integ/lymphatic Flashcards
1
Q
this is the outer most layer of the skin and is avascular and water-resistant
A
epidermis
2
Q
this is 20-30x thicker than the epidermis. contains blood vessels and lymphatics, nerves, and nerve endings, and sensory neurons, hair follicles, sweat glands, sebaceous glands and nails
A
dermis
3
Q
this layer consists of dead keratinized cells (is the horny layer)
A
stratum corneum
4
Q
this is found in areas with thicker epidermis (ex: palms, soles of feet)
A
stratum lucidum
5
Q
this produces keratin
A
stratum granulosum
6
Q
this provides strength and flexibility
A
stratum spinosum
7
Q
this is where new epithelial cells are produced
A
stratum basale
8
Q
this is the underlying layer of connective tissue, contains blood vessels, lymphatics which nourish the epidermis
A
dermis
9
Q
panincian corpusules are found where
A
reticular layer of the dermis
10
Q
these are all examples of accessory structures
A
hair follicles, nails, sebaceous glands, sweat glands
11
Q
this functions as calorie reserve, shock absorption and padding and is not well vascularized
A
adipose
12
Q
this is wound closure by use of sutures or staples
A
primary intention
13
Q
this is healing by natural wound closure by the healing cascde
A
secondary intention
14
Q
debridement is an example of this
A
tertiary healing or delayed primary intention
15
Q
this method is used in contaminated wounds with excessive tissue loss
A
delayed primary intention
16
Q
loss of epidermis only
A
superficial wound
17
Q
loss of epidermis and dermis
A
partial thickness
18
Q
loss of dermis, subcutaneous fat and sometimes bone
A
full thickness
19
Q
skin appendages are intact (hair follicles and pores) with this type of wound
A
partial thickness
20
Q
this type of wound heals primarily by epithelialization
A
partial thickness
21
Q
these wounds heal by contraction and scar tissue formation
A
full thickness wounds
22
Q
when healed, these types of wounds lack tensile strength
A
full thickness
23
Q
this is a chemical mediator released by injured mast cells - it cause vasodilation and increased capillary permeability
A
histamine
24
Q
histamine causes what
A
vasodilation and increased capillary permeability
25
this is necessary to kickstart the healing cascade
inflammation! ! ! !
26
these stimulate angiogenesis
growth factors
27
this manufactures collagen
fibroblasts ?
28
this requires a moist environment
migration of epithelial cells
29
red, beefy, glossy slightly bumpy area
granulation tissue
30
this occurs when granulation tissue rises above the level of the surrounding skin
hypergranulation
31
when new epidermal cells touch one another, cell division stops due to
contact inhibition
32
this is when the wound bed is too dry
desiccation
33
this is when the wound bed has too much moisture
maceration
34
this is the most common type of burn
thermal
35
this type of burn only involves the superficial layers of the epidermis - skin will appear pink or bright red and it will blanch when pressure is applied
epidermal burn
36
this involves epidermis and top layer of dermis and is extremely painful because of exposed nerve endings. it will blister and cause moistening/weeping skin
superficial partial thickness burn
37
this type of burn affects epidermis, superficial dermis, and skin appendages & will cause damage to sensory nerves, does not blanch under pressure, no blisters
deep partial thickness burn
38
this may not be as painful as superficial second degree burns
deep partial thickness burn
39
epidermis and dermis are affected, complete destruction of sweat glands and sebaceous glands, destruction of sensory nerves
full thickness burns
40
this degree burn has a high risk of hypertrophic scarring
full thickness burn
41
this burn will have charred black skin and is usually caused by electrical injury - underlying muscle, tendon, ligament and bone can be affected
subdermal burn
42
central portion of wound, irreparable cell damage, may expand up to 48 hours after initial injury
zone of coagulation
43
zone of cellular injury, decreased tissue perfusion, can form tiny emboli that further impede
zone of stasis
44
outermost edge of tissue damage, minimal tissue injury, redness due to vasodilation
zone of hyperemia
45
