and granulating
(2) yellow: possible infection or necrotic tissue; need cleaning or debridement
(3) black: necrotic tissue; needs cleaning and debridement

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44
Q

what scale is the most widely used scale for classifying pressure ulcers?

A

National Pressure Ulcer Advisory Panel (NPUAP)

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45
Q

how does the Wagner Ulcer Grade Classification classify ulcers? what condition is it most commonly used for?

A

(1) Uses pressure depth and infection using grades from 0-6

(2) most used for diabetic foot ulcers

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46
Q

what does each grade indicate for the Wagner Ulcer Grade Classification?

A

Grade 0: preulcerative lesions; healed ulcers; bony
deformity
Grade 1: superficial ulcer without subcutaneous
involvement
Grade 2: affects subcutaneous tissue; may
expose bone, tendon, etc.
Grade 3: osteitis, abscess or osteomyelitis
Grade 4: gangrene of digit
Grade 5: gangrene of the foot requiring disarticulation

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47
Q

what are the 4 steps a physical therapist should go through with a wound care patient?

A

(1) General Assessment
(2) Diagnosis
(3) Prognosis and Goals
(4) Re-evaluation

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48
Q

what information should you get from a patient when assessing a wound? (5)

A

(1) wound onset
(2) etiology
(3) signs / symptoms
(4) pain
(5) psychosocial history

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49
Q

what are the two main aspects of a would care examination?

A

(1) Test for factors related to comorbidities

(2) Wound examination

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50
Q

what are the 3 methods used to determine the size of the a wound?

A

(1) perpendicular method
(2) clock method
(3) tracing / wound photography

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51
Q

what is assessed using the clock method of wound measurement?

A

(1) length
(2) width
(3) depth

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52
Q

what is undermining when referring to wound care? how does it typically present?

A

(1) disruption in the attachment of the skin to underlying structures
(2) often presents as dark/discolored tissue surrounding the periwound

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53
Q

what is tunneling when referring to wound care?

A

a wound that “tunnels” underneath the skin; sometimes there may be two visible openings that are connected underneath the skin (via tunneling)

54
Q

what is eschar tissue?

A

necrotic tissue; typically black, flat and shinny

55
Q

what is slough tissue?

A

non-viable subcutaneous tissue; typically soft and yellow as a result of autolytic debridement

56
Q

what is granulation tissue?

A

viable tissue; usually bright red (composed of matrix and capillaries)

57
Q

what is the difference between viable and non-viable muscle tissue?

A

(1) viable: red in color, hurts to touch, can contract

(2) non-viable: grey in color,, non-painful and doesn’t contract

58
Q

what is the difference between viable and non-viable bone?

A

(1) viable: white / tan apperance

(2) non-viable: black

59
Q

how is a tendon kept viable following a full-thickness wound injury?

A

must remain moist to prevent desiccation (dryness)

60
Q

what is the difference between viable and non-viable adipose tissue?

A

(1) viable: shiny globules

(2) non-viable: dull, yellow

61
Q

what is hypergranulation tissue?

A

(1) abnormal healing of granulation tissue that overrides the tissue surface
(2) although red, it will cause an inability to heal as the edges will not be able to approximate over the edges of the granulation

62
Q

what are the 6 ways to describe the amount of drainage?

A

(1) scant: small remnant of drainage of dressing
(2) minimal: 25% of dressing is covered
(3) moderate: 50% is covered
(4) heavy: 100% is covered
(5) copious: multiple layers
(6) strike through: drainage visible through last layer

63
Q

how is serous drainage described?

A

clear serum

64
Q

how is sanguineous drainage described?

A

bloody

65
Q

how is serosanguineous drainage described?

A

mixture of serous and sanguineous (clear and bloody)

66
Q

how is purulent drainage described?

A

thick, viscous drainage that may smell (pus)

67
Q

how is infected drainage described?

A

various colors and often has an odor

68
Q

what are some ways the periwound may present?

A

(1) erythema (redness)
(2) ischemic (pale)
(3) hemosiderin staining (brown / purple discoloration; typical with venous insufficiency)
(4) ecchymosis (bruising)

69
Q

when is the odor of a wound assessed?

A

AFTER the dressing is removed and the wound is cleaned

70
Q

what is peripheral artery disease characterized by? (3)

A

(1) arterial insufficiency
(2) claudication
(3) rest pain (more so against gravity)

71
Q

what is claudication?

A

heavy, painful legs; cramping (usually the calfs) during exertion that dissipates at rest

72
Q

what is one way physical therapists can determine arterial sufficiency?

