Integument Flashcards
1
Q
When would you use a unna boot?
A
For a venous ulcer to unload the wound
2
Q
where is the thickest skin in the body?
A
palms of hand and sole of foot, contains stratum lucidum
3
Q
what is excreted with sweat and why is that important?
A
Urea and salt, which aids in elimination of metabolic waste
4
Q
layers of epidermis from superficial to deep
A
stratum corneum, lucium
granulosum, spinosum, basale
5
Q
what cells can you find in statrum granulosum
A
live keratinocytes and langerhans cells for immunity
6
Q
what is found in stratum spinosum
A
ketatinocytes and langerhans
7
Q
what cells are found in the stratum basale
A
merkel cells, melanocytes, epidermal cells
8
Q
what is found in the dermis
A
collagen, elastin, mucopolysaccharide matrix, lymph, bv, nerves and nerve endings, hair follicles, sebaceous and sweat glands, fibroblasts, macrophages lymphocytes, mast cells
9
Q
what types of glands are sebaceous glands and what is the function of sebum
A
exocrine, defends against bacteria and fungus
10
Q
where are apocrine sweat glands and when are the stimulated
A
found in axillary and genital regions, activated with stress
11
Q
superficial or partial thickness wounds occur in what layer of skin
A
epidermis
12
Q
do we want wounds wet or dry
A
wet
13
Q
within 10 to 15 minutes of a dermal wound what happens
A
initial vasoconstriction to reduce blood loss and decrease risk of infection, fibrin plug created, this is called homeostasis
14
Q
what occurs in the inflammatory phase of healing and how long is this phase
A
24-48 hours, rubor, calor, swelling, pain, loss of function, vasodilation from non-injured vessels occur to bring leukocytes and growth factors for healing.
15
Q
what happens at the end of the inflammatory phase
A
Phagocytosis and neovascularization
16
Q
key cells in the inflammatory phase of healing
A
mast cells, platelets, leukocytes, macrophages–> can be impaired by diabetes
17
Q
4 primary events of granulation/proliferative phase
A
- angiogenesis
- granulation formation
- wound contraction
- epithelialization
18
Q
primary cells of granulation phase
A
myofibroblasts for wound contraction
fibroblasts for collagen, elastin and glycosaminoglycan production
epithelial cells for epithelialization
19
Q
maturation/matrix formation phase: time after injury and what happens
A
begins 2-4 weeks after injury and can last for years
continued collagen synthesis and alignment
20
Q
normal scar formation
A
pink, bright for 6-12 weeks then lavender to soft pink for 12-15 moths which will finally flatten and turn white
21
Q
how can you reduce hypertrophic or kelloid scarring
A
compression garments, silicon gels/sheets
22
Q
what can delay wound healing
A
advanced age
impaired oxygenation
poor nutrition
comorbidities
wound bioburden
infection
stress
disease
medications
cool temperatures
iatrogenic (pressure, shear forces)
smoking
23
Q
what will infection and increased wound bioburden do to phases of healing
A
prolong the inflammatory phase
24
Q
stress effect on wounds
A
decreases pro inflammatory cytokines and increases wound hypoxia
25
uticaria=
allergic hive reaction, red elevated patches
26
xeroderma=
excessive dry skin with shedding
deficiency of thyroid function, diabetes
27
when might you see clubbing of the nails
chrons's disease, cyanois, lung cancer or chronic hypoxia, ulcerative colitis, biliary cirrhosis, neoplasm, GI involvement
28
what is schamroth's window test:
positive if don't see diamond shape space when nails from opposite hands are placed back to back
INDICATES CLUBBING
29
stemmer's sign=
thickened fold of skin at the base of second toe or second finger when pinched or lifted
sign of primary lymphedema
30
cherry red skin color may indicate
liver or renal issues
31
hypohidrosis
may indicate dehydration, ichthyosis, hypothyroidism or late stage DM
32
central causes of cyanosis can be seen where
oral mucosa, tongue, lips
33
peripheral causes of cyanosis
nail beds, hands or feet
34
cyanosis may indicate
lack of hemoglobin from congestive heart failure, advanced lung disease, congenital heart disease, venous obstruction
35
pallor may be seen with
anemia, internal hemorrhage
36
brown/yellow spots on skin may indicate
liver malignancies, pregnancy, uterine malignancies, aging
37
hyperthyroid versus hypothyroidism temperatures
heat in hyper, cold in hypo
38
serous exudate=
watery serum
39
purulent exudate=
contains pus
40
sanguineous exudate=
contains blood
41
macerated ulcer=
softened tissues due to high fluid environment
42
clean read wounds are
healthy, granulating wounds, need protection
43
yellow wounds
include slough (which is necrotic dead tissue)
44
indolent ulcer=
slow to heal
45
infected periwound (cellulitis)
erythema, warmth and swelling
