Integumentary

Question 1

role of lymphatic system

Answer 1

drainage/sanitation
one way system to transport lymph w proteins/water/fatty/acids/cellular components through lymph nodes, thymus, bone marrow, spleen, tonsils, Small intestine
- remove waste, excess fluid
- alert immune system
- return fluid and plasma proteins to blood

Question 2

lymphatic system anatomy small to large

Answer 2

lymph capillary
pre collectors
collectors
lymph nodes
lymphatic trunks
R lymphatic duct and thoracic duct

Question 3

lymph formation

Answer 3

precollectors fill with low interstitial pressure
interstitial pressure increases with filling, inlet valves open w Pressure
fill lymph vessel w fluid, lowering pressure and close valves
valves open to precollector and fluid flows onward

Question 4

transport capacity

Answer 4

amount of fluid the system can move at maximum intensity
normally works at 10% capacity

Question 5

functional reserve

Answer 5

difference between transport capacity and amount of fluid being transported at rest

Question 6

lymphatic load

Answer 6

amount of fluid being transported at rest

Question 7

dynamic insufficiency

Answer 7

caused by immobility, CHF, sprained ankle, increased LL

Question 8

mechanical insufficiency

Answer 8

caused by damage to lymphatic system making it unable to handle increased LL
eg lymphedema
also surgery, infection, trauma causing reduced TC

Question 9

causes of lymphedema

mechanical cause within lymphatic system

Answer 9

TC dropping below LL
causes accumulation of fluid in subcutaneous tissue
risk factors include: excess weight, arm infection/injury

Question 10

diagnosis of lymphedema

primary/secondary

Answer 10

primary: from abnormally developed lymphatic system
secondary: results from known injury

Question 11

clinical presentation of lymphedema

Answer 11

slow progression
mild warmth
no color change
painless
full/heavy feeling
pitting edema
asymmetrical limbs

Question 12

differences between lymphedema and general edema

Answer 12

risk factors
other diagnoses
Stemmer sign: + for lymphedema
acute injury is general
general chronic edema comes with skin changes, achy pain, progressing through day

Question 13

stages of lymphedema

Answer 13

0: no edema, - stemmer
1: soft pitting edema, reversible w elevation, increase w activity, - stemmer
2: spontaneously irreversible, edema progressing to nonpitting brawny edema, not reversed w elevation, + stemmer, fibrosclerotic tissue, frequent infection/skin changes
3: lymphostatic elephantiasis, severe brawny edema not reversed w elevation, + stemmer, fibrosclerotic tissue, frequent infection, skin changes

Question 14

Stemmer sign

Answer 14

+ if skin cannot be pinched and lifted at base of fingers or toes

Question 15

lymphedema treatment

Answer 15

depends on cause, which should be addressed
medications

Question 16

cellulitis

Answer 16

bacterial skin infection with open wound

Question 17

cellulitis s/s

Answer 17

red, edema, tender, pain, warm, blister, fever, headache, chills, weakness, red streaks

Question 18

cellulitis diagnosis

Answer 18

blood tests, skin culture

Question 19

cellulitis treatment

Answer 19

antibiotics (oral/topical/IV)
wound dressing
pain meds
surgery

Question 20

complications of cellulitis

Answer 20

extensive tissue damage, gangrene, blood infection causing sepsis, amputation, deat

Question 21

prevention of cellulitis

Answer 21

hygiene, protect dry skin, protective footwear, wound prevention

Question 22

function of the epidermis

Answer 22

skin integrity
physical barrier to pathogens
protect against cellular fluid loss

Question 23

function of the dermis

Answer 23

tensile strengh/support
retain moisture, blood O2

Question 24

normal wound healing timeline

Answer 24

1: inflammatory 1-10 days
2: proliferative 3-21 days
3: maturation 7 days - 2 years

Question 25

factors affecting wound healing

Answer 25

age
comorbidities
edema
bad wound care
infectionlifestyle
stress
medications

Question 26

what happens when healing phases are interrupted?

Answer 26

1: chronic inflammation cycle can occur
2: delay healing resulting in chronic wound
3: scar tissue remodeling, only 80% strength of normal tissue

Question 27

ideal wound healing environment

Answer 27

moist
breathable barrier
controlled exudate for peri wound integrity
change bandage when leakage

Question 28

wound characteristics to take note off

Answer 28

location
size
shape
edges
tunneling
base compared to sides
periwound area
pain

Question 29

serous drainage

Answer 29

clear/watery
inflammatory/proliferative phases

Question 30

sanguineous drainage

Answer 30

red/watery
inflammatory/proliferative phases

Question 31

serosanguineous drainage

Answer 31

clear/pink/watery
inflammatory/proliferative phases

Question 32

seropurulent drainage

Answer 32

cloudly/opaque/yellow/waterly
early warning sign of infection, abn finding

Question 33

purulent drainage

Answer 33

yellow/green/thick
wound infection, abn finding

Question 34

necrotic tissue types

Answer 34

slough: easily removed moist/stringy white or yellow tissue attached to wound
eschar: hard dehydrated tissue adhered to healthy tissue
gangrene: death of tissue due to interrupted blood dlow
hyperkeratosis: white callus, firm/soggy texture

Question 35

primary intention wound closure

Answer 35

surgeon closes edges by approximating with flue/stitches, etc
opening called dehiscence

Question 36

secondary intention wound closure

Answer 36

wound left open to heal on its own
new tissue laying down in wound bed closes eventually
heal deepest to superficial

Question 37

tertiary intention wound closure

Answer 37

delayed primary
secondary intention fails and it is closed surgically
may be purposefully delayed due to infection, closed once healed

Question 38

abn findings in wound healing

Answer 38

changing: color, odor
persistent edema
necrotic tissue
tunneling
infection
ridge at wound edge
hypertrophic scarring

Question 39

venous ulcer

Answer 39

edema, pain in dependent position, cyanotic, pigmentation of skin, exudate

Question 40

arterial ulcer

Answer 40

poor pulse, severe pain, cool to touch, trophic changes to skin, deep ulcers, black gangrenous skin

Question 41

diabetic ulcer

Answer 41

diminished pulse
sensory loss
ulcer present
may develop gangrene

Question 42

pressure ulcer

Answer 42

pain if sensation intact
color change
warm if infection/fever
necrotic tissue
over bony prominences
can be gangrene

Question 43

Braden Scale

Answer 43

predict pressure sore risk
use sensory perception, moisture, activity, mobility, nutrition, friction/shear

Question 44

stages of pressure ulcers

Answer 44

1: intact skin, nonblanchable redness
2: partial thickness tissue loss, no slough
3: full thickness tissue loss, visible structures underneath
4: full thickness w exposed bone, slough or eschar
unstageable: full thickness, covered in slough
deep tissue injury: purple area of discolored skin due to soft tissue damage

Question 45

risk factors for diabetic ulcers

Answer 45

poor footwear/deformity/foot trauma
non compliance w dx management
lack of protective sensation
skin changes
Hx of amputation
alc/tobacco
immobile
advanced age
weakened immune
vascular disease

Question 46

wagner diabetic ulcer grades

Answer 46

0: no open lesion, may be preulcerative
1: superficial ulcer, not subcutaneous
2: deep ulcer into subcutaneous, may expose structures
3: deep ulcer w abscess/bone infection
4: gangrene –> maybe amputation
5: gangrene w deep tissue injury –> definitely amputation