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Term 4 > Integ. Unit 1 > Flashcards

Integ. Unit 1 Flashcards

1
Q

How is the skin organized into?

A
  • Epidermis: This is an avascular superficial layer
  • Dermis: This is a vascular under layer
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2
Q

What are the functions of the skin?

A
  • Protection
  • Sensation
  • Maintenance of fluid
  • Immunity
  • Thermoregulation
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3
Q

The Epidermis is comprised of 5 layers that contain important cellular functions, what are the layers from superfical to deep?

A
  1. Stratum Corneum
  2. Stratum Lucidum
  3. Stratum Granulosum
  4. Stratum Spinosum
  5. Straum Basale
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4
Q

What are the Primary Cells of the Epidermis?

A
  • Keratinocytes
  • Melanocytes
  • Langerhans Cells
  • Merkel Cells
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5
Q

What is the Dermis?

A
  • This is a vascular layer near the basement membrane
  • This binds the epidermis to subcutaneuous tissue (hypodermis)
  • And contains encapsulated nerves
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6
Q

What is the Cellular Composition of the Dermis?

A
  • Fibroblast
  • Meissner’s Corpuscles
  • Pacinian Corpuscles
  • Hair Follicles
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7
Q

What 3 things characterizes wound by level of involvement?

A
  • Severity
  • Level of tissue involvement
  • Color of the wound
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8
Q

Would Classification: Color

What does a classification of a Red wound mean?

A

2° Granulation tissue
- Normal healing

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9
Q

Would Classification: Color

What does a classification of a Yellow wound mean?

A

Fibrin left from the healing process
- Yellow slough on wound base
- Medium for bacterial growth

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10
Q

Would Classification: Color

What does a classification of a Black wound mean?

A

Eschar, indicates necrosis
- Cannot accurately assess wound covered in eschar

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11
Q

If a patient has a Red wound, what is indicated?

A

Clean, Healing; granulation

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12
Q

Skin Loss

What is Erosion? What are the Clinical Signs?

A

Erosion is epidermal loss only

Clinical Signs:
- Erythema and minimal to no bleeding

Such as superficial burns (1st degree burns)

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13
Q

Skin Loss

What are Partial Thinkness Wounds? What are the Clinical Signs?

A

Partial Thickness Wounds is loss of both epidermis and dermis

Clinical Signs:
- Bleeding

Such as 2nd degree burns or skin tears

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14
Q

What are Full Thickness Wounds? What are the Clinical Signs?

A

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

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15
Q

With the skin, what is the healing response?

A
  • Cell signaling
  • Macrophage activity
  • Follows 4 general phases:
    Hemostasis -> Inflammation -> Proliferation -> Remodeling
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16
Q

With Healing Responses, what are the characteristics of
Phase 1: Hemostasis?

A
  • 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

17
Q

With Healing Response, what are the characteristics of Phase 2: Inflammation?

A
  • 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

18
Q

With Healing Response, what are the characteristics of Phase 3: Proliferation?

A
  • 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

This is the "Beefy Red" Granulation Tissue
19
Q

With Healing Response, what are the characteristics of Phase 4: Maturation/Remodeling?

A

Primary Characteristics:
-Wound contraction
-Fibroblast to myofibroblast conversation
-Melanocyte aggregation
-Increased tensile strength
–recidivism
-Collagen replacement

Clinical Signs:
- Blanching

20
Q

What are the 3 classifications of wound response?

A
  • Healing by primary intention
  • Healing by delayed primary intention (aka tertiary)
  • Healing by secondary intention
21
Q

What is Healing by Primary Intention?

A
  • Minimal tissue loss and good approximation
    –Eventually secured with staples, surgical, or sutures
  • No scap formation noted secondary to minimal cell death
  • Resolves in approximately 2 weeks

Ex. Surgical incisions clear or bacteria/pathogens

22
Q

What is Delayed Primary Intention (aka Tertiary Intention)?

A
  • Suspected debris or pathogens in the wound
  • Resulting granuloma
  • Marked inflammation response
  • Usually closed surgically once deemed free of pathogens/debris
23
Q

What is Secondary Intention?

A
  • 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

24
Q

What is the Extracellular Matix comprised of?

A
  • Collagen (structural protein)
    –Helps formulate new tissue
  • Elastine (Structural protein)
    –Stretch properties
  • Proteoglycans (GAGs
25
Q

How do Chronic wounds usually occur from? How long does it take to heal?

What is the most common type of chronic wound?

A

Usually occur due to:
- Foreign debris in the wounds
- Pathogenic occupants
- Disease

Chronic wounds may take months or years to close

Venous Insufficienvy ulcers

26
Q

What are some Impeding Factors to healing?

A
  • Infection
  • Medications
  • Comorbidities
  • Cancer/Radiation
  • Autoimmune Disorders
  • Stress
  • Modifiable behaviours/lack of sleep
27
Q

What are 2 types of infections that affect wound healing?

A
  • Bacterial Infection
  • Fungal Infection
28
Q

What types of medications can affect wound healing?

A

Steroids
- It delays all phases of healing
- Vitamin A may be effective

NSAIDS
- Possible decrease of platelet aggregation
- Decreased tensile strength of tissue

29
Q

What are different Co-morbidities that can affect wound healing?

A

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

30
Q

How can Cancer/Radiation affect wound healing?

A
  • 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
31
Q

How might psychosocial behaviors affect wound healing?

A

Stress
- Results in high levels of cortisol which delay the inflammatory phase
- Hormones allow for vasoconstriction
Smoking
- This causes vasoconstriction, which then decreases would 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

32
Q

Identifying Factors: Abnormal Lab Values

If a person has Increased or Decreased WBCs, how may this affect wound healing?

What is considered Normal?

A
  • 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

33
Q

Identifying Factors: Abnormal Lab Values

If a person has increased or decreased hemoglobin, how may this affect wound healing?

What is considered Normal?

A
  • 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

33
Q

Identifying Factors: Abnormal Lab Values

If a person has increased or decreased Hematocrit, how may this affect wound healing?

What is considered Normal?

A
  • 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%

34
Q

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?

A
  • 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

Noirmal is 2.50 seconds

35
Q

Identifying Factors: Abnormal Lab Values

If a person has increased HbA1C%, how may this affect wound healing?

What is considered Normal?

A
  • If the persons HbA1C% is increased this may indicate delayed wound healing

Normal is ≤5.7%

36
Q

Identifying Factors: Abnormal Lab Values

If a person has increased Average Glucose, how may this affect wound healing?

What is considered Normal?

A
  • If the persons Glucose is increased this may indicate delayed wound healing

Normal is < 100 mg/dL

Term 4 (14 decks)

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