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Pressure/Neuropathic ulcers > integ/lymphatic > Flashcards

integ/lymphatic Flashcards

1
Q

this is the outer most layer of the skin and is avascular and water-resistant

A

epidermis

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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

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3
Q

this layer consists of dead keratinized cells (is the horny layer)

A

stratum corneum

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4
Q

this is found in areas with thicker epidermis (ex: palms, soles of feet)

A

stratum lucidum

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5
Q

this produces keratin

A

stratum granulosum

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6
Q

this provides strength and flexibility

A

stratum spinosum

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7
Q

this is where new epithelial cells are produced

A

stratum basale

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8
Q

this is the underlying layer of connective tissue, contains blood vessels, lymphatics which nourish the epidermis

A

dermis

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9
Q

panincian corpusules are found where

A

reticular layer of the dermis

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10
Q

these are all examples of accessory structures

A

hair follicles, nails, sebaceous glands, sweat glands

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11
Q

this functions as calorie reserve, shock absorption and padding and is not well vascularized

A

adipose

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12
Q

this is wound closure by use of sutures or staples

A

primary intention

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13
Q

this is healing by natural wound closure by the healing cascde

A

secondary intention

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14
Q

debridement is an example of this

A

tertiary healing or delayed primary intention

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15
Q

this method is used in contaminated wounds with excessive tissue loss

A

delayed primary intention

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16
Q

loss of epidermis only

A

superficial wound

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17
Q

loss of epidermis and dermis

A

partial thickness

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18
Q

loss of dermis, subcutaneous fat and sometimes bone

A

full thickness

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19
Q

skin appendages are intact (hair follicles and pores) with this type of wound

A

partial thickness

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20
Q

this type of wound heals primarily by epithelialization

A

partial thickness

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21
Q

these wounds heal by contraction and scar tissue formation

A

full thickness wounds

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22
Q

when healed, these types of wounds lack tensile strength

A

full thickness

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23
Q

this is a chemical mediator released by injured mast cells - it cause vasodilation and increased capillary permeability

A

histamine

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24
Q

histamine causes what

A

vasodilation and increased capillary permeability

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25
Q

this is necessary to kickstart the healing cascade

A

inflammation! ! ! !

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26
Q

these stimulate angiogenesis

A

growth factors

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27
Q

this manufactures collagen

A

fibroblasts ?

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28
Q

this requires a moist environment

A

migration of epithelial cells

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29
Q

red, beefy, glossy slightly bumpy area

A

granulation tissue

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30
Q

this occurs when granulation tissue rises above the level of the surrounding skin

A

hypergranulation

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31
Q

when new epidermal cells touch one another, cell division stops due to

A

contact inhibition

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32
Q

this is when the wound bed is too dry

A

desiccation

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33
Q

this is when the wound bed has too much moisture

A

maceration

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34
Q

this is the most common type of burn

A

thermal

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35
Q

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

A

epidermal burn

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36
Q

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

A

superficial partial thickness burn

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37
Q

this type of burn affects epidermis, superficial dermis, and skin appendages & will cause damage to sensory nerves, does not blanch under pressure, no blisters

A

deep partial thickness burn

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38
Q

this may not be as painful as superficial second degree burns

A

deep partial thickness burn

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39
Q

epidermis and dermis are affected, complete destruction of sweat glands and sebaceous glands, destruction of sensory nerves

A

full thickness burns

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40
Q

this degree burn has a high risk of hypertrophic scarring

A

full thickness burn

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41
Q

this burn will have charred black skin and is usually caused by electrical injury - underlying muscle, tendon, ligament and bone can be affected

A

subdermal burn

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42
Q

central portion of wound, irreparable cell damage, may expand up to 48 hours after initial injury

A

zone of coagulation

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43
Q

zone of cellular injury, decreased tissue perfusion, can form tiny emboli that further impede

A

zone of stasis

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44
Q

outermost edge of tissue damage, minimal tissue injury, redness due to vasodilation

A

zone of hyperemia

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45
Q

abnormal growth of bone tissue imbedded within soft tissue

A

heterotypic ossification

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46
Q

this begins at the time of injury and concludes with restoration of the capillary permeability 48-72 hours

