Integumentary

Question 1

What are the three layers of the skin?

Answer 1

1. Epidermis
2. Dermis
3. Subcutaneous tissue

Question 2

Nosocomial infection:

Answer 2

Acquired within a hospital (eg. nosocomial pneumonia)

Question 3

Latrogenic infection:

Answer 3

Result from a treatment or diagnostic procedure (eg. bacteraemia from peripheral or central venous cannulation)

Question 4

Chain of infection:

Answer 4

1. Etiological agent (virus, bacteria)
2. Reservoir (humans)
3. Portal of exit (coughing, sneezing, wounds)
4. Method of transmission (via healthcare worker hands)
5. Portal of entry
6. Susceptible host

Question 5

Standard precautions examples:

Answer 5

• hand hygiene (5 moments)
• PPE
• sharps use and disposal
• environmental cleaning
• cough etiquette
• aseptic non-touch technique
• waste management

Question 6

Additional precautions examples:

Answer 6

May be required where patient has highly transmissible infection:

• patient-dedicated equipment
• single rooms
• air handling
• enhanced cleaning
• specific PPE

Question 7

Functions of skin:

Answer 7

• protection of underlying tissues and organs
• excretion of salts, water and organic wastes (glands)
• maintenance of body temperature
• production of melanin and keratin
• synthesis of vitamin D
• storage of lipids
• detection of touch, pressure, pain and temperature

Question 8

Integumentary objective assessment:

Answer 8

1. Inspect and palpate
   - colour (eg. jaundice, pallor, erythema, cyanosis)
   - cap refill (normal <3secs)
   - temperature (dorsum)
   - moisture
   - turgor (from dehydration) & oedema
   - nails (clubbing, cigarette stains)
   - colour and texture of hair, balding pattern

Question 9

Risk factors for delayed wound healing or chronic wounds:

Answer 9

• diabetes
• excess alcohol intake
• inadequate nutrition
• inflammatory disease
• polypharmacy
• renal failure
• smoking
• vascular disease
• poor circulation
• older age
• location of wound

Question 10

Minimising patient harm in pressure ulcers (SSKIN)

Answer 10

• Skin assessment: skin touch test
• Surface: mattresses, pillows, lifting heels off bed (soft surfaces)
• Keep moving
• Incontinence
• Nutrition and hydration

Question 11

Pressure ulcer risk factors:

Answer 11

• immobility
• older age
• lack of sensory perception
• poor nutrition or hydration
• excess moisture or dryness
• poor skin integrity
• reduced blood flow
• incontinence
• friction and shearing
• incorrect positioning
• hard support surfaces

Question 12

Primary intention healing:

Answer 12

• tissue surfaces are closed and there is minimal tissue loss
• eg. surgical incision
• wound edges are easily opened

Question 13

Secondary intention healing

Answer 13

• extensive wound and considerable tissue loss
• eg. pressure ulcers
• wound heals through process of granulation

Question 14

Tertiary intention healing

Answer 14

• wounds left open for 3-5 days
• eg. traumatic wounds and abscess drainage
• primary intention is then attempted

Question 15

Three type of exudate:

Answer 15

1. Serous
2. Purulent
3. Sanguineous (hemorrhagic)

Question 16

Serous exudate:

Answer 16

• Mostly serum
• looks watery and has few cells
• eg. blister from a burn

Question 17

Purulent exudate:

Answer 17

• thicker
• presence of pus (consists of leukocytes, liquefied dead tissue debris, bacteria)
• colour varies with organisms

Question 18

Sanguineous (hemorrhagic) exudate

Answer 18

• large amounts of RBCs
• indicates severe damage to capillaries
• seen in open wounds
• serosanguineous exudate = consists of clear and blood-tinged drainage
• purosanguineous exudate = consists of pus and blood

Question 19

Local factors affecting wound healing:

Answer 19

• pressure
• desiccation
• maceration
• trauma
• oedema
• infection
• foreign bodies
• necrosis
• dead space

Question 20

Systemic factors affecting wound healing

Answer 20

• age
• circulation and oxygenation
• nutritional status
• medication and health status
• glucose control
• immunosuppression

Question 21

Define pressure ulcer:

Answer 21

Any lesion caused by unrelieved pressure, including shearing and friction forces
- due to a deficiency in the blood supply to the tissue (localised ischaemia)

Question 22

Risk assessment tools for pressure ulcers:

Answer 22

• Braden scale
• Norton’s Scale
• Waterloo scale

Question 23

Assessing common pressure sites:

Answer 23

• inspect pressure areas for discolouration (brisk cap refill or blanch response when palpated)
• inspect pressure areas for abrasions and excoriations
• palpate temp of pressure areas (increased is abnormal and may be due to inflammation or trapped blood)
• palpate for oedema

Question 24

Preventing pressure ulcers:

Answer 24

• Providing nutrition
• maintaining skin hygiene (reduces friction, moisturising lotions)
• avoiding skin trauma (wrinkle-free surfaces, position, ambulation)
• providing supportive devices (wedges, pillows, heel protectors, mattresses)

Question 25

Treating pressure ulcers:

Answer 25

- Minimise direct pressure - schedule position changes - clean and dress ulcer using surgical asepsis - obtain sample of drainage for culture and sensitivity - mobilise

Question 26

Aseptic Non-Touch Technique:

Answer 26

- patient is considered 'dirty' 1. appropriate and effective hand hygiene 2. maintaining non-touch technique 3. using new sterilised equipment 4. cleaning existing key parts

Question 27

Wound field theory:

Answer 27

- the patient wound is considered part of the environment

Question 28

Key nutrients for wound healing:

Answer 28

- Vitamins A, C, E - Minerals zinc and iron - Dietary protein, amino acids - Energy from carbohydrates and fats

Question 29

Which two layers of the epidermis are responsible for the germination of skin cells?

Answer 29

- stratum spinosum and straum basale | - make up the stratum germinativum

Question 30

What influence does site/location of a wound have on healing?

Answer 30

- areas exposed to more moisture and friction will take longer to heal - skin depth influences ease of healing - easier to heal in places of more tissue and more elastic tissue - less protection around wounds on bony prominences

Question 31

Why is a moist wound environment advocated?

Answer 31

- prevents dehydration - enhances angiogenesis and collagen synthesis - promotes granulation - reduces pain - helps debridement

Question 32

What clinical features should be assessed and documented in a wound assessment?

Answer 32

- location - colour - exudate - pain - temperature - skin flap or intact skin - dressings - solution used to clean wound

Question 33

What is the difference between the three types of transmission precautions required?

Answer 33

Contact precautions: infectious disease spread by contact, gloves & gown, patient dedicated equipment. Droplet precautions: infectious disease spread by respiratory droplets, surgical mask, single-patient room Airborne precautions: infectious disease spread by airborne route, P2 respirator, negative pressure room.