A

ABI (ankle brachial index)

73
Q

what are normal levels for ABI? what are borderline PAD values?

A

(1) normal: 1.0-1.29

2

74
Q

what are ABI values ofr mild, moderate, and severe PAD?

A

(1) mild: 0.7-0.9
(2) mod: 0.4-0.69
(3) severe: <0.4

75
Q

what does an ABI value greater than 1.3 indicate?

A

heavy vessel calcification

76
Q

how is rubor of dependency test administered and interpreted?

A

(1) legs elevated to 30 degrees in supine
(2) once pallor is observed, legs are brought to a dependent level
(3) normal: slight pink appearance (return to color within 15 seconds)
(4) abnormal: bright red (baseline takes >30 seconds)

77
Q

why does redness occur during the rubor of dependency test?

A

in patients with PAD, redness is caused by dilation of arteries in an attempt to reperfuse the extremity, compensating for poor arterial flow

78
Q

how does an arterial insufficiency wound present?

A

(1) around and small with smooth borders (looks like a hole punch)
(2) lacks granulation and looks pale
(3) distal digits

79
Q

what is the treatment for arterial insufficiency?

A 
(1) PRAFO
(P) protection
(R) relief
(AFO) ankle foot orthosis
(2) infrared light
(3) debridement
80
Q

how is blood in the venous system pumped back towards the heart? what prevents back flow?

A

muscle pump; valves prevent back flow

81
Q

what causes venous wounds?

A

abnormal vessel valves allow for retrograde flow causing pooling in distal LEs

82
Q

what is edema below the lower leg characterized as?

A

venous insufficiency

83
Q

what is edema extending yo the thigh called?

A

lymphedema

84
Q

are varicose veins easier to see in standing or supine when assessing a patient?

A

standing (blood pools because it has to fight against gravity)

85
Q

how do venous insufficiency wounds present?

A

(1) gaiter area (above malleoli)
(2) insidious
(3) uneven edges, shallow, little eschar
(4) moderate to copious serous (no infection) or purulent (infection) drainage
(5) periwound: increased thickness

86
Q

what is the gold standard treatment for venous insufficiency?

A

compression

87
Q

what comorbidity would you NOT use compression for when treating a patient for venous insufficiency?

A

congestive heart failure or PAD (compression for these populations can cause serious complications or DEATH)

88
Q

what are the three types of compression used for treatment of venous insufficiency?

A

(1) spiral: used for bed bound patients or require minimal compression
(2) figure 8: provides twice as much compression as spiral; used for patients use regularly walk and have good ABI
(3) 4 layer: includes 4 layers which are cotton padding, non-elastic, long stretch (figure 8), and self adhering bandage (listed from deepest to most superficial)

89
Q

what is the proper name for a pressure sore?

A

pressure injury

90
Q

what are the 4 mechanisms that are thought to cause pressure injuries?

A

(1) ischemia: compression of capillaries
(2) impaired lymphatic flow: increased metabolic waste
(3) reperfusion: inflammatory response
(4) deformation of tissues

91
Q

how long does it take for local hyperemia to occur at the location of a pressure injury?

A

30 minutes

92
Q

how long does it take for ischemia to occur at the location of a pressure injury?

A

2-6 hours of continuous pressure

93
Q

how long does it take for necrosis to occur at the location of a pressure injury?

A

6 hours of continuous pressure

94
Q

how long does it take for ulceration to occur at the location of a pressure injury?

A

2 weeks after necrosis

95
Q

how do Stage 1 pressure injures present?

A

non-blanchable erythema of intact skin

96
Q

how do Stage 2 pressure injures present?

A

partial thickness loss with exposed dermis

97
Q

how do Stage 3 pressure injures present?

A

full thickness skin loss; bone / tendon / muscle not exposed (may include necrotic tissue)

98
Q

how do Stage 4 pressure injures present?

A

full thickness skin and tissue loss; exposed bone / muscle / tendon

99
Q

how do unstageable pressure injures present?

A

obscured full-thickness skin and tissue loss; base covered in slough or eschar (until wound is debrided, the full depth can’t be ascertained)

100
Q

how do suspected deep tissue injuries present?

A

persistent non-blanchable, deep red, maroon, or purple coloration

101
Q

necrotic tissue is present within a pressure wound what level is it automatically classified as?

A

stage 3 (at least)

102
Q

what are risk factors for pressure injuries?

A

(1) immobility
(2) inactivity
(3) sensory loss
(4) shear / friction forces

103
Q

what are the 6 variables of the Braden scale that are assessed? what is the max score?

