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PT Exam - 1 > Integ Exam Intro- Class 3 > Flashcards

Integ Exam Intro- Class 3 Flashcards

1
Q

when did PT get involved with wounds

A

first and second world wars

were called reconstruction aides

primarily infected gun shot wounds

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2
Q

role of PT

A

sharp debridement

modalities

dressing selection

compression therapy

fxnal mobility

education

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3
Q

our role is

A

fxnal based

wound management

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4
Q

role –> fxnal based

A

biomechanics and fxnal mobility

strengthening and ROM

ADLs

discharge planning

pt education

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5
Q

biomechanics and fxnal mobility

A

WB considerations

mobility considerations

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6
Q

wound management –> role

A

wound assessments and interventions

pt eduacation

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7
Q

wound assessments and interventions

A

wound bed prep

dressing recommendations

wound care modalities

compression therapy

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8
Q

wound bed prep

A

debridement

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9
Q

layers of the skin

A

epidermis

dermis

subcutaneous tissue

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10
Q

fxn of the skin

A

protective

immunological

homeostasis

thermoregulation

neurosensory

social-interaction

metabolist

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11
Q

partial thickness would

A

includes the epidermis and part of the dermis

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12
Q

full thickness wound

A

through dermis

may extend into subcutaneous tissue, muscle and bone

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13
Q

wound

A

structural or physiological disruption of skin that incites normal or abnormal repair responses

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14
Q

acute wounds

A

heal in a timely manner

go through an expected course of tissue repair

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15
Q

chronic wounds

A

fail to heal in an expected time frame

arterial, venous, neuropathic nature

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16
Q

types of wound repair

A

primary intention

secondary intention

tertiary intension

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17
Q

primary intention

A

surgical intervention to heal a wound

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18
Q

secondary intension

A

our body heals on its own

the body granulates and create scar tissue on its own

epithelization to resurface the wound

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19
Q

tertiary intention

A

wound is left open for a reason

left open for 4-5 days

then cleaned out again and sewed back up

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20
Q

reasons to leave a wound open –> tertiary

A

allow infection, inflammation and moisture to leave the wound

avoid tension necrosis

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21
Q

all 3 types of healing…

A

go through the same 3 phases of healing

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22
Q

whats the difference b/w the 3 types of healing

A

scar tissue formation

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23
Q

phases of healing

A

inflammatory

proliferative

maturation

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24
Q

inflammatory phase –> signs

A

edema

erythema

warmth

pain

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25
inflammatory phase characterized by
vascular and cellular response
26
inflammatory phase has a predominance of
leukocytes --> macrophages
27
proliferative phase
formation of granulation tissue and reepithelization
28
the proliferative phase includes
wound contraction
29
maturation phase
collagen fibers reorganize scar strength 70-80% of normal skin
30
vascular response --> inflammatory phase
platelets activate fibrinogen is converted vasoconstriction
31
what is released during the vascular phase of the inflammatory phase
chemoattractant
32
_______ of leukocytes --> vascular response
margination
33
macrophages.... --> vascular response
predominate
34
the proliferative phase is predominated by
cellular activity to repair traumatized tissue
35
what cellular activity repairs tissue --> proloferative phase
neovascularization fibroplasia re-epithelization
36
neovascularization --> proliferative phase
growth factors, low O2 and lactic acid promote angiogenesis
37
fibroplasia --> proliferative phase
formation of granulation tissue
38
formation of granulation tissue --> fibroplasia
dense vascular network fibroblasts and ground substance (extracellular matrix) --> matrix contains collagen and elastin
39
proliferative phase includes
wound contraction
40
proliferative phase --> re-epithelialization
keratinocyte migration form wound edge --> within wound
41
combination of granulation and epithelium tissue
biochemically correct wound environment
42
biochemically correct wound environment
the wound will close keep it moist (do not let it dry out) and keep a dressing on it
43
how long does the remodeling phase last
up to a yr or more
44
in the remodeling phase --> fibers are
reoriented
45
what happens to the extracellular matrix in the remodeling phase
consistency changes
46
wound strength --> remodeling phase
reaches up to 80% of pre-injured state
47
factors impeding wound healing
local factors clinician induced factors systemic factors
48
local factors
bio-burden tissue perfusion wound desiccation foreign bodies pressure shear friction
49
bio-burden
bacterial loads: 10^5/gm of tissue = clinical infection
50
tissue perfusion
macro v. micro circulation
51
shear
undermining
52
systemic factors
stress situations obesity temp comorbidities nutrition age
53
stress situations
psychological stress, pain or noise
54
obesity
increased complications --> increased infections and days on a vent --> decreased tissue perfusion and oxygenation immobility and prolonged hospitalization
55
temp
hypothermic stress --> thermoregulatory vasoconstriction
56
comorbidities
DM immunocompromised conditions cancer arterial/venous insufficiency
57
nutrition
essential for body's response to infection and injury
58
serum albumin
< 3.5 g/dL gives picture of the past three weeks on nutrition decreases as we get older affected by dehydration
59
prealbumin
< 18g/ dL not eating enough, gives picture of last 2-3 days little more accurate
60
elderly pts --> nutrition
@higher risk from decreased appetite difficulties with eating and swallowing
61
age --> decreased
healing response cohesion b/w epidermal and dermal layers skin moisture
62
clinical consideration --> age
dressing frequency selective v. non-selective decreased cytotoxic agents
63
clinician induced factors
meds topical agents over utilization dressing poor infection control
64
meds
antibiotics steroids NSAIDS immunosuppressing drugs
65
topical agents
bacteriostatic and cytotoxic (to fibroblasts)
66
over utilization
whirlpool electrical stimulation intermittent pneumatic compression therapy
67
dressings
wet --> dry dressings synthetic dressings dressings adhesives
68
wet--> dry dressings
for mechanical debridement only when packed to firmly pieces of gauze fibers left behind when gauze allowed to dry out
69
synthetic dressings
when used improperly
70
dressing adhesives
may cause skin tears
71
poor infection control
clinicians who dont wash their hands no gloves donned poor sterile technique
72
wound infections will
delay healing
73
how do wound infections delay healing
affecting collagen metabolism -decreases synthesis -increases lysis of collagen
74
effects of wound infections are related to
toxins enzymes wastes from bacteria deposited into environment
75
infections decrease
amount of O2 for collagen synthesis and for oxidative killing by neutrophils
76
goal for health care team
to prevent bacterial contamination of wounds to deal with present infections to prevent contamination of themselves and of other pts when caring for other pts with infections
77
local infection
erythema or skin discoloration edema warmth induration increased pain purulent wound exudate w/ or w/o foul odor
78
systemic infection
increased temp increased WBCs confusion or agitation red streaks from wound tachycardic tachypneic hypotension
79
inflamed v. infected --> erythema
inflamed --> well defined borders, not as intense infected: intense discoloration, well demarcated and distinct borders, red stripes and streaking
80
inflamed v. infected --> temp
inflamed: elevated locally infected: systemic fever
81
inflamed v. infected --> exudate character
inflamed: bleedings and serosanguinous --> serous infected: serous and seropurulent --> purulent
82
inflamed v. infected --> exudate amount
inflamed: usually minimal, decreases in 3-5 days infected: mod-heavy and remains high
83
inflamed v. infected --> exudate odor
inflamed: +/- due to necrotic tissue infected: specific to pathogen
84
inflamed v. infected --> pain
inflamed: variable infected: persistent
85
inflamed v. infected --> edema and induration
inflamed: slight swelling, firmness at wound edge infected: edema and induration is localized and with warmth

PT Exam - 1 (15 decks)

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