Integumentary Flashcards
Integumentary I: wound healing
True or false: serum pre-albumin of 15mg/dL is indicative adequate long-term nutrition
False: albumin of <3.5 g/dL is indicative of long-term malnutrition
18-day half-life
Integumentary I: wound healing
Patient requires getting enough protein for appropriate wound healing.
Which is the laboratory assessment indicative of a short-term poor nutritional status?
Serum Prealbumin <20 mg/dK
(past 2 to 3 days)
Integumentary I: wound healing
Patient requires getting enough protein for appropriate wound healing.
Which is the laboratory assessment indicative of a long-term poor nutritional status?
Serum Albumin <3.5 g/dL
(10 to 15 days)
Affected by age, dehydration.
Integumentary I: wound healing
in the hemostasis phase of wound healing…
exposed subendothelial collagen attracts platelets to create a stable plug
Integumentary I: wound healing
in the inflammatory phase of wound healing…
vasodilation → neutrophils (3-24h) → macrophages
Integumentary I: wound healing
What is the most predominant cell in the inflammatory phase?
macrophages
Integumentary I: wound healing
Describe the 3 types of wound repair?
- Primary intention (sutures approximation)
- Secondary intention (reapproximation of skin)
- Tertiary intention (leave wound open)
Integumentary I: wound healing
_______ is the primary source of energy for healing
Glucose
Integumentary I: wound healing
Functions as a constituent in enzyme systems to metabolize fats and carbohydrates to synthesize nucleic acids and proteins.Also a constituent of immune systems and collagen
formation for increased tensile strength
Zinc
Integumentary I: wound healing
Local Factors Impeding Wound Healing
- Bio-burden (competition for nutrients)
- Tissue Perfusion (↓ macro → ↓micro)
- Eschar / Desiccation (Death of cells)
- Foreign bodies
- Pressure, shear, friction, moisture
Integumentary I: wound healing
Systemic Factors Impeding Wound Healing
- Stress (↑ sympathetic)
- Obesity
- Temperature
- Comorbidities (DM, PVD, Neuropathy)
- Cancer
- Arterial Insufficiency
- Venous insufficiency
- Nutrition
- Age
Integumentary I: wound healing
Clinician-induced Factors Impeding Wound Healing
- Medications (antibiotics, may need some good bugs)
- Topical agents (chemicals?)
- Dressings (wet to dry is for debridement only)
- Poor infection control
- Modalities overutilization
- whirlpool: toxic additives, pressures harmful, dependent position
- Electrical: premature closure
- compression therapy: tissue ischemia.
Integumentary I: wound healing
Wound infections delay wound healing by affecting…
collagen metabolism – decreases synthesis and increases lysis of collagen. Effects are related to toxins, enzymes, and wastes from bacteria deposited into the environment.
Integumentary I: wound healing
Infections decreases the amount of _______ for collagen synthesis and for oxidative killing by neutrophils
oxygen
Integumentary I: wound healing
first, the second and third line of defense
- 1st: skin, mucous memebrane
- 2nd: cellular response
- 3rd: immune system
Integumentary I: wound healing
Wound extends to the dermis but not through the dermis. It may heal by reepithelialization
(classification by thickness)
Partial Thickness
Integumentary I: wound healing
Wound extends through both epidermis and dermis. It may involve subcutaneous tissues, muscle, and possibly bone.
(classification by thickness)
Full thickness
Integumentary I: wound healing
Nonblanchable erythema of intact skin usually over a bony prominence
(classification by staging)
Stage I
Integumentary I: wound healing
Partial thickness skin loss involving the epidermis and/or dermis. Does not go through the dermis. Clinically presents as a blister
(classification by staging)
Stage II
Integumentary I: wound healing
Full thickness skin loss involving damage to subcutaneous tissue. It may extend to fascia but not through it. May have undermining or tunneling
(classification by staging)
Stage III
Integumentary I: wound healing
Full thickness skin loss with extensive tissue destruction. Damage extended to muscle, bone, tendons and joint capsule.
(classification by staging)
Stage IV
Integumentary I: wound healing
Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.
(classification by staging)
Unstageable
Integumentary I: wound healing
Color of tissue necrosis
white, yellow, black
Integumentary I: wound healing
a pulse of 3+ is
normal
Integumentary I: wound healing
a pulse of 2+ is
diminished
Integumentary I: wound healing
a pulse of 1+ is
barely perceptible
Integumentary I: wound healing
a pulse of 4+ is
stronger than normal, bounding; possible aneurysm
Integumentary I: wound healing
Trancutaneous Partial Pressure of Oxygen (TcPo2) machine assesses arterial microcirculation.
a TcPo2 < 30mmHG means…
Impaired blood flow. Poor to No healing → No debridement
Integumentary I: wound healing
Trancutaneous Partial Pressure of Oxygen (TcPo2) assesses arterial microcirculation.
TcPo2 > 30mmHG means
Adequate blood flow with potential to heal; Debridement allowed
Integumentary I: wound healing
Trancutaneous Partial Pressure of Oxygen (TcPo2) assesses arterial microcirculation.
TcPo2 > 40 mmHG means
normal blood flow
