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Integumentary Mid Term > Impairment of Integ System > Flashcards

Impairment of Integ System Flashcards

1
Q

True/ False: The skin is the largest organ of the body?

A

True

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2
Q

What are 6 main functions of skin?

A
  1. regulate body temp
  2. protection from trauma
  3. prevention of fluid loss or gaim
  4. prevention of bacteria and viral penetration
  5. sensory reception
  6. produces vit D- helps GI system absorb calcium for bone health
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3
Q

What are four major layers of skin?

A
  1. epidermis
  2. dermis
  3. basement membrane
  4. subcutaneuous
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4
Q

What is the role of epidermis?

A

protection, plays role in Vit D synthesis

it is avascular

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5
Q

What are 4 primary cells of epidermis?

A
  1. kerintinocytes- 90% (proteins)
  2. melanocytes- pigment and protection
  3. merkel cells- mechanoreceptors
  4. langerhans- help fight infection
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6
Q

What are layers of epidermis?

A
  1. stratum basale
  2. spinosum
  3. granulosum
  4. lucidum- toughest
  5. corneum
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7
Q

How long does it take cells to go from corneum to basale?

A

14 days

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8
Q

What are characteristics of dermis?

A

highly vascularized containing superficial lymphatic system and sensory organs

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9
Q

What are 2 layers of dermis?

A
  1. papillary dermis- made of collagen and elastin

2. reticular dermis- contains appendages (80% of dermis)

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10
Q

What are four appendages?

A

hair follicles, sabaceous (oil), sudoriferous glands (sweat), nails

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11
Q

What cells compose dermis?

A

fibroblast (make collagen and elastin), macrophages, mast cells (open cells and vascular system), WBC (neutrophils)

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12
Q

What should healthy dermis look like?

A

red, pink, shiny, moist

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13
Q

What is characteristics of subcutaneous layer?

A

energy storage centers, anchors dermis, supports muscles bone, fascia, highly vascular

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14
Q

What is goal of normal wound healing?

A

striving to achieve homeostasis

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15
Q

What are potential barriers to wound healing?

A
  1. co morbidity
  2. meds (steroids)
  3. nutrition
  4. age
  5. stress
  6. body size
  7. infxn
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16
Q

What are the three phases of wound healing?

A
  1. inflammation
  2. proliferation
  3. maturation and remodeling
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17
Q

Before stage 1 what is vascular response?

A

attempt for hemostasis, vasoconstriction, platelet/clotting factors, fibrin mesh laid down

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18
Q

How long is inflammatory stage?

A

10 days

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19
Q

What are characteristics of this stage?

A

redness, heat, edema, pain and loss of function

histamine released which expands cells hitting pain receptors

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20
Q

What are the goals in inflammatory stage?

A

provide hemostasis, bring neutrophils and macrophages (eaters) into wound, provide clean wound site for tissue restoration

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21
Q

What is the main reason the inflammatory is interrupted?

A

vascular insufficiency which limits amount of O2 and other nutrients to area, also limits what current cells can do that are there

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22
Q

T/F: Macrophages, growth hormones and autolytic debridement all occur in inflammatory story?

A

True

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23
Q

What are characteristics of proliferative stage?

A

overlaps for Inflam stage, starts 3-5 post injury and last 3 + weeks

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24
Q

What is goal of prolif stage

A

fill in wound defect with new granulation tissue and restore integrity of skin

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25
Q

What are four processes in this stage?

A
  1. angiogenisis
  2. collegen synthesis
  3. contraction
  4. epitheliazation
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26
Q

What are angioblasts?

A

cells in blood vessel formation

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27
Q

what is a myofibroblast?

A

in between fribroblast and smooth muscle, actin rich

helps with contraction of wound

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28
Q

What happens during angiogenesis?

A

granulation tissue is developed, color of wound is pink to bright red, very fragile needs protection

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29
Q

What happens during collagen synthesis?

A

fibroblasts produces extracellular matrix and collegen and fill wound bottom up

this eventually will replace granulation with scar tissue

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30
Q

What happens during contraction stage?

A

process of pulling margains of wound close together

too much contraction can cause contracture

needs a warm high O2 environment

31
Q

What type of contraction occurs faster?

A

linear faster than circular

32
Q

What is zinc good for?