abnormal growth of bone tissue imbedded within soft tissue
heterotypic ossification
46
this begins at the time of injury and concludes with restoration of the capillary permeability 48-72 hours
emergent
47
this begins with initiation of decrease in fluids & ends when capillary integrity returns to near normal, large fluid shifts have decreased
resuscitation
48
pain rating scales used as outcome measures in burn assessment
VAS
0 to 10 pain scale
Brief pain inventory
McGill Pain Questionnaire
49
surgical incision thorugh eschar into subcutaneous tissue, releases inelastic necrotic tissue that may compromise circulation
escharotomy
50
this is often seen with circumferential burns
escharotomy
51
muscle/bone is pulled in one direction while surface tissues are pulled in an opposite direction
shear
52
this leads to distortion/damage to blood vessels, usually at deep tissue level
shear
53
why is it important to know about that history of pressure injuries
because if hx of pressure injury - after pressure injury they never rully regain skin thickness
54
this is a tool that utilizes six subscales in order to assess a pressure injury
braden scale
55
this looks at five categories in order to assess a pressure ulcer
norton pressure ulcer scale
56
this is an assessment tool that takes DM, HTN, HCT, hemoglobin, albumin and fever into account
norton pressure ulcer scale
57
how often should pts turn when lying down in order to prevent pressure ulcer
2 hours
58
how often should pts shift to prevent pressure ulcer when sitting
every 15 minutes
59
when a pt is side lying they should avoid direct pressure on what
trochanter
60
not yet an open wound
nonblanachable erythema present
changes in skin texture and consistency is boggy
Stage I pressure injury
61
partial thickness that affects dermis and part of dermis
| WILL include BLISTERS
stage II pressure injury
62
deep ulcer that has extensive necrosis
FULL thickness
Epidermis, dermis, and subcutaneous tissue involves - extends to BUT not through the subcutaneous fascia
Stage III pressure injury
63
FULL thickness, DEEP ulceration may have undermining.... involves epidermis, dermis, subcutaneous tissue through the fascia to muscle, tendon, jt capsule and sometimes bone
Stage IV pressure injury
64
this has visual signs of necrotic tissue but no opening
suspected deep tissue injury
65
this is rated 0 to 7 based on observation of ulcer, higher scores represent severity of wound. this allows clinician to chart progress by subtracting score at reassessment from score at initial evaluation
sessing scale
66
this tool has 13 items rated from 1 to 5
pressure score status tool
67
this type of debridement removes necrotic tissue only, leaves uninvolved skin intact
selective
68
this involves the use of semipermeable flims, absorbent dressings
autolytic debridement
69
this involes the use of sharp or hydrotherapy
mechanical debridement
70
diabetic ulcers generally occur where
plantar aspect of the foot (but can also be found on the toes and dorsum depending on weight bearing load)
71
this is the primary risk factor for development of diabetic foot ulcers
DPN (diabetic peripheral neuropathy)
72
contributing factors to the onset of DPN
fluctuations in glucose levels, duration of DM, age, tobacco and/or alcohol use, patient height and gender, prolonged hyperglycemia
73
this can disrupt cellular metabolisms with the neurons
hyperglycemia
74
this involves decreased perspiration and sebaceous secretion in the distal lower extermities and feet
autonomic neuropathy
75
with this, skin is prone to dryness, cracks, callus formation and breakdown
autonomic neuropathy
76
this affects intrinsic muscles of the foot
motor neuropathy
77
these areas are prone to callus and are sites of breakdown
metatarsal heads, interdigitial areas
78
people with this are prone to fungal infections and deformities of toe nails
DM
79
this is a scale that uses grads from 0-5 in order to assess wounds
wagner scale
80
localized gangrene - no more than 2 digits
grade 4 on wagner scale
81
most likely spots for diabetic ulcers
midfoot, heel, metatarsal heads
| can sometimes occur in between toes & at dorsum of toes (IP jts)
82
contraindications to total contact casting
significant PVD
