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Fall 2024: Integumentary Systems > Final Exam > Flashcards

Final Exam Flashcards

1
Q

List the types of acute burns

A
  • TENS/SJS
  • Friction injuries
  • Frostbite
  • IV infiltrates
  • Pressure injuries
  • Traumatic amputations
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2
Q

List the types of reconstructive burns

A
  • Congenital conditions
  • Scar contractures
  • Cleft lip and palate
  • Dog bites
  • Port wine stains
  • Congenital hairy nevus
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3
Q

T or F? Burn injuries change capillary permeability into the size of RBCs, then the edema goes to the burn site leaving the body hypovolemic

A

True

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4
Q

T or F? Over-resuscitation (too much fluid) can cause excess edema, stress kidney function, pulmonary complications, heart failure, etc.

A

True

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5
Q

Compartment syndrome can affect the ___________________, especially if the burn is circumferential

A

area of a burn

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6
Q

What are the 4 factors for assessing a burn?

A
  • Mechanism of injury
  • Depth of injury
  • TBSA% (total body surface area)
  • Other influential factors (PMH, social history)
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7
Q

What are the 3 zones of a burn?

A
  • Zone of hyperemia
  • Zone of stasis
  • Zone of coagulation
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8
Q

List the types of burns

A
  • Thermal
  • Chemical
  • Electrical
  • Friction
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9
Q

List the different types of thermal burns

A
  • Flame
  • Scald
  • Contact
  • Flash
  • Friction
  • Sunburn
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10
Q

T or F? pH of chemical can affect treatment of a chemical burn

A

True

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11
Q

How should you treat a chemical burn?

A

Flush with water to remove any chemicals

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12
Q

Describe electrical injuries

A
  • May cause damage to the skin and to internal tissues
  • EKG should be done on al patients with electrical burns to rule out cardiac issues
  • Common in hands/fingers
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13
Q

Describe friction burns

A
  • Most common: Treadmill belt, road rash, vacuum brushes
  • Radiographs should be taken to rule out fractures with trauma history
  • Deep injuries over thin skin on fingers can mean tendon involvement
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14
Q

Describe the burn classification scale (+ healing times)

A

First Degree:
- Superficial (<7 days)

Second Degree:
- Superficial partial thickness (7-21 days)
- Deep partial thickness (21-35 days)

Third Degree:
- Full Thickness (>30 days)

Fourth Degree:
- Full thickness (N/A)

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15
Q

What is the “wallace rule of nines”

A

A tool used to estimate the TBSA (Total burn surface area)

Alternative: Lund & Browder chart

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16
Q

List he TBSA% of the human body

A

Head: 9%
Torso: 36%
Arms: 9% each
Legs: 18% each
Genitalia: 1%

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17
Q

Which factors affect how a patient is treated

A
  • Age
  • PMH/comorbidities
  • Body areas involved
  • Medical status
  • Additional trauma
  • Social concerns
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18
Q

How should you prevent infection of a burn?

A

Superficial/Smaller injuries:
- Topical agent (bactroban, bacitracin)

Deeper injuries:
- Soak with different agent (silver, sulfamylon, etc.)

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19
Q

T or F? A superficial second degree burn would be appropriate for barrier dressing

A

True

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20
Q

How should you debride necrotic/dead tissue

A
  • Collagenase
  • In-clinic debridement
  • Mod sedation procedures
  • Tangential excision in operating room
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21
Q

List the priorities of wound closure (in order from most to least important)

A
  1. Survival
  2. Function
  3. Appearance
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22
Q

T or F? The likelihood of scarring is most likely if it takes more than 14 days

A

True

23
Q

How should a clinician manage a scar?

A
  • Scar massage
  • Pressure garment
  • Topical silicone
  • Laser treatments (surgical)
  • Z-plasty (surgical)
  • Release and graft (surgical)
24
Q

If a patient has a palmar burn, their hand should be _______ when in a splint

If a patient has circumferential burns, their hand should be _____________ or ___________

A

Fisted

Extended of slight flexion

25
Q

How long does a scar take to mature?

A

At least 12 months

26
Q

List the characteristics of immature/active scars, and mature scars

A

Immature Scars:
- Red
- Raised
- Ridged

Mature Scars:
- Pale
- Planar
- Pliable

27
Q

T or F? Hypertrophic scars stays between the wound borders, keloids expand beyond the wound borders

A

True

28
Q

Patients with thermal burns should receive immediate care if…

A
  • full thickness burn
  • partial thickness >/= 10% TBSA
  • partial or full thickness burns on the face
  • patient has burn and other comorbidities
29
Q

List the healing times for different burns

A

Superficial: <7 days

Superficial partial thickness: 7-21 days

Deep partial thickness: 21-35 days

Full thickness: >30 days

Full thickness (to bone, muscle, subcutaneous): N/A

30
Q

What is an abrasion?

A
  • Wound caused by friction to the skin’s surface
  • May be superficial or partial thickness

Ex: skinned knee, road rash, floor burn, raspberry

31
Q

What do abrasions look like?

A
  • May or may not be contaminated
  • Mild, stinging sensation
  • Light to mod bleeding
  • Rarely progress to be chronic wounds
  • Risk for infection if patient is older or immunocompromised
32
Q

Which interventions should be used with abrasions?