A

a

33
Q

Iron?

A

b

34
Q

copper?

A

C

35
Q

vitamin c?

A

d

36
Q

What happens in epitheliazation stage stage?

A

keratinocytes migrate in a single layer across wound, think of ends of wounds sliding across wound surface

cells cannot migrate over dead tissue

37
Q

What is goal of epi stage?

A

close wound, not healed but closer

38
Q

How long should an acute surgical wound complete proliferation stage of wound healing?

A

4 weeks, closed not healed

39
Q

What happens if the wound becomes chronic during epi stage?

A

lack or moisture causes rolled edges

there can also be too much or too little fluid

40
Q

What are characteristics of maturation stage?

A

final wound healing phase, begins when granulation tissue is formed during prolif stage and continues 1-2 post injury

41
Q

What is the strength of the scar tissue post injury?

A

80% as strong as original

42
Q

What type of collagen is used during remoldeling?

A

starts with type 3 and then is replaced by type 1

43
Q

What happens if there is too much collagen synthesis?

A

hypergranulation can occur in forms of hypertrophic (puffy) or keloid scars (scar outside border of original wound)

44
Q

What do most scar changes occur?

A

within first 6-12 months

45
Q

How can a PT check if scar is healing properly?

A

it should move in every direction

46
Q

What is collegen ratio in normal skin?

A

4:1 type 1/3

hypertrophic- 2:1 1/3

47
Q

What is dehiscense?

A

insufficient scar formation- due to impaired collegan synthesis

48
Q

What color should scar mature into?

A

high vascular to low vascular

49
Q

what can’t a scar do if appendages were damage?

A

sweat, have hair, secrete oil and no senseation

50
Q

What can help with scar management?

A

silver nitrate sticks ( cuts back hypergranulation), compression, massage, e stim

51
Q

What can be done to patient to increase wound healing?

A

increase their circulation, ventilation, watch nutrition and treat co morbidities

52
Q

What factors related to the wound affect healing?

A

mechanism of onset, time since onset, location, dimensions, temp, hydration, necrotic tissue, infxn, edema

53
Q

Why is oxygen so important to wound healing?

A

fibroblasts are oxygen sensitive, and healing is energy dependent

54
Q

Which stage of healing is most reliant on O2?

A

proliferative stage has increased metabolism and protein synthesis

55
Q

What level of PO2 is needed for collagen synthesis

A

atleast over 40 mmHG, anything under the wound is at great risk for infxn

56
Q

What nutrient is most important for wound healing?

A

protein, pts should be having 1.5 kg/ day

carbs also vital for energy

57
Q

What should pts albumin levels be?

A

3.5 mg/kg

58
Q

What is vitamin C useful for with wound healing?

A

collagen synthesis, minimize scarring

59
Q

B12?

A

helps with O2 uptake

60
Q

Folic acid?

A

RBC production

61
Q

vit A?

A

inflammation response

62
Q

Vit E?

A

helps break down fat for energy

63
Q

Zinc?

A

WBC count

64
Q

Iron?

A

helps with RBC count which increases O2 transport

65
Q

Arginine?

A

triggers growth hormone

66
Q

What is a superficial wound?

A

superficial skin lesion only penetrating dermis like a scrape or sunburn

usually self healing

67
Q

What is a partial thickness wound?

A

penetrates through epidermis and top portion dermis like a blister, heals primarily by epithelization

68
Q

What is a full thickness wound?

A

penetrates through epidermis, dermis and extends into subcutaneous tissue

heals by secondary intention-contracture, epitheliazation, granulation and scar tissue development

69
Q

What is a primary wound closure?

A

aka primary intention

usually a surgical wound closed by sutures or staples

closes within 7 days with little to no scarring

70
Q

What happens if primary closure is opened?

A

usually has to close by secondary intention

71
Q

What is secondary closure?

A

heals from bottom up and includes granulation etc. involves scar formation

72
Q

For secondary closure at what time period should a wound have substantial healing?

A

after 2 weeks wound should atleast be smaller

73
Q

What is delayed primary closure?

A

wound heals by secondary closure and then is closed by primary closure

74
Q

What are reasons for delayed closure?

A

large amount of tissue loss, large amount of swelling, contamination, high infxn risk

Integumentary Mid Term (11 decks)

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