A

emergent

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47
Q

this begins with initiation of decrease in fluids & ends when capillary integrity returns to near normal, large fluid shifts have decreased

A

resuscitation

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48
Q

pain rating scales used as outcome measures in burn assessment

A

VAS
0 to 10 pain scale
Brief pain inventory
McGill Pain Questionnaire

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49
Q

surgical incision thorugh eschar into subcutaneous tissue, releases inelastic necrotic tissue that may compromise circulation

A

escharotomy

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50
Q

this is often seen with circumferential burns

A

escharotomy

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51
Q

muscle/bone is pulled in one direction while surface tissues are pulled in an opposite direction

A

shear

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52
Q

this leads to distortion/damage to blood vessels, usually at deep tissue level

A

shear

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53
Q

why is it important to know about that history of pressure injuries

A

because if hx of pressure injury - after pressure injury they never rully regain skin thickness

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54
Q

this is a tool that utilizes six subscales in order to assess a pressure injury

A

braden scale

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55
Q

this looks at five categories in order to assess a pressure ulcer

A

norton pressure ulcer scale

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56
Q

this is an assessment tool that takes DM, HTN, HCT, hemoglobin, albumin and fever into account

A

norton pressure ulcer scale

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57
Q

how often should pts turn when lying down in order to prevent pressure ulcer

A

2 hours

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58
Q

how often should pts shift to prevent pressure ulcer when sitting

A

every 15 minutes

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59
Q

when a pt is side lying they should avoid direct pressure on what

A

trochanter

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60
Q

not yet an open wound
nonblanachable erythema present
changes in skin texture and consistency is boggy

A

Stage I pressure injury

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61
Q

partial thickness that affects dermis and part of dermis

WILL include BLISTERS

A

stage II pressure injury

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62
Q

deep ulcer that has extensive necrosis
FULL thickness
Epidermis, dermis, and subcutaneous tissue involves - extends to BUT not through the subcutaneous fascia

A

Stage III pressure injury

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63
Q

FULL thickness, DEEP ulceration may have undermining…. involves epidermis, dermis, subcutaneous tissue through the fascia to muscle, tendon, jt capsule and sometimes bone

A

Stage IV pressure injury

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64
Q

this has visual signs of necrotic tissue but no opening

A

suspected deep tissue injury

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65
Q

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

A

sessing scale

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66
Q

this tool has 13 items rated from 1 to 5

A

pressure score status tool

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67
Q

this type of debridement removes necrotic tissue only, leaves uninvolved skin intact

A

selective

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68
Q

this involves the use of semipermeable flims, absorbent dressings

A

autolytic debridement

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69
Q

this involes the use of sharp or hydrotherapy

A

mechanical debridement

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70
Q

diabetic ulcers generally occur where

A

plantar aspect of the foot (but can also be found on the toes and dorsum depending on weight bearing load)

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71
Q

this is the primary risk factor for development of diabetic foot ulcers

A

DPN (diabetic peripheral neuropathy)

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72
Q

contributing factors to the onset of DPN

A

fluctuations in glucose levels, duration of DM, age, tobacco and/or alcohol use, patient height and gender, prolonged hyperglycemia

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73
Q

this can disrupt cellular metabolisms with the neurons

A

hyperglycemia

74
Q

this involves decreased perspiration and sebaceous secretion in the distal lower extermities and feet

A

autonomic neuropathy

75
Q

with this, skin is prone to dryness, cracks, callus formation and breakdown

A

autonomic neuropathy

76
Q

this affects intrinsic muscles of the foot

A

motor neuropathy

77
Q

these areas are prone to callus and are sites of breakdown

A

metatarsal heads, interdigitial areas

78
Q

people with this are prone to fungal infections and deformities of toe nails

A

DM

79
Q

this is a scale that uses grads from 0-5 in order to assess wounds

A

wagner scale

80
Q

localized gangrene - no more than 2 digits

A

grade 4 on wagner scale

81
Q

most likely spots for diabetic ulcers

A

midfoot, heel, metatarsal heads

can sometimes occur in between toes & at dorsum of toes (IP jts)

82
Q

contraindications to total contact casting

A

significant PVD
Infected wounds
osteomyelitis

83
Q

these are caused by blockage and/or insuffieciency

A

arterial ulcers

84
Q

these can be causes of arterial ulcers

A

trauma, atheroscleoriss, thrombosis

85
Q

pt has intermitten claudication, rubor of dependency, absence of hair, trophic changes to nails, pain worse with elevation & better in dependent position

