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NPTE > Integument > Flashcards

Integument Flashcards

1
Q

When would you use a unna boot?

A

For a venous ulcer to unload the wound

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2
Q

where is the thickest skin in the body?

A

palms of hand and sole of foot, contains stratum lucidum

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3
Q

what is excreted with sweat and why is that important?

A

Urea and salt, which aids in elimination of metabolic waste

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4
Q

layers of epidermis from superficial to deep

A

stratum corneum, lucium
granulosum, spinosum, basale

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5
Q

what cells can you find in statrum granulosum

A

live keratinocytes and langerhans cells for immunity

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6
Q

what is found in stratum spinosum

A

ketatinocytes and langerhans

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7
Q

what cells are found in the stratum basale

A

merkel cells, melanocytes, epidermal cells

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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

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9
Q

what types of glands are sebaceous glands and what is the function of sebum

A

exocrine, defends against bacteria and fungus

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10
Q

where are apocrine sweat glands and when are the stimulated

A

found in axillary and genital regions, activated with stress

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11
Q

superficial or partial thickness wounds occur in what layer of skin

A

epidermis

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12
Q

do we want wounds wet or dry

A

wet

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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

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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.

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15
Q

what happens at the end of the inflammatory phase

A

Phagocytosis and neovascularization

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16
Q

key cells in the inflammatory phase of healing

A

mast cells, platelets, leukocytes, macrophages–> can be impaired by diabetes

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17
Q

4 primary events of granulation/proliferative phase

A
  1. angiogenesis
  2. granulation formation
  3. wound contraction
  4. epithelialization
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18
Q

primary cells of granulation phase

A

myofibroblasts for wound contraction
fibroblasts for collagen, elastin and glycosaminoglycan production
epithelial cells for epithelialization

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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

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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

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21
Q

how can you reduce hypertrophic or kelloid scarring

A

compression garments, silicon gels/sheets

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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

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23
Q

what will infection and increased wound bioburden do to phases of healing

A

prolong the inflammatory phase

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24
Q

stress effect on wounds

A

decreases pro inflammatory cytokines and increases wound hypoxia

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25
Q

uticaria=

A

allergic hive reaction, red elevated patches

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26
Q

xeroderma=

A

excessive dry skin with shedding
deficiency of thyroid function, diabetes

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27
Q

when might you see clubbing of the nails

A

chrons’s disease, cyanois, lung cancer or chronic hypoxia, ulcerative colitis, biliary cirrhosis, neoplasm, GI involvement

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28
Q

what is schamroth’s window test:

A

positive if don’t see diamond shape space when nails from opposite hands are placed back to back
INDICATES CLUBBING

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29
Q

stemmer’s sign=

A

thickened fold of skin at the base of second toe or second finger when pinched or lifted
sign of primary lymphedema

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30
Q

cherry red skin color may indicate

A

liver or renal issues

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31
Q

hypohidrosis

A

may indicate dehydration, ichthyosis, hypothyroidism or late stage DM

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32
Q

central causes of cyanosis can be seen where

A

oral mucosa, tongue, lips

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33
Q

peripheral causes of cyanosis

A

nail beds, hands or feet

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34
Q

cyanosis may indicate

A

lack of hemoglobin from congestive heart failure, advanced lung disease, congenital heart disease, venous obstruction

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35
Q

pallor may be seen with

A

anemia, internal hemorrhage

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36
Q

brown/yellow spots on skin may indicate

A

liver malignancies, pregnancy, uterine malignancies, aging

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37
Q

hyperthyroid versus hypothyroidism temperatures

A

heat in hyper, cold in hypo

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38
Q

serous exudate=

A

watery serum

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39
Q

purulent exudate=

A

contains pus

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40
Q

sanguineous exudate=

A

contains blood

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41
Q

macerated ulcer=

A

softened tissues due to high fluid environment

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42
Q

clean read wounds are

A

healthy, granulating wounds, need protection

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43
Q

yellow wounds

A

include slough (which is necrotic dead tissue)

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44
Q

indolent ulcer=

A

slow to heal

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45
Q

infected periwound (cellulitis)