46
macerated periwound
moisture (urine or feces) or increased drainage, at risk for wound deterioration and enlargement
47
components of wound exam
location, size, tunneling, exudate, color and involved tissues, temperature, girth, periwound, sensory integrity, infection, scar tissue, video, pain and imaging if needed
48
arterial imaging for wound care
arteriogram, doppler US, magnetic resonance angiography, CT angiography
49
impetigo
superficial skin infection from staphylococci or streptococci: inflammation, itching, small pus-filled vesicles, contagious common in elderly and children
50
venous imaging for wound care
doppler US, magnetic resonance venography, CT venography
51
Herpes simplex
cold sore or fever blister, contact spread
52
herpes 2
genital
53
herpes zoster
cerebral ganglia or ganglia of the posterior nerve roots, can follow any nerve path, red papules progressing to vesicles develop along a dermatome
accompanied by fever, chills, malaise or GI issues , can happen in CN III or V
54
contraindications with herpes zoster
Heat and US
55
Tinea corporis
ringworm, hair skin or nails, ring shaped patches with vesicles or scales, direct contact spread,
treated with topical or oral antigfungal drugs like griseofulvin
56
griseofulvin or antifungal side effects
HA, GI issues, fatigue, insomnia, photosensitivity, monitor liver function
57
tinea pedis
fungal infection typically found in-between toes
erythema, inflammation, pruritus, itching, pain
can become bacterial infection, cellulitis
58
yeast grows in areas of
increased moisture
59
treat yeast (candidiasis)
reduce moisture, anti fungal ointment, potentially silver infused dressing in skin folds
60
psoriatic arthritis affects which joints
small distal joints
61
butterfly rash is typical of what disease
systemic lupus erythematosus (occurs on the nose)
62
SLE signs and symptoms
affects young women, fever, malaise, butterfly rash, skin lesions, chronic fatigue, arthralgia, arthritis, skin rashes, photosensitivity, anemia, hair loss, raynaud's
63
DLE (discoid lupus)
only skin issues, flare-ups with sun exposure, can resolve or atrophy, permanent scarring hypopigmentation or hyperpigmentation
64
Scleroderma
chronic, autoimmune disease of connective tissue which causes fibrosis of skin, joints, blood vessels and internal organs, accompanied by raynauds phenomenon
65
PT for scleroderma
prevention of contractures, skin care education, exercise and joint protection
check vitals, look for hypertension
66
PT management for polymyositis (PM) or dermatomyositis (DM)
fatigue management and conservation of energy,
exercise: aerobic and resistance exercise at low levels are appropriate, skin care and positioning, monitor for steroid side effects like myopathy, neuropathy or diabetes
avoid overload (rhabdo)
avoid immobility ( pressure injuries and contractures)
They are also given corticosteroids and immunosuppressants
67
diffuse systemic sclerosis disease
symmetrical, widespread skin of distal and proximal extremities, face, trunk rapid progresseion
68
limited cutaneous systemic sclerosis
involves skin of face lower arms and lower legs and internal organ involvement
69
other than gauze what can be used for infected wounds
silver impregnated foam
70
treat diabetic ulcer
offload the wound by using protective therapeutic footwear
pt education on glycemic control and nutrition
skin care
71
how to treat scabies
scabicide, mites will burrow into the skin and cause inflammation, itching and pruritis/urticaria
72
ABCDEs of malignant melanoma
A= asymmetrical, uneven edges, lopsided
B= border, irregular poorly defined, notching
C= color variations, especially mixtures of black, blue or red
Diameter= larger than 6 mm
Evolving= usually elevated, moles that have changed over time
73
What is a basal cell carcinoma:
slow growing epithelial basal cell tumor, raised patch with ivory appearance
rarely metastasizes, common on face for fair skinned individuals and associated with prolonged sun exposure
74
what is a squamous cell carcinoma:
poorly defined margins, presents as flat red area, ulcer or nodule, grows more quickly, common on sun exposed skin (face, neck and back of hands)
those of mucosal or lingual origin typically from tobacco or alcohol use
75
malignant melanoma
tumor of melanocytes, superficial spreading melanoma (SSM) is most commonw
76
what are the risk factors for malignant melanoma
family history, intense year round sun exposure, fair skin, freckles, changing moles, >50 y/o, oozing lesions, swelled, red, sensations of itching burning or pain
77
Treatment for Kaposi's sarcoma
wound care (whirlpool or pulsed lavage with suction) avoid shearing, contractures and edema
78
Stage I pressure ulcer