A
  • Irrigate with water or saline
  • Selective or non-selective debridement
  • Clean wounds should be covered with a moisture-retentive dressing
  • Contaminated wounds should use antimicrobial and gauze
  • Patient can shower but not bathe/swim until skin barrier is restored

Potential dressings: Film + Gauze

33
Q

What is a laceration?

A
  • Caused by cutting or tearing of the skin surface
  • Ranges from partial thickness to deep structures
  • Smooth or irregular
  • Varying degrees of contamination
  • May bleed profusely
34
Q

Which interventions should be used with lacerations?

A
  • Clean, minor wounds do not require tetanus prophylaxis (puncture wounds sometimes do)
  • Monitor for infection and dehiscence
  • May shower but not bathe or swim without an occlusive dressing
  • Excessive bleeding would be referred to emergency care facility
35
Q

What is a skin tear?

A
  • Traumatic wound resulting from shear or friction forces that separate the epidermis and dermis
  • Partial thickness
  • Extremely common and typically avoidable
  • Most common on arms, hands, pretibial region
  • Most common with elderly individuals
36
Q

What does a skin tear look like?

A
  • Linear tear or flap
  • Wound edges can be approximated and may have tissue defect
  • Slight serous drainage
  • Minimal bleeding
  • Minimal pain
37
Q

Which interventions should be used with skin tears?

A
  • Irrigate with saline or water
  • Treat with skin sealant
  • Moisture retentive dressing (hydrogel, gauze)
  • Avoid adhesives
  • Typically heal without complication
  • Watch for infection (especially in the elderly)
38
Q

Describe surgical wounds

A
  • Keep clean and dry for 24-48 hours
  • Minimal draining/bleeding

Precautions:
- Sutures are more likely to cause inflammation than staples
- May have delayed sensitivity or allergic reaction to chemical agents

39
Q

Describe a dehisced surgical wound

A
  • Typically occurs 4-14 days after surgery
  • Present with .5-3.4% of abdominopelvic surgeries
  • High mortality rate
  • Contraindications include estim, pulse lavage, US

Patient factors include: malnutrition, diabetes, anemia, COPD, steroids, smoking

40
Q

T or F? Dehisced surgical wounds result from too much tension on the wound edges

A

True

41
Q

Describe radiation-induced skin damage

A
  • Those receiving both radiation and chemo are at greater risk for skin reactions
  • 95% of individuals who receive radiation get some type of skin damage
  • Inhibits inflammatory response and proliferative phase of healing

Patient factors: Age, comorbidities, meds, nutrition, hydration, immune function

42
Q

What do radiation-induced skin reactions look like?

A
  • Ranges from dermatitis to full thickness tissue loss
  • Begins as early as 2-3 weeks of treatment start date (can last up to 4 weeks after finishing)
  • Mild reactions include inflammation, slight erythema, local edema
  • Dry, scaly, itchy, hyperpigmented skin due to sebaceous glands
  • Late tissue injury causes radiation fibrosis
  • Ulcers may occur up to an average of 9 years later
43
Q

Describe the grading scale of radiation-induced skin reactions

A

Grade 1:
- Faint erythema
- Decreased sweating response
- Epilation
- Dry desquamation

Grade 2:
- Bright erythema
- Tender to touch
- Mod edema
- Moist desquamation

Grade 3:
- Moist desquamation with pitting edema

Grade 4:
- Ulceration or necrosis

44
Q

Which interventions should be used with radiation-induced skin reactions?

A
  • Protect from mechanical forces (shear, friction, pressure)
  • Avoid perfumes
  • Should wear loose fitting clothing
  • Washing the area w water and maybe mild soap
  • Moisturize the intact skin
  • Desquamation benefits from silver dressing
45
Q

List the do’s and dont’s for patients with irritated skin

A

Do
- Perform daily skin checks
- Bathe daily or less often using a mild soap
- Protect the skin
- Drink plenty of non-caffeinated, non-alcoholic fluids
- Apply sunscreen to areas with radiation fibrosis

Don’t
- Wear constrictive clothing
- Scratch skin even if itchy
- Use a hot tub
- Use adhesive bandages
- Massage during active treatment

46
Q

What is pyoderma gangrenosum?

A
  • Noninfectious, progressive necrotizing skin condition
  • 75% of patients have a systemic inflammatory condition

Presentation:
- Begins as a small, painful papule, vesicle or pustule on LE or trunk
- Generally a cluster of ulcerations that rapidly expand
- Progresses to full thickness ulcerations with irregular, purple borders
- Undermining and lack of dermal support lead to epidermal necrosis
- Differential diagnosis includes cancer, vasculitis, primary infection, drug induced skin reaction, spider bite, chronic VI

Takes 1-3 years to heal

47
Q

Which interventions are used for pyoderma gangrenosum?

A
  • Medications
  • Corticosteroids
  • Local wound care
48
Q

T or F? Pyoderma gangrenosum is slow wound healing (69% of wounds resolve after 1 year)

A

True

49
Q

T or F? Pyoderma gangreneosum recurrence is common

A

True

50
Q

What type of wound is caused by friction to the skin’s surface?

A

Abrasion

51
Q

Patients with abrasions or lacerations are advised to not do what

A

Take baths or go swimming without an occlusive dressing

52
Q

Which population is most vulnerable to skin tears?

A

Infants and the elderly

53
Q

Which modalities are contraindicated for dehisced (broken) surgical wounds

A
  • EStim
  • US
  • Pulse lavage (w/ suction)

Fall 2024: Integumentary Systems (11 decks)

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