A

erythema, warmth and swelling

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46
Q

macerated periwound

A

moisture (urine or feces) or increased drainage, at risk for wound deterioration and enlargement

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47
Q

components of wound exam

A

location, size, tunneling, exudate, color and involved tissues, temperature, girth, periwound, sensory integrity, infection, scar tissue, video, pain and imaging if needed

48
Q

arterial imaging for wound care

A

arteriogram, doppler US, magnetic resonance angiography, CT angiography

49
Q

impetigo

A

superficial skin infection from staphylococci or streptococci: inflammation, itching, small pus-filled vesicles, contagious common in elderly and children

50
Q

venous imaging for wound care

A

doppler US, magnetic resonance venography, CT venography

51
Q

Herpes simplex

A

cold sore or fever blister, contact spread

52
Q

herpes 2

A

genital

53
Q

herpes zoster

A

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
Q

contraindications with herpes zoster

A

Heat and US

55
Q

Tinea corporis

A

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
Q

griseofulvin or antifungal side effects

A

HA, GI issues, fatigue, insomnia, photosensitivity, monitor liver function

57
Q

tinea pedis

A

fungal infection typically found in-between toes
erythema, inflammation, pruritus, itching, pain
can become bacterial infection, cellulitis

58
Q

yeast grows in areas of

A

increased moisture

59
Q

treat yeast (candidiasis)

A

reduce moisture, anti fungal ointment, potentially silver infused dressing in skin folds

60
Q

psoriatic arthritis affects which joints

A

small distal joints

61
Q

butterfly rash is typical of what disease

A

systemic lupus erythematosus (occurs on the nose)

62
Q

SLE signs and symptoms

A

affects young women, fever, malaise, butterfly rash, skin lesions, chronic fatigue, arthralgia, arthritis, skin rashes, photosensitivity, anemia, hair loss, raynaud’s

63
Q

DLE (discoid lupus)

A

only skin issues, flare-ups with sun exposure, can resolve or atrophy, permanent scarring hypopigmentation or hyperpigmentation

64
Q

Scleroderma

A

chronic, autoimmune disease of connective tissue which causes fibrosis of skin, joints, blood vessels and internal organs, accompanied by raynauds phenomenon

65
Q

PT for scleroderma

A

prevention of contractures, skin care education, exercise and joint protection
check vitals, look for hypertension

66
Q

PT management for polymyositis (PM) or dermatomyositis (DM)

A

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
Q

diffuse systemic sclerosis disease

A

symmetrical, widespread skin of distal and proximal extremities, face, trunk rapid progresseion

68
Q

limited cutaneous systemic sclerosis

A

involves skin of face lower arms and lower legs and internal organ involvement

69
Q

other than gauze what can be used for infected wounds

A

silver impregnated foam

70
Q

treat diabetic ulcer

A

offload the wound by using protective therapeutic footwear
pt education on glycemic control and nutrition
skin care

71
Q

how to treat scabies

A

scabicide, mites will burrow into the skin and cause inflammation, itching and pruritis/urticaria

72
Q

ABCDEs of malignant melanoma

A

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
Q

What is a basal cell carcinoma:

A

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
Q

what is a squamous cell carcinoma:

A

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
Q

malignant melanoma

A

tumor of melanocytes, superficial spreading melanoma (SSM) is most commonw

76
Q

what are the risk factors for malignant melanoma

A

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
Q

Treatment for Kaposi’s sarcoma

A

wound care (whirlpool or pulsed lavage with suction) avoid shearing, contractures and edema

78
Q

Stage I pressure ulcer

A

non-blanchable erythema, may include change in temp, tissue consistency and sensation

79
Q

Stage II pressure ulcer

A

partial-thickness skin loss, involves epidermis, dermis or both. Superficial, presents clinically as an abrasion, blister or shallow crater

80
Q

Stage III pressure ulcer

A

full thickness skin loss, involves damage or necrosis of sub Q tissue. May show fascia but not through it, deep crater

81
Q

Stage IV pressure ulcer

A

full thickness skin loss, necrosis, damage to muscle, bone or supporting structures, undermining and sinus tracts

