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-other systems npte > integumentary 1/23 > Flashcards

integumentary 1/23 Flashcards

1
Q

what term for healing? only with what kind of wound?
epithelial tissue proliferates from the wound edges
restores the surface (epidermis) of the skin

A

epithelialization

partial thickness wound - part of dermis preserved

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2
Q

what term for healing? only with what kind of wound?
beefy, red, vascularized fibroblasts
gradually fills in the hole with a collagen matrix aka scar tissue.

A

granulation tissue

Full-thickness wounds: penetrate 100% of the dermis, into the underlying hypodermal tissue

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3
Q

what healing phase?
1-4 days peak
Pain, redness, swelling, heat

A

Inflammatory phase

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4
Q

what healing phase?
4-20 days peak
fibroblasts put down new tissue
Deposition and creating of connective tissue

A

Proliferation Phase

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5
Q

what healing phase?
21 days to up to 2 years
collagen align itself to be like normal tissue
Strengthening, reorganizing, remodeling collagen fibers

A

Maturation Phase

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6
Q

what type of wound?

thermal injury by flame, scald, or contact

A

Burns

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7
Q

what type of wound?

sustained pressure, usually over a bony prominence

A

Pressure Ulcers

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8
Q

what type of wound?

Poor vascular perfusion, resulting in skin break-down

A

Vascular Ulcers

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9
Q

what type of wound?

Neuropathy, most commonly from diabetes, resulting in decreased sensation, lack of sweat glands, and poor vascularity

A

Neuropathic Ulcers

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10
Q 
what type of wound?
surgical opening (colostomy)
A

Stomas

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11
Q

what type of wound?

surgical wounds, cuts

A

Lacerations

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12
Q

what type of wound?

mechanical injury of scrape or rub

A

Abrasions

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13
Q

what type of burn?

keeps burning until neutralized (acids, bases, caustic agents)

A

Chemical

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14
Q

what type of burn?
entry, exit, and inside track injuries
multiple injuries

A

Electrical burns

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15
Q 
what type of burn?
thermal agent (flame, scald, contact)
most common
A

Thermal burns

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16
Q

what degree burn?

Superficial, redness, hot to touch, no blisters

A

1st degree

Superficial burn

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17
Q

what degree burn?
Skin is mostly intact, most of the basal layer is intact
Blisters, redness, very painful

A

2nd degree

Superficial partial thickness

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18
Q 
what degree burn?
Extends >50% through dermis
Yellow/white, some blisters
Exudate, eschar
Less painful
A

2nd degree

Deep partial thickness

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19
Q

what degree burn?
White/brown/blackish, painless, dry
Down to subcutaneous, adipose
Must heal via granulation

A

3rd degree

Full thickness

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20
Q 
what healing phase?
inflammatory cells (neutrophils, eosinophils, and monocytes)
A

Inflammatory phase

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21
Q

what healing phase?

  • Platelets aggregate around exposed collagen
  • Platelets release growth factors (GFs) and cytokines
  • “call” a variety of inflammatory cells (neutrophils, eosinophils, and monocytes) to initiate next phase
A

Hemostasis

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22
Q

what healing phase?

  • Proteolytic enzyme notably neutrophils, eosinophils, and macrophages
  • Pro-inflammatory cytokines induce synthesis of collagen via fibroblasts
  • Secrete growth factors that stimulate migration of fibroblasts, epithelial cells and vascular endothelial cells into the wound
A

Inflammatory Phase

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23
Q

what healing phase?

  • Fibroblast proliferation guide the formation of the ECM extracellular matrix
  • Vascular endothelial cell proliferation, promote angiogenesis, leads to granulation
  • Keratinocyte migration across newly formed granulation tissue to edge of wound and proliferate, re-epithelization
A

Proliferative stage

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24
Q

what healing phase?

  • Balance between the synthesis of new components of the scar matrix
  • Fibroblasts are the major cell type that synthesizes collagen, elastin, and proteoglycans
  • Form cross-links in ECM
  • Angiogenesis ceases and the density of capillaries in the wound site decreases as the scar matures, so stronger scar
  • 75% of its original tensile strength
A

maturation phase

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25
Q

what to document about wound?

A

Document wound size

diameter, depth, shape, border, tunneling, drainage

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26
Q

stage of bed sore, decubiti, pressure ulcer?