Infected wounds
osteomyelitis
83
these are caused by blockage and/or insuffieciency
arterial ulcers
84
these can be causes of arterial ulcers
trauma, atheroscleoriss, thrombosis
85
pt has intermitten claudication, rubor of dependency, absence of hair, trophic changes to nails, pain worse with elevation & better in dependent position
arterial insufficiency
86
ABI score when arterial circulation is normal
1.0
87
causes of venous ulcers
vascular congestion, chronic edema, impaired venous return
88
these wounds are typically located below the knee in gaitor area
venous ulcers
89
medications that can cause LE edema
calcium channel blockers, corticosteroids, estrogen, progesterone, testosterone, NSAIDs, antihypertensive, hydralazine hydocholoride
90
normal venous filling time
5 to 15 seconds
91
treatment of venous hypertension
must be 18 cm above level of heart
| 20-30 mins at a time for a total of 2 hours a day
92
this is a paste bandage - gauze impregnated with zinc and calamine
UNNA's boot
93
contraindication for compression therapy
CHF
94
caution for compression therapy
renal insufficiency
95
ABI less than .8 suggests what
arterial involvement
96
swelling of any part of the body that happens as a side effect of tx for different types of cancer
lymphedema
97
swelling that occurs in areas of inflammation of injury
edema
98
lymph vessels take how much percent of blood from extremities back to the hear
10%
99
three primary functions of the lymphatic system
maintenance of fluid balance
fascilitation of the absorption of dietary fats fromt he GI tract to the bloodstream for metabolism or storage
third is the enhancement and facilitation of the immune system
100
increased lymphatic load on a healthy lymphatic system
dynamic insufficiency
101
normal amount of fluid, but an impaired transport capacity
mechanical insufficiency
102
combined insufficiency
increased load on a damaged lymphatic system
103
congenital lymphedema classification - individual is born with malfunctioning lymphatic system
primary
104
this classification of lymphedema occurs after there is damage to the lymph system
secondary
105
this is a disorder characterized by symmetric enlargement of the legs due to deposts of fat beneath the skin, mostly affects women, cause is unknown
lipedema
106
symptoms of lymphedema
pins and needles, decreased flexibility/strength, one limb looks larger than others, painful swelling, decreased flexibility/strength in the affected limb
107
symptom of this includes milky fluid leaked from skin
lymphedema
108
positive stemmers sign is a sign of this
lymphedema
109
this is assessed by pulling up on the skin at the base of the second toe or finger
stemmer sign
110
a positive test occurs when the skin is unable to be pulled up at second toe or finger
stemmer sign
111
this is the most effective and least invasive approach to the treatment of lymphedema
complete decongestive therapy
112
CDT standard of care includes what four componenets
1. meticulous skin care and hygiene
2. manual lymph drainage techniques
3. multi-layered bandages
4. remedial exercises
113
objectives in the tx of lymphedema (CDT)
control and reduce swelling, prevent progression of lymphedema, prevent infection, improve the patient's overall quality of life
114
this tx of lymphedema involves specific manual hand movements that follow lymph pathways to facilitate the movement of fluid in lymph vessels
MLD manual lymph drainage
115
what immediately follows MLD tx
bandaging
116
these bandages prevent re-accumulation of lymph fluid in the tissues
low stretch bandages
117
these bandages do not stretch as much and only in one direction providing resistance against the working muscles
short stretch
118
when are bandages worn until
overnight until the next MLD session
119
these provide low resting pressure and high working pressure and are therefore ideal for tx of lymphedema
short stretch bandages
120
this helps to increase tissue pressure and causes a reduciton in filtration
MLB - multi layered bandaging
121
this helps to inhibit the re-accumulation of fluid
MLB
122
what type of exercise should you avoid with lymphedema
high intensity/high resistance exercises
123
when should you perform exercises for lymphedema