A

(1) sensory perception
(2) moisture
(3) activity
(4) mobility
(5) nutrition
(6) friction and shear
Max Score: 23 (this being lowest risk for pressure sore)

104
Q

what is considered low risk for pressure injuries according to the Norton scale?

A

17-20 out of 20

105
Q

what are interventions we can implement as PTs to treat or prevent pressure injuries?

A

(1) pressure relief - PRAFO’s
(2) pressure redistribution support systems (roho cushions, air mattresses)
(3) care for moisture prone areas (barrier creams)
(4) reduce friction / shearing forces

106
Q

what is debridement?

A

removal of dead, damaged, or devitalized tissue

107
Q

what is the purpose of debridement?

A

(1) encourages wound healing process
(2) reduces chronic inflammation by removing necrotic tissue
(3) promotes keratinocyte growth

108
Q

what are some things to consider before debriding a wound?

A

(1) history taking (lab values, medications, INR level, pain level)
(2) ABI value (vascular insufficiency would require a referral)

109
Q

what are contraindications to debridement?

A

(1) ABI < 0.4
(2) dry gangrene or dry ischemic wounds
(3) elevated temp
(4) cellulitis (or other bacterial infections)
(5) visible exposure to bone, tendon
(6) prosthetic devices
(7) evidence of extreme undermining

110
Q

when should you debride stable eschar?

A

NEVER

111
Q

how is a wound debrided using biological agents?

A

maggot / leech therapy

(1) maggots only debride necrotic tissue and stay in the wound for 1-4 days
(2) leech therapy brings blood to the area

112
Q

what is autolytic debridement?

A

using the body’s natural healing mechanisms to debride non-viable tissue

113
Q

what is enzymatic debridement?

A

using chemicals to remove non-viable tissue

114
Q

what is mechanical debridement?

A

using outside force or energy to dislodge the non-viable tissue

115
Q

what is sharp debridement?

A

using instruments to remove non-viable tissue

116
Q

what is involved with autolytic debridement?

A

(1) cleaning wound
(2) maintain moist environment
(3) cross hatch eschar
(4) cover with dressing to promote healing

117
Q

what are advantages and disadvantages of autolytic debridement?

A 
Advantages
(1) rapid improvement
(2) selective (doesn't debride health tissue)
(3) can combine w/ other debridement types
Disadvantages
(1) caregiver education
(2) slower than sharp
(3) increased risk for infection
118
Q

what is involved with enzymatic debridement?

A

(1) obtain physician’s orders
(2) cleanse wound
(3) apply enzyme to non-viable tissue
(4) cover with dressing
(5) administer 1-2x / day

119
Q

what are advantages and disadvantages of enzymatic debridement?

A 
Advantages
(1) selective
(2) can combine w/ other debridement types
Disadvantages
(1) costly
(2) slow to notice improvement
120
Q

what is the main enzymatic agent for debridement?

A

Santyl

121
Q

what are the gold standard parameters for using pulsatile lavage debridement?

A

35-50 cc syringe
19 gauge catheter
4-9 PSI
Avoid PSI >15

122
Q

what are advantages and disadvantages of mechanical debridement?

A 
Advantages
(1) used in a variety of settings
(2) decreased bacteria
Disadvantages
(1) painful
(2) non-selective
(3) may cause maceration
123
Q

what is involved with sharp debridement?

A

(1) pre-medicate
(2) assembly agents to stop excess bleeding
(3) cleanse wound
(4) use scalpel blades to remove non-viable tissue

124
Q

what are advantages and disadvantages of sharp debridement?

A 
Advantages
(1) selective
(2) speed
Disadvantages
(1) painful
(2) requires experience
(3) increased potential for complications
125
Q

how long should pressure be applied to a wound with excess bleeding before using topic agents?

A

5-10 minutes

126
Q

how can corticosteroids affect healing? what can be used to mediate the effects of steroids?

A

(1) steroids cause a delay in all phases of healing

(2) vitamin A

127
Q

how can NSAIDs affect wound healing? (2)

A

(1) decreased platelet aggregation

(2) decreased tensile strength of tissues

128
Q

what is a granuloma?

A

a mass of granulation tissue, typically produced in response to infection, inflammation, or debris

129
Q

what type of bacterial gives off a characteristically sweet odor?

A

pseudomonas

130
Q

what type of odor does gangrene typically give off?

A

very foul odor

131
Q

what is the Braden scale used to predict?

A

pressure sore risk

Integumentary (2 decks)

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