Nonblancheable erythema

A

Stage I

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27
Q

stage of bed sore, decubiti, pressure ulcer?

covered thickly in eschar or adherent slough

A

unstageable

need to remove eschar, slough

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28
Q

stage of bed sore, decubiti, pressure ulcer?

Partial thickness skin loss

A

Stage II

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29
Q

stage of bed sore, decubiti, pressure ulcer?

Full thickness to the underlying fascia

A

Stage III

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30
Q

stage of bed sore, decubiti, pressure ulcer?

Full thickness to bone, tendon or muscle

A

Stage IV

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31
Q 
scale for risk for pressure ulcer?
max score? good or bad?
low risk for pressure ulcer?
moderate risk? 
high risk?
A 
braden scale 
max score 23, good 
15-16 low risk for pressure ulcer
13-14 moderate risk 
<12 high risk
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32
Q

interventions if high risk for pressure ulcer

A
  • positioning- tilt one way (pillow under hip, leg)
  • Offload bony prominences, float the heels
  • turning schedule, movement!, bed mobility training
  • good nutrition
  • air mattress
  • wheelchair - always cushion, gel, Roho
  • Keep skin clean and dry
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33
Q

how to decrease friction/shearing during transfer?

A
  • Lift, don’t drag
  • Keep head of bed low (to avoid sliding)
  • Use draw sheet
  • Bed mobility training
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34
Q

venous or arterial?
• Punched out, even edges, deeper
• Linked to atherosclerosis, claudication

A

arterial

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35
Q

venous or arterial?
• Loss of hair
• Cyanotic, pale, ashen

A

arterial

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36
Q

venous or arterial?

• Linked to diabetes, hypertension, hyperlipidemia, smoking

A

arterial

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37
Q

venous or arterial?
• Painful
• Minimal drainage
• Absent or decreased pulse, Low ABI

A

arterial

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38
Q

venous or arterial?
• Rubor of dependency
• ABI

A

arterial

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39
Q

venous or arterial?
• Large, irregular edges
• Shallow depth, inflamed surrounding skin
• Usually above the malleoli

A

venous

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40
Q

venous or arterial?
• Edema, indurated, hyperpigmented, hemosiderin staining, red
• Moderate to maximal drainage

A

venous

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41
Q

venous or arterial?
• Usually minimal pain
Decreased pain with elevation

A

venous

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42
Q

venous or arterial?

• High ABI >.08

A

venous

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43
Q

ABI test
best score?
cutoffs?

A

Ratio of: (highest ankle blood pressure) / (highest brachial pressure)
best 1.0
<0.8 common arterial ulcer, intermittent claudication
>1.2 calcification, arterial hardening/plaques, not reliable reading

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44
Q

venous or arterial wound management?
• Nutrition
• Revascularization
• Control modifiable risk factors

A

arterial

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45
Q

venous or arterial wound management?
• Moist/optimal wound environment (eg. occlusive dressing, hydrogel)
• Debridement of dead skin
• Protect and prevent with good footwear and regular inspections

A

arterial

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46
Q

venous or arterial wound management?
• Nutrition
• Compression, Unna Boot (multilayer lower compression gauze bandage with zinc oxide dressing), short stretch
• Control modifiable risk factors

A

venous

47
Q

venous or arterial wound management?
• Control exudate (eg. Highly absorptive dressing, multi-layer)
• Debridement
• Protect and prevent with good footwear and regular inspections

A

venous

48
Q

what pathology?
inflammation of skin
- common around venous ulcer
- caused by bacteria infection streptococci or staphylococci
- risk factors: increased age, immunosuppression, trauma, presence of wound, venous insufficiency
what next?
what similar?

A

cellulitis

refer to physician for systemic antibiotics, need to rule out DVT and contact dermatitis

49
Q

ideal environment for wound healing

A

Keep the skin dry
Keep wound moist
- Absorb exudate, Impermeable

50
Q

what type of wound?

  • ulcer on the plantar surface of the foot
  • often bony prominence, eg. metatarsal head
A

Diabetic Neuropathic Foot Ulcers

51
Q 
what type of wound?
• Decreased blood flow to capillaries
• Lack of perspiration/dry, cracking skin 
• Deterioration of bones/muscles/joints 
• Callus buildup
• Dry cracked callus holds bacteria
A

Diabetic Neuropathic Foot Ulcers

52
Q

what type of wound?