A

arterial insufficiency

86
Q

ABI score when arterial circulation is normal

A

1.0

87
Q

causes of venous ulcers

A

vascular congestion, chronic edema, impaired venous return

88
Q

these wounds are typically located below the knee in gaitor area

A

venous ulcers

89
Q

medications that can cause LE edema

A

calcium channel blockers, corticosteroids, estrogen, progesterone, testosterone, NSAIDs, antihypertensive, hydralazine hydocholoride

90
Q

normal venous filling time

A

5 to 15 seconds

91
Q

treatment of venous hypertension

A

must be 18 cm above level of heart

20-30 mins at a time for a total of 2 hours a day

92
Q

this is a paste bandage - gauze impregnated with zinc and calamine

A

UNNA’s boot

93
Q

contraindication for compression therapy

A

CHF

94
Q

caution for compression therapy

A

renal insufficiency

95
Q

ABI less than .8 suggests what

A

arterial involvement

96
Q

swelling of any part of the body that happens as a side effect of tx for different types of cancer

A

lymphedema

97
Q

swelling that occurs in areas of inflammation of injury

A

edema

98
Q

lymph vessels take how much percent of blood from extremities back to the hear

A

10%

99
Q

three primary functions of the lymphatic system

A

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
Q

increased lymphatic load on a healthy lymphatic system

A

dynamic insufficiency

101
Q

normal amount of fluid, but an impaired transport capacity

A

mechanical insufficiency

102
Q

combined insufficiency

A

increased load on a damaged lymphatic system

103
Q

congenital lymphedema classification - individual is born with malfunctioning lymphatic system

A

primary

104
Q

this classification of lymphedema occurs after there is damage to the lymph system

A

secondary

105
Q

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

A

lipedema

106
Q

symptoms of lymphedema

A

pins and needles, decreased flexibility/strength, one limb looks larger than others, painful swelling, decreased flexibility/strength in the affected limb

107
Q

symptom of this includes milky fluid leaked from skin

A

lymphedema

108
Q

positive stemmers sign is a sign of this

A

lymphedema

109
Q

this is assessed by pulling up on the skin at the base of the second toe or finger

A

stemmer sign

110
Q

a positive test occurs when the skin is unable to be pulled up at second toe or finger

A

stemmer sign

111
Q

this is the most effective and least invasive approach to the treatment of lymphedema

A

complete decongestive therapy

112
Q

CDT standard of care includes what four componenets

A
  1. meticulous skin care and hygiene
  2. manual lymph drainage techniques
  3. multi-layered bandages
  4. remedial exercises
113
Q

objectives in the tx of lymphedema (CDT)

A

control and reduce swelling, prevent progression of lymphedema, prevent infection, improve the patient’s overall quality of life

114
Q

this tx of lymphedema involves specific manual hand movements that follow lymph pathways to facilitate the movement of fluid in lymph vessels

A

MLD manual lymph drainage

115
Q

what immediately follows MLD tx

A

bandaging

116
Q

these bandages prevent re-accumulation of lymph fluid in the tissues

A

low stretch bandages

117
Q

these bandages do not stretch as much and only in one direction providing resistance against the working muscles

A

short stretch

118
Q

when are bandages worn until

A

overnight until the next MLD session

119
Q

these provide low resting pressure and high working pressure and are therefore ideal for tx of lymphedema

A

short stretch bandages

120
Q

this helps to increase tissue pressure and causes a reduciton in filtration

A

MLB - multi layered bandaging

121
Q

this helps to inhibit the re-accumulation of fluid

A

MLB

122
Q

what type of exercise should you avoid with lymphedema

A

high intensity/high resistance exercises

123
Q

when should you perform exercises for lymphedema

A

1-2x day WITH BANDAGE ON - recommend exercise moderately

124
Q

this promotes lymph flow

A

active muscle pump

125
Q

contraindications to manual lymphatic drainage

A 
thrombosis 
congestive heart failure (pt needs cardiac clearance)
acute infection
active disease w/o adjuvant therapy
arterial disease ABI .8 or below
126
Q

edema is not visible of evident using limb measurements

A

stage 0 lymphedema

127
Q

fluids starts to collect in the affected area and causes swelling - affeected area looks puffy

