Integ. Unit 1 Flashcards
How is the skin organized into?
- Epidermis: This is an avascular superficial layer
- Dermis: This is a vascular under layer
What are the functions of the skin?
- Protection
- Sensation
- Maintenance of fluid
- Immunity
- Thermoregulation
The Epidermis is comprised of 5 layers that contain important cellular functions, what are the layers from superfical to deep?
- Stratum Corneum
- Stratum Lucidum
- Stratum Granulosum
- Stratum Spinosum
- Straum Basale
What are the Primary Cells of the Epidermis?
- Keratinocytes
- Melanocytes
- Langerhans Cells
- Merkel Cells
What is the Dermis?
- This is a vascular layer near the basement membrane
- This binds the epidermis to subcutaneuous tissue (hypodermis)
- And contains encapsulated nerves
What is the Cellular Composition of the Dermis?
- Fibroblast
- Meissner’s Corpuscles
- Pacinian Corpuscles
- Hair Follicles
What 3 things characterizes wound by level of involvement?
- Severity
- Level of tissue involvement
- Color of the wound
Would Classification: Color
What does a classification of a Red wound mean?
2° Granulation tissue
- Normal healing
Would Classification: Color
What does a classification of a Yellow wound mean?
Fibrin left from the healing process
- Yellow slough on wound base
- Medium for bacterial growth
Would Classification: Color
What does a classification of a Black wound mean?
Eschar, indicates necrosis
- Cannot accurately assess wound covered in eschar
If a patient has a Red wound, what is indicated?
Clean, Healing; granulation
Skin Loss
What is Erosion? What are the Clinical Signs?
AKA superficial wound
Erosion is epidermal loss only
Clinical Signs:
- Erythema and minimal to no bleeding
Such as superficial burns (1st degree burns)
Skin Loss
What are Partial Thinkness Wounds? What are the Clinical Signs?
Partial Thickness Wounds is loss of both epidermis and dermis
Clinical Signs:
- Bleeding
Such as 2nd degree burns or skin tears
What are Full Thickness Wounds? What are the Clinical Signs?
Full Thickness Wounds is loss of the epidermis, dermis and hypodermis
Clinical Signs:
- Possible exposure of bone/tendon/ligament/muscle
Such as Surgical Incisions, wound requiring debridement of necrotic tissue
With the skin, what is the healing response?
- Cell signaling
- Macrophage activity
- Follows 4 general phases:
Hemostasis -> Inflammation -> Proliferation -> Remodeling
With Healing Responses, what are the characteristics of
Phase 1: Hemostasis?
- Takes less than 1 hour
Primary Characteristics:
-Platelet Aggregation
-Cellular Action and clot formation (scab)
-Brief arteriole vasoconstriction
-Influx of neutrophils
Clinical Signs:
- Inflammation
- Edema
With Healing Response, what are the characteristics of Phase 2: Inflammation?
- Takes between 1hr to 4 days
- The goal is to increase cirulation to the site of injury
Primary Characteristics:
-Vasodilation
-Leukocyte and macrophage formation
-Angiogenesis: formation of new blood vessels
-Autolytic debridment
Clinical Signs:
- Increased body temperature
- Rubor, Tumor, Dolor, Calor
With Healing Response, what are the characteristics of Phase 3: Proliferation?
- Takes between 4-12 days
Primary Characteristics:
-Angiogenesis of small vessels
-Formation of new extracellular matrix and epidermal cells
-Proliferation of fibroblast
-Proteogycan/collagen synthesis
-Granulation tissue formation
Clinical Signs:
- “Beefy red” granulation tissue (with full-thickness)
- Re-epithelialization occurs after granulation tissue
With Healing Response, what are the characteristics of Phase 4: Maturation/Remodeling?
Primary Characteristics:
-Wound contraction
-Fibroblast to myofibroblast conversation
-Melanocyte aggregation
-Increased tensile strength
–recidivism
-Collagen replacement
Clinical Signs:
- Blanching
What are the 3 classifications of wound response?
- Healing by primary intention
- Healing by delayed primary intention (aka tertiary)
- Healing by secondary intention
What is Healing by Primary Intention?
- Minimal tissue loss and good approximation
–Eventually secured with staples, surgical, or sutures - No scab formation noted secondary to minimal cell death
- Resolves in approximately 2 weeks
Ex. Surgical incisions clear or bacteria/pathogens
What is Delayed Primary Intention (aka Tertiary Intention)?