  • Excessive blood glucose damages capillaries, nerves, and collagen/muscular support
  • loss of protective sensation
A

Diabetic Neuropathic Foot Ulcers

53
Q

what type of wound?

  • foot collapse, builds callus but dries up and breeds bacteria
  • common over navicular plantar surface
A

Diabetic Neuropathic Foot Ulcers

charcot foot - collpasing foot

54
Q

what scale for grading Diabetic Neuropathic Foot Ulcers?
max score?
low score?

A

wagner scale

grade good 0 to 5 bad

55
Q

what wagner scale grade?

  • thick calluses, bone deformities, claw toes, prominent metatarsal heads
  • no opening yet
  • foot at risk
A

grade 0

56
Q

what wagner scale grade?

  • total destruction of thickness of skin, superficial
  • ulcer appears
A

grade 1

57
Q

what wagner scale grade?

  • penetrates through skin, fat, and ligaments
  • down to subcutaneous layer
  • does not affect bone
  • infected
  • deep ulcer
A

grade 2

58
Q

what wagner scale grade?

  • limited necrosis in toes or foot
  • osteomyelitis appears
  • abscessed deep ulcers
A

grade 3

59
Q

what wagner scale grade?

  • limited necrosis in toes or foot
  • limited gangrene on digits
A

grade 4

60
Q

what wagner scale grade?

  • extensive gangrene
  • necrosis of complete foot with systemic effects
  • need amputation
A

grade 5

61
Q

type of debridement?

cover it/seal it in and let body’s own system do the work

A

Autolytic

62
Q 
type of debridement?
Wound scrubbing
wet-to-dry,
whirlpool,
pulsatile lavage,
ultrasound
A

Mechanical

63
Q

type of debridement?

placement of external enzyme to break up eschar

A

Enzymatic

64
Q

type of debridement?

Scalpel, scissors, sharps

A

selective

65
Q

type of debridement?

Whirlpool, lavage, wet-to-dry, scrubbing

A

non-selective

66
Q

infected or inflamed wound?

  • redness is Splotchy, expansive, stripes
  • Systemic fever
A

infected

67
Q

infected or inflamed wound?

  • Strong odor
  • Moderate to maximal, serous to purulent exudate
A

infected

68
Q

infected or inflamed wound?

  • Persistent
  • Surrounding tissue indurated/very firm about to pop, increased temp
A

infected

69
Q

infected or inflamed wound?

  • redness is Well defined borders
  • temp increase is localized
A

inflamed

70
Q

what non selective debridement

will pull out slough and good tissue, may prevent granulation/epithelial tissue from forming and covering wound

A

wet to dry

71
Q

infected or inflamed wound?

  • weak odor
  • exudate minimal, sanguineous (bloody)
A

inflamed

72
Q

infected or inflamed wound?

  • Variable pain
  • slight to minimal firm induration
A

inflamed

73
Q

what dressing?

  • very absorptive (2)
  • use for mod to heavy exudate
  • helps wick away moisture from wound
A

Calcium Alginate- non-woven, non-adhesive pads, form a moist gel

Hydrofibers (Aquacell)

74
Q

what dressing?

  • absorptive
  • area in contact with the wound surface is non-adhesive for easy removal
  • min to mod exudate use type with border
  • mod to max exudate - need secondary dressing
  • use on partial- and full-thickness wounds
A

foam- foamed polymer solutions with small, open cells capable of holding fluids

75
Q

what dressing?

  • allows you to easily monitor and seal it in
  • coated on one side with an adhesive
  • no absorption
  • impermeable to liquid, water and bacteria but permeable to moisture vapor and atmospheric gases
  • epithelializing wound, superficial wound and shallow wound with low exudates,
  • primary or secondary dressing
  • eg. Tegaderm
A

transparent film

76
Q

what dressing?

  • water and glycerin
  • no absorption
  • best for dry wounds to provide moisture
A

hydrogel

77
Q

what dressing?

  • occlusive bandage, two layers, inner colloidal layer and outer water- impermeable layer.
  • some absorption
  • contact wound exudate forms gels and provide moist environment
  • Available as sheets or thin films, useful on areas that require contouring, such as heels and sacral ulcers.
  • not indicated for neuropathic ulcers or highly exudating wounds
  • mostly secondary dressing
A

Hydrocolloid

78
Q

what dressing?

  • little absorption, non-wicking can cause maceration if there is exudate
  • highly permeable and relatively non-occlusive
  • cotton, polyester or rayon
  • used for cleansing, packing and covering a variety of wounds
A

Gauze

79
Q

what dressing?