82
Q

Unstageable wound

A

deep tissue is obscured due to slough or eschar and can’t determine extent of damage

83
Q

Deep tissue injury

A

discolored, dark bruise under skin, likely progresses to full thickness injury

84
Q

what scale is used for diabetic/neuropathic wounds

A

wagner classification

85
Q

what ABI is compression contraindicated

A

<0.7, for high compression sustained compression contraindicated for <0.6 or with active DVT

86
Q

treating venous ulcers

A

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
Q

common sites of arterial ulcers

A

toes, feet, bony areas

87
Q

when may walking be contraindicated due to a wound

A

arterial wound when ABI <4, if there is gangrene or ulceration and resting pain

88
Q
A
89
Q

Bates wound assessment is for what type of wounds

A

pressure ulcers

90
Q

critical burn for child or older adult is classified by

A

> 10 % of full thickness burns or >20% of partial thickness burns

91
Q

critical burn for any patient

A

> 25% total body surface area

92
Q

moderate burn for adult

A

15-25% TBSA mixed between partial and full thickness

93
Q

moderate burn for child or older adult=

A

<10% full thickness burns and 10-20% total body surface area of partial thickness burn

94
Q

To be classified as a moderate burn, burns can’t

A

involve face, hands, feet, genitalia, perineum or major joints

95
Q

Critical burns no matter the depth will involve

A

face, eyes, ears, hands or perineu, or if impairment or respiratory issues exist

96
Q

minor burn for children or older adults

A

<2% full thickness or <10% partial thickness

97
Q

minor burn for adult

A

<15% TBSA partial thickness

98
Q

common findings in liver cirrhosis

A

jaundice, spider angiomas, nails of terry, palmar erythema

99
Q

slate grey skin is a manifestation of ______

A

hemochromatosis

100
Q

indications for autolytic debridement

A

patients on anticoagulant therapy, individuals that can’t tolerate other forms of debridement, AL NECROTIC WOUNDS FOR MEDICALLY STABLE PATIENTS

101
Q

enzymatic debridement indications

A

all moist necrotic wounds, eschar after cross-hatching, homebound individuals, can’t tolerate surgical debridement

102
Q

mechanical debridement indications

A

wounds with moist necrotic tissue or foreign material present

103
Q

indications for sharp debridement

A

scoring and/or exicision of leathery eschar, excision of mosit necrotic tissue, biofilm removal

104
Q

Surgical debridement indications

A

advancing cellulitis with sepsis, immunocompromised individuals, infection that threatens the patient’s life, granulation and scar tissue may be excised, biofilm removal

105
Q

most efficient method of debridement for deep or complicated pressure ulcers stage III or IV

A

surgical debridement

106
Q

contraindications to surgical wound debridement

A

cardiac/pulmonary diseases, diabetes, severe spasticity, individuals who can’t tolerate surgery, short life expectancy, quality of life can’t be improved

107
Q

why might you use ultrasound for debridement of a wound

A

selective removal of necrotic tissue and biofilm, REDUCES BIOBURDEN, increase ANGIOGENESIS, prepares wound bed for grafting or flap closure

108
Q

what is a contact layer dressing

A

serves as a porous barrier layer to protect wound bed from direct trauma from other dressings

109
Q

albumin level that demonstrates malnutrition

A

<3.5

110
Q

nutrition during wound healing

A

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
Q

dressing that can be used for autolytic debridement

A

transparent films, hydrocolloids (necrosis and slough), hydrogels will promote it and alginates

112
Q

what to be careful of when using gauze dressings

A

need a second layer, avoid direct contact with granulating tissue, increased infection rates, can macerate the wound if too wet

113
Q

wet to dry gauze can be used for _____ debridement

A

mechanical

114
Q

dressing for a stage I or II pressure ulcer

A

transparent film, it is permeable to atmospheric oxygen and moisture but impermeable to water, bacteria and environmental contaminants

115
Q

when would you use a hydrogel dressing

A

for partial and full thickness wounds with necrosis and slough, burns and tissues damaged by radiation

116
Q
A

NPTE (7 decks)

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