1-2x day WITH BANDAGE ON - recommend exercise moderately
124
this promotes lymph flow
active muscle pump
125
contraindications to manual lymphatic drainage
```
thrombosis
congestive heart failure (pt needs cardiac clearance)
acute infection
active disease w/o adjuvant therapy
arterial disease ABI .8 or below
```
126
edema is not visible of evident using limb measurements
stage 0 lymphedema
127
fluids starts to collect in the affected area and causes swelling - affeected area looks puffy
stage 1 lymphedema
128
limb elevation alone rarely reduces swelling - pitting is manifested
stage 2 lymphedema
129
extensive swelling present - tissue is fibrotic and hard and pitting is not possible
stage 3 lymphedema
130
wound that fails to heal after 3 months
chronic wound
131
cutaneous condition characterized by deposits of excessive amounts of collagen which gives rise to a raised scar - but not to the degree observed with keloids
hypertrophic scar
132
aggressive ulceration squamous cell carcinoma presenting in an area of previously traumatized chronically inflamed or scarred skin
marjolin's ulcer
133
channel that exists underneath the wound
sinus
134
dead space under sinus that joints together
tunneling
135
dead space with no direction
undermining
136
edges of wound have a rolled appearance
epibole
137
this occurs when something stops the cells from moving across the wound bed
epibole
138
these type of wound bends impair tissue repair
dry wound beds
139
TIME model for wound examination
tissue
infection/inflammation
moisture imbalance
Edge of wound
140
these are cytotoxic
antiseptics
141
wounds present bellow malleolus on foot/ankle
arterial wound
142
edema is present and there is high exudate with this type of wound
venous - it is worse at end of the day
143
how to palpate popliteal pulse
ask pt to flex their knee to roughly 60 keeping their foot on the bed, place both hands on the front of knee and place your fingers in the popliteal space
144
where do you palpate for resting capillary refill
distal toe
145
longer refill time for capillary refill test may indicate what
arterial insufficiency
146
this is the ratio of systolic BP at ankle compared to systolic BP in UE
ABI
147
normal ABI
1
148
this ABI value is considered significant for PAD
.8
149
3+ scale pitting edema
severe
150
moderate pitting edema
2+
151
wound will not heal with TcPO2 of this
less than 20 mmHg
152
with TcPO2 of less than 20 what will happen
wound will not heal
153
TcPO2 greater than 30 mmHg what will happen
wound should heal. safe for debridement
154
at this TcPO2 wound should heal and is safe for debridement
> 30
155
RED wound
pink granulation tissue, protect wound and maintain most environment
156
YELLOW wound
moist, yellow slough - remove exudate and debris, absorb drainage
157
BLACK wound
black, thick eschar firmly adhered - debride necrotic tissue
158
surface area of wound
length x width
159
where do you measure wound depth
at deepest region
160
with the clock method, what does 12 oclock usually correspond to
the pts head
161
wound tracing
planimetry
162
increase pain, change in exudate, odor are all signs of what
infection
163
signs of infection may be diminished in what conditions
steroid treatment, ischemia, malnutrition, neuropathy
164
for ulcers, failure to heal can be a sign of this
infection
165
this type of wound has an entry and exit point
chemical
166
RULE of nines
| head and neck
9%
167
anterior trunk rule of nines
18%
168
posterior trunk rule of nines
18%
169
bilateral anterior arm, forearm, and hand
9%
170
bilateral posterior arm, forearm, hand
19%
171
genital region
1%
172
bilateral anterior leg and foot
18%
173
bilateral posterior leg and foot
18%
174
anticipated deformity with burn on ankle
plantar flexion
175
anticipated deformity with burn on knee
flexion
176
anticipated deformity with burn on elbow
flexion and pronation
177
anticipated deformity with burn on hip
flexion and adduction
178
anticipated deformity with burn on hand and wrist
extension or hyperextension of MCP joints
179
anticipated deformity with burn on anterior chest and axilla
shoulder adduction, extension, and medial rotation
180
anticipated deformity with burn on anterior neck
flexion with possible lateral flexion