  • coated with petrolatum or iodine
  • primary dressing promotes moist environment
  • non-adherent and require a secondary dressing
  • eg. Xeroform
A

Impregnated Gauze

80
Q

what type of debridement?
Collagenase Santyl
breaks down eschar

A

Enzymatic Debridement

81
Q

what is this for?

Regranex

A

growth factor for wound healing

82
Q

what are these for?
• Silvadene, silver (Ag)
• Iodoflex
• Bacitracin, neomycin, polymyxin B (triple antibiotic)

A

antimicrobials

83
Q

what is this for?

Negative Pressure Wound Therapy (WoundVac)

A

highly exudating wounds

84
Q

what dressing?

  • strong hydrophilic gel formation, which limits wound exudates and minimizes bacterial contamination
  • suitable for moderate to heavy drainage wounds
  • not suggested for dry wound, third degree burn wound and severe wounds with exposed bone.
  • require secondary dressings because it could dehydrate the wound which delay healing.
A

Calcium Alginate

85
Q 
what intervention?
increase O2 deliver to whole body
help with tissue hypoxemia
good for chronic diabetic ulcer 
expensive
A

hyperbaric chamber

86
Q

what modality?

  • applied at low intensity with pulsed duty cycle
  • enhances all phases of healing
  • fibroblast, endothelial, wbc activity stimulated
  • enhance strength and elasticity of scar tissue
A

ultrasound

87
Q

what modality?

  • Enhance healing for chronic ulcers, burns, donor and graft sites
  • Monophasic direct current stimulates angiogenesis, epithelial migration, decreased bacteria activity, wound pain, increase oxygen perfusion, tensile strength
A

HVPC

88
Q

what dressing?

  • Derived from seaweed extraction
  • Use for partial or full thickness draining wounds
  • Pressure or venous insufficiency ulcers
  • Infected wounds with excess drainage
  • Requires secondary dressing
  • cannot be used on exposed tendon, joint capsule, or bone
A

alginates

89
Q

what dressing?

  • Encourages autolytic debridement
  • moderate absorption
  • partial and full thickness wounds with varying levels exudate
  • may traumatize periwound
A

foam

90
Q

what dressing?

  • Infected or non-infected
  • can be used for wet to wet, wet to moist, or wet to dry debridement
  • increased infection rate compared to occlusive dressing
A

gauze

91
Q

what dressing?

  • gel forming polymers with strong film or foam adhesive
  • use for partial and full thickness wounds
  • can be used with granular or necrotic wounds
  • moist enviroment for wound healing
  • allows autolytic debridement
  • cannot be used on infected wounds
A

hydrocolloids

92
Q

what dressing?

  • made of varying amounts of water and glycerin
  • moisture retentive, provides moist environment
  • used on superficial and partial thickness wounds (abrasions, blisters, pressure ulcers) with minimal drainage
  • allows autolytic debridement
  • potential for dressings to dehydrate
  • typicall requires secondary dressing
A

hydrogel

93
Q

what dressing?

  • thin membranes and water-resistant adhesives
  • highly elastic able to conform to body contours
  • allow easy visual inspection of wound
  • superficial or partial thickness wound with minimal drainage (eg. scalds, abrasions, laceration)
  • moist environment for healing
    • allows autolytic debridement
  • cannot be used on infected wounds
  • may traumatize periwound
A

transparent film

94
Q

dressing with silver will be deactived by

often incorporated in foam dressings, alginate dressings, gauzes and films for antimicrobial activity

A

saline deactivates silver

must used DI water

95
Q 
ranking non occlusive to most occlusive or vice versa?
hydrocolloid
hydrogel
semipermeable foam
semipermeable film
impregnated gauze
alginate
traditional gauze
A

most occlusive to non occlusive

least permeable to most permeable

96
Q 
ranking least o most moisture retentive or vice versa?
alginates
semipermeable foam
hydrocolloid
hydrogels
semipermeable films
A

most to least moisture retentive

97
Q

burn zone?

area of burn received most severe injury with irreversible cell damage

A

zone of coagulation

98
Q

burn zone?

area of less severe injury that possesses reversible damage and surrounds zone of coagulation

A

zone of stasis

99
Q

burn zone?
area surrounding zone of stasis that presents with inflammation, but will fully recover without any intervention or permanent damage

A

zone of hyperemia

100
Q

compression garments for burns
indicated for what kind of burns?
pressure?
hours per day?