- Suspected debris or pathogens in the wound
- Resulting granuloma
- Marked inflammation response
- Usually closed surgically once deemed free of pathogens/debris
What is Secondary Intention?
- Usual wound healing process for non-surgical wounds
- Myofibroblast aid in wound closure
Clinical Note:
- Wound seen in the clinic will be of either delayed primary intention or secondary intention
What is the Extracellular Matix comprised of?
- Collagen (structural protein)
–Helps formulate new tissue - Elastine (Structural protein)
–Stretch properties - Proteoglycans (GAGs
How do Chronic wounds usually occur from? How long does it take to heal?
What is the most common type of chronic wound?
Usually occur due to:
- Foreign debris in the wounds
- Pathogenic occupants
- Disease
Chronic wounds may take months or years to close
Venous Insufficiency ulcers
What are some Impeding Factors to healing?
- Infection
- Medications
- Comorbidities
- Cancer/Radiation
- Autoimmune Disorders
- Stress
- Modifiable behaviours/lack of sleep
What are 2 types of infections that affect wound healing?
- Bacterial Infection
- Fungal Infection
What types of medications can affect wound healing?
Steroids
- It delays all phases of healing
- Vitamin A may be effective
NSAIDS
- Possible decrease of platelet aggregation
- Decreased tensile strength of tissue
What are different Co-morbidities that can affect wound healing?
Diabetes
- Healing can be delayed due to the effects of increased glucose levels on leuokocyte function
Arterial Insufficiency
- This results in a decreased ability for waste products to be removed and for nutrients to be delivered to the site of injury
Chronic Edema
- which may cause venous indufficiency, which will limit the blood that can circulate through more proximal vasculature and fluid remains in the distal extremities
Cardiac Diseases
- Any heart disease automatically predisposes the person toward poor wound healing
How can Cancer/Radiation affect wound healing?
- Radiation destroys the good cells capable of wound healing as well as the malignant cancer cells. Also we would see a decrease in tissue tensile strength
- Chemotherapy may cause a decrease in blood flow and sensation to the extremities, this may lead to further tissue degradation. Also affects the nutritional system
What psychosocial behaviors affect wound healing and how?
Stress
- Results in high levels of cortisol which delay the inflammatory phase
- Hormones allow for vasoconstriction
Smoking
- This causes vasoconstriction, which then decreases wound healing process
Alcohol
- Excessive alcohol consumption can lead to increased insulin resistance and high blood glucose levels inhibiting healing in all phases
- Greater than 4 drinks/day or 14 drinks/week
Identifying Factors: Abnormal Lab Values
If a person has Increased or Decreased WBCs, how may this affect wound healing?
What is considered Normal?
- If a persons WBCs are increased, this may indicate infection or trauma
- If a persons WBCs are decreased, this may indicate a decreased immune response to bacteria
Both of these cause a delay in wound healing
Normal is 4.5-11x 10^3/mm^3
Identifying Factors: Abnormal Lab Values
If a person has increased or decreased hemoglobin, how may this affect wound healing?
What is considered Normal?
- If a persons hemoglobin count is increased, this may indicate that wound may fail to progress
- If a persons hemoglobin cout is decreased, this may indicate the wound may fail to progress/may have pale appearance
Normal is 12-18 g/dL
Identifying Factors: Abnormal Lab Values
If a person has increased or decreased Hematocrit, how may this affect wound healing?
What is considered Normal?
- If a persons hematocrit is increased, this may be a sign of throbi/emboli
- If a persons hematocrit is decreased, this may be a sign that the wound will fail to progress/may appear pale
Normal between 36-50%
Identifying Factors: Abnormal Lab Values
If a person has increased or decreased Prothrombin time IRN (PT-IRN), how may this affect wound healing?
What is considered Normal?
- If a persons Prothrombin time IRN (PT-INR) is increased, this may be a sign that the wound will bleed easily
- If a persons Prothrombin Time IRN (PT-IRN) is decreased, this may be a sign of increased clotting
Normal is 2.50 seconds
Identifying Factors: Abnormal Lab Values
If a person has increased HbA1C%, how may this affect wound healing?
What is considered Normal?
Blood sugar
- If the persons HbA1C% is increased this may indicate delayed wound healing
Normal is ≤5.7%
Identifying Factors: Abnormal Lab Values
If a person has increased Average Glucose, how may this affect wound healing?
What is considered Normal?
- If the persons Glucose is increased this may indicate delayed wound healing
Normal is < 100 mg/dL
