Impairment of Integ System Flashcards
True/ False: The skin is the largest organ of the body?
True
What are 6 main functions of skin?
- regulate body temp
- protection from trauma
- prevention of fluid loss or gaim
- prevention of bacteria and viral penetration
- sensory reception
- produces vit D- helps GI system absorb calcium for bone health
What are four major layers of skin?
- epidermis
- dermis
- basement membrane
- subcutaneuous
What is the role of epidermis?
protection, plays role in Vit D synthesis
it is avascular
What are 4 primary cells of epidermis?
- kerintinocytes- 90% (proteins)
- melanocytes- pigment and protection
- merkel cells- mechanoreceptors
- langerhans- help fight infection
What are layers of epidermis?
- stratum basale
- spinosum
- granulosum
- lucidum- toughest
- corneum
How long does it take cells to go from corneum to basale?
14 days
What are characteristics of dermis?
highly vascularized containing superficial lymphatic system and sensory organs
What are 2 layers of dermis?
- papillary dermis- made of collagen and elastin
2. reticular dermis- contains appendages (80% of dermis)
What are four appendages?
hair follicles, sabaceous (oil), sudoriferous glands (sweat), nails
What cells compose dermis?
fibroblast (make collagen and elastin), macrophages, mast cells (open cells and vascular system), WBC (neutrophils)
What should healthy dermis look like?
red, pink, shiny, moist
What is characteristics of subcutaneous layer?
energy storage centers, anchors dermis, supports muscles bone, fascia, highly vascular
What is goal of normal wound healing?
striving to achieve homeostasis
What are potential barriers to wound healing?
- co morbidity
- meds (steroids)
- nutrition
- age
- stress
- body size
- infxn
What are the three phases of wound healing?
- inflammation
- proliferation
- maturation and remodeling
Before stage 1 what is vascular response?
attempt for hemostasis, vasoconstriction, platelet/clotting factors, fibrin mesh laid down
How long is inflammatory stage?
10 days
What are characteristics of this stage?
redness, heat, edema, pain and loss of function
histamine released which expands cells hitting pain receptors
What are the goals in inflammatory stage?
provide hemostasis, bring neutrophils and macrophages (eaters) into wound, provide clean wound site for tissue restoration
What is the main reason the inflammatory is interrupted?
vascular insufficiency which limits amount of O2 and other nutrients to area, also limits what current cells can do that are there
T/F: Macrophages, growth hormones and autolytic debridement all occur in inflammatory story?
True
What are characteristics of proliferative stage?
overlaps for Inflam stage, starts 3-5 post injury and last 3 + weeks
What is goal of prolif stage
fill in wound defect with new granulation tissue and restore integrity of skin
What are four processes in this stage?
- angiogenisis
- collegen synthesis
- contraction
- epitheliazation
What are angioblasts?
cells in blood vessel formation
what is a myofibroblast?
in between fribroblast and smooth muscle, actin rich
helps with contraction of wound
What happens during angiogenesis?
granulation tissue is developed, color of wound is pink to bright red, very fragile needs protection
What happens during collagen synthesis?
fibroblasts produces extracellular matrix and collegen and fill wound bottom up
this eventually will replace granulation with scar tissue
What happens during contraction stage?
process of pulling margains of wound close together
too much contraction can cause contracture
needs a warm high O2 environment
What type of contraction occurs faster?
linear faster than circular
What is zinc good for?
a
Iron?
b
copper?
C
vitamin c?
d
What happens in epitheliazation stage stage?
keratinocytes migrate in a single layer across wound, think of ends of wounds sliding across wound surface
cells cannot migrate over dead tissue
What is goal of epi stage?
close wound, not healed but closer
How long should an acute surgical wound complete proliferation stage of wound healing?
4 weeks, closed not healed
What happens if the wound becomes chronic during epi stage?
lack or moisture causes rolled edges
there can also be too much or too little fluid
What are characteristics of maturation stage?
final wound healing phase, begins when granulation tissue is formed during prolif stage and continues 1-2 post injury
What is the strength of the scar tissue post injury?
80% as strong as original
What type of collagen is used during remoldeling?
starts with type 3 and then is replaced by type 1
What happens if there is too much collagen synthesis?
hypergranulation can occur in forms of hypertrophic (puffy) or keloid scars (scar outside border of original wound)
What do most scar changes occur?
within first 6-12 months
How can a PT check if scar is healing properly?
it should move in every direction
What is collegen ratio in normal skin?
4:1 type 1/3
hypertrophic- 2:1 1/3
What is dehiscense?
insufficient scar formation- due to impaired collegan synthesis
What color should scar mature into?
high vascular to low vascular
what can’t a scar do if appendages were damage?
sweat, have hair, secrete oil and no senseation
What can help with scar management?
silver nitrate sticks ( cuts back hypergranulation), compression, massage, e stim
What can be done to patient to increase wound healing?
increase their circulation, ventilation, watch nutrition and treat co morbidities
What factors related to the wound affect healing?
mechanism of onset, time since onset, location, dimensions, temp, hydration, necrotic tissue, infxn, edema
Why is oxygen so important to wound healing?
fibroblasts are oxygen sensitive, and healing is energy dependent
Which stage of healing is most reliant on O2?
proliferative stage has increased metabolism and protein synthesis
What level of PO2 is needed for collagen synthesis
atleast over 40 mmHG, anything under the wound is at great risk for infxn
What nutrient is most important for wound healing?
protein, pts should be having 1.5 kg/ day
carbs also vital for energy
What should pts albumin levels be?
3.5 mg/kg
What is vitamin C useful for with wound healing?
collagen synthesis, minimize scarring
B12?
helps with O2 uptake
Folic acid?
RBC production
vit A?
inflammation response
Vit E?
helps break down fat for energy
Zinc?
WBC count
Iron?
helps with RBC count which increases O2 transport
Arginine?
triggers growth hormone
What is a superficial wound?
superficial skin lesion only penetrating dermis like a scrape or sunburn
usually self healing
What is a partial thickness wound?
penetrates through epidermis and top portion dermis like a blister, heals primarily by epithelization
What is a full thickness wound?
penetrates through epidermis, dermis and extends into subcutaneous tissue
heals by secondary intention-contracture, epitheliazation, granulation and scar tissue development
What is a primary wound closure?
aka primary intention
usually a surgical wound closed by sutures or staples
closes within 7 days with little to no scarring
What happens if primary closure is opened?
usually has to close by secondary intention
What is secondary closure?
heals from bottom up and includes granulation etc. involves scar formation
For secondary closure at what time period should a wound have substantial healing?
after 2 weeks wound should atleast be smaller
What is delayed primary closure?
wound heals by secondary closure and then is closed by primary closure
What are reasons for delayed closure?
large amount of tissue loss, large amount of swelling, contamination, high infxn risk