non-blanchable erythema, may include change in temp, tissue consistency and sensation
79
Stage II pressure ulcer
partial-thickness skin loss, involves epidermis, dermis or both. Superficial, presents clinically as an abrasion, blister or shallow crater
80
Stage III pressure ulcer
full thickness skin loss, involves damage or necrosis of sub Q tissue. May show fascia but not through it, deep crater
81
Stage IV pressure ulcer
full thickness skin loss, necrosis, damage to muscle, bone or supporting structures, undermining and sinus tracts
82
Unstageable wound
deep tissue is obscured due to slough or eschar and can't determine extent of damage
83
Deep tissue injury
discolored, dark bruise under skin, likely progresses to full thickness injury
84
what scale is used for diabetic/neuropathic wounds
wagner classification
85
what ABI is compression contraindicated
<0.7, for high compression sustained compression contraindicated for <0.6 or with active DVT
86
treating venous ulcers
inelastic or short stretch compression: unna boot, profore, circaid (day and night wear) , potentially ultrasound, biological or bioengineered dressings or pharmacological intervention , surgery or vein ablation
86
common sites of arterial ulcers
toes, feet, bony areas
87
when may walking be contraindicated due to a wound
arterial wound when ABI <4, if there is gangrene or ulceration and resting pain
88
89
Bates wound assessment is for what type of wounds
pressure ulcers
90
critical burn for child or older adult is classified by
>10 % of full thickness burns or >20% of partial thickness burns
91
critical burn for any patient
>25% total body surface area
92
moderate burn for adult
15-25% TBSA mixed between partial and full thickness
93
moderate burn for child or older adult=
<10% full thickness burns and 10-20% total body surface area of partial thickness burn
94
To be classified as a moderate burn, burns can't
involve face, hands, feet, genitalia, perineum or major joints
95
Critical burns no matter the depth will involve
face, eyes, ears, hands or perineu, or if impairment or respiratory issues exist
96
minor burn for children or older adults
<2% full thickness or <10% partial thickness
97
minor burn for adult
<15% TBSA partial thickness
98
common findings in liver cirrhosis
jaundice, spider angiomas, nails of terry, palmar erythema
99
slate grey skin is a manifestation of ______
hemochromatosis
100
indications for autolytic debridement
patients on anticoagulant therapy, individuals that can't tolerate other forms of debridement, AL NECROTIC WOUNDS FOR MEDICALLY STABLE PATIENTS
101
enzymatic debridement indications
all moist necrotic wounds, eschar after cross-hatching, homebound individuals, can't tolerate surgical debridement
102
mechanical debridement indications
wounds with moist necrotic tissue or foreign material present
103
indications for sharp debridement
scoring and/or exicision of leathery eschar, excision of mosit necrotic tissue, biofilm removal
104
Surgical debridement indications
advancing cellulitis with sepsis, immunocompromised individuals, infection that threatens the patient's life, granulation and scar tissue may be excised, biofilm removal
105
most efficient method of debridement for deep or complicated pressure ulcers stage III or IV
surgical debridement
106
contraindications to surgical wound debridement
cardiac/pulmonary diseases, diabetes, severe spasticity, individuals who can't tolerate surgery, short life expectancy, quality of life can't be improved
107
why might you use ultrasound for debridement of a wound
selective removal of necrotic tissue and biofilm, REDUCES BIOBURDEN, increase ANGIOGENESIS, prepares wound bed for grafting or flap closure
108
what is a contact layer dressing
serves as a porous barrier layer to protect wound bed from direct trauma from other dressings
109
albumin level that demonstrates malnutrition
<3.5
110
nutrition during wound healing
high calorie/high protein uptake: 25-35 kcal/kg and protein 1.5-2.5 gm/kg body weight (even higher for trauma stress and burns)
111
dressing that can be used for autolytic debridement
transparent films, hydrocolloids (necrosis and slough), hydrogels will promote it and alginates
112
what to be careful of when using gauze dressings
need a second layer, avoid direct contact with granulating tissue, increased infection rates, can macerate the wound if too wet
113
wet to dry gauze can be used for _____ debridement
mechanical
114
dressing for a stage I or II pressure ulcer
transparent film, it is permeable to atmospheric oxygen and moisture but impermeable to water, bacteria and environmental contaminants
115
when would you use a hydrogel dressing
for partial and full thickness wounds with necrosis and slough, burns and tissues damaged by radiation
116