A

stage 1 lymphedema

128
Q

limb elevation alone rarely reduces swelling - pitting is manifested

A

stage 2 lymphedema

129
Q

extensive swelling present - tissue is fibrotic and hard and pitting is not possible

A

stage 3 lymphedema

130
Q

wound that fails to heal after 3 months

A

chronic wound

131
Q

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

A

hypertrophic scar

132
Q

aggressive ulceration squamous cell carcinoma presenting in an area of previously traumatized chronically inflamed or scarred skin

A

marjolin’s ulcer

133
Q

channel that exists underneath the wound

A

sinus

134
Q

dead space under sinus that joints together

A

tunneling

135
Q

dead space with no direction

A

undermining

136
Q

edges of wound have a rolled appearance

A

epibole

137
Q

this occurs when something stops the cells from moving across the wound bed

A

epibole

138
Q

these type of wound bends impair tissue repair

A

dry wound beds

139
Q

TIME model for wound examination

A

tissue
infection/inflammation
moisture imbalance
Edge of wound

140
Q

these are cytotoxic

A

antiseptics

141
Q

wounds present bellow malleolus on foot/ankle

A

arterial wound

142
Q

edema is present and there is high exudate with this type of wound

A

venous - it is worse at end of the day

143
Q

how to palpate popliteal pulse

A

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
Q

where do you palpate for resting capillary refill

A

distal toe

145
Q

longer refill time for capillary refill test may indicate what

A

arterial insufficiency

146
Q

this is the ratio of systolic BP at ankle compared to systolic BP in UE

A

ABI

147
Q

normal ABI

A

1

148
Q

this ABI value is considered significant for PAD

A

.8

149
Q

3+ scale pitting edema

A

severe

150
Q

moderate pitting edema

A

2+

151
Q

wound will not heal with TcPO2 of this

A

less than 20 mmHg

152
Q

with TcPO2 of less than 20 what will happen

A

wound will not heal

153
Q

TcPO2 greater than 30 mmHg what will happen

A

wound should heal. safe for debridement

154
Q

at this TcPO2 wound should heal and is safe for debridement

A

> 30

155
Q

RED wound

A

pink granulation tissue, protect wound and maintain most environment

156
Q

YELLOW wound

A

moist, yellow slough - remove exudate and debris, absorb drainage

157
Q

BLACK wound

A

black, thick eschar firmly adhered - debride necrotic tissue

158
Q

surface area of wound

A

length x width

159
Q

where do you measure wound depth

A

at deepest region

160
Q

with the clock method, what does 12 oclock usually correspond to

A

the pts head

161
Q

wound tracing

A

planimetry

162
Q

increase pain, change in exudate, odor are all signs of what

A

infection

163
Q

signs of infection may be diminished in what conditions

A

steroid treatment, ischemia, malnutrition, neuropathy

164
Q

for ulcers, failure to heal can be a sign of this

A

infection

165
Q

this type of wound has an entry and exit point

A

chemical

166
Q

RULE of nines

head and neck

A

9%

167
Q

anterior trunk rule of nines

A

18%

168
Q

posterior trunk rule of nines

A

18%

169
Q

bilateral anterior arm, forearm, and hand

A

9%

170
Q

bilateral posterior arm, forearm, hand

A

19%

171
Q

genital region

A

1%

172
Q

bilateral anterior leg and foot

A

18%

173
Q

bilateral posterior leg and foot

A

18%

174
Q

anticipated deformity with burn on ankle

A

plantar flexion

175
Q

anticipated deformity with burn on knee

A

flexion

176
Q

anticipated deformity with burn on elbow

A

flexion and pronation

177
Q

anticipated deformity with burn on hip

A

flexion and adduction

178
Q

anticipated deformity with burn on hand and wrist

A

extension or hyperextension of MCP joints

179
Q

anticipated deformity with burn on anterior chest and axilla

A

shoulder adduction, extension, and medial rotation

180
Q

anticipated deformity with burn on anterior neck

A

flexion with possible lateral flexion

Pressure/Neuropathic ulcers (2 decks)

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