A
  • for burns requiring >14 days to heal
  • compression 15-35mmHg to balance collagen synthesis and lysis
  • wear 22-23 hours per day until scar matured
101
Q

desensitization intervention post amputation or burns

  • why?
  • duration, frequency?
A

prevent developing hypersensitivity, improve tolerance to variable temperature, touch, pressure, vibration to decrease discomfrt
- 5-10min, 3-4x/day

102
Q 
topical agent for burn?
\+ use with or w/o dressing
\+ painless, can apply to wound directly, 
\+ broad spectrum
\+ effective against yeast
- does not penetrate into eschar
A

silver sulfadiazine

103
Q 
topical agent for burn?
\+ broad spectrum
\+ non allergenic
\+ dressing application painless
- poor penetration
- discolors, hard to assess
- can cause severe electrolyte imbalance
- remove of dressing is painful
A

silver nitrate

104
Q 
topical agent for burn?
\+ broad spectrum
\+ antifungal
\+ easily removed w water
- no effective against pseudomonas
- may impair thyroid function
- painful application
A

povidone-iodine

105
Q 
topical agent for burn?
\+ broad spectrum
\+ penetrates burn eschar
\+ may be used with or without occlusive dressings
- may cause metabolic acidosis
- may compromised respiratory function
- may inhibit epithelialization
- painful application
A

mafenide acetate

106
Q 
topical agent for burn?
\+ broad spectrum
\+ may be covered or left open to air
- has caused resistant strains
- ototoxic
- nephrotoxic
A

gentamicin

107
Q 
topical agent for burn?
\+ bacteriocidal
\+ broad spectrum
- may lead to overgrowth of fungus and pseudomonas
- painful application
A

nitrofurazone

108
Q

what pathology?
superficial irritation of skin after exposure to precipitating agent
- common irritants poison ivy, latex, soap, nickel, rubber, topical antibiotics
- symptoms: intense itching, burning, red skin, edema
how to treat?

A

contact dermatitis

- treat: remove source of irritation, topical steroid

109
Q

what pathology?
- dark brown or black nonviable tissue becomes hardened
- loss of vascular supply leads to local tissue death
- common in fingers, toes, limbs
- hardened tissue not painful, but significant pain at line of demarcation
- develops slowly
- sometimes leads to self-amputation
- risk factors: DM, atherosclerosis, poor circulation
what can it progress to?
treatment?

A

dry gangrene
can progress to wet gangrene if infection occurs
treat: serious medication condition, needs immediate medical intervention, pharmacological intervention, surgery, hyperbaric O2 therapy

110
Q

what pathology?
- bacterial infection in affected tissue, swelling causes sudden stop of blood flow
- can develop after severe burn, frostbite, or injury requiring immediate treatment
- spreads quickly and can be fatal
- presentation: swelling and pain at site of infection, skin turns red to brown to black, blisters with pus, fever, general malaise
treatment?

A

wet gangrene
treat: immediate medical intervention, surgical debridement, intravenous antibiotic treatment, medication, surgery, hyperbaric O2 therapy

111
Q

what pathology?
fungal infection affects toenails and nailbed
- present: yellow or brown nail discoloration, hyperkeratosis, hypertrophy of nail

A

onychomycosis

112
Q

what pathology?
- chronic autoimmune disease, T cells inflam skin and produce accelerated skin cell growth, cause raised red patching on surface of skin
- may be triggered by skin injury, insufficient /excess sunlight, stress, excessive alcohol, HIV infection, smoking, certain meds
- typically over both knees and elbows
treatment?
- how long does it last?

A

plaque psoriasis

treat: control symptoms and prevent secondary infection with topical application to systemic meds and phototherapy
- lifelong condition, can be managed and controlled

113
Q

what pathology?
- superficial fungal infection causes epidermal thickening and scaly skin appearance
- fungus is opportunistic, will rapidly multiply in warm and moist environment
- symptoms: itching, redness, peeling skin between toes, pain, odor, breaks in skin
treatment?
prevention?

A

tinea pedis, athlete’s foot
treat: medication topical or oral antibiotics
may recur
prevent: dry feet when bathing or swimming, wear sandals in public pools/showers, change socks frequently, proper hygiene, avoid shoes that create moist environment

-other systems npte (7 decks)

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