Integumentary: Eval/prognosis & interventions

Question 1

What fasting glucose levels and A1c levels indicate diabetes?

Answer 1

glucose above 115???
A1c >6 %

Question 2

If a patient has an Ankle Brachial Index of .65 what does this indicate?

Answer 2

patient has abnormal status: PAD likely
normal=1+
.9-.99=borderline
<.9=abnomral
<.5=severe PAD
if > 1.4=calcified arteries

Question 3

List what ABCDE stands for

Answer 3

A=asymmetrical
B=border (are edges irregular)
C=color (is it same or different)
D=Diameter (is it bigger than 6 mm (size of pencil eraser)
E=evolving (has it changed in size/appearance)

Question 4

Describe exudate types

Answer 4

Serous=clear (normal)
Sanguineous=red/bloody discharge
Purulent=yellow/green–>INFECTION

Question 5

A patient has a bulls eye rash and a fever and nausea what pathology is likley?

Answer 5

Lyme disease
Tx=antibiotics

Question 6

What are perks of occlusive dressing?

Answer 6

Maintain moist wound, helps w/ autolytic debridement,
cons=no absorption

Question 7

Should wet to dry dressings be used for debridment?

Answer 7

NO–>takes away good and bad, should avoid always

Question 8

Pros and cons of gauze?

Answer 8

Pros=cheap, can use with topical meds, mechanical debridement
cons=need 2ndary dressing

Question 9

Alginates

Answer 9

Pros=for mod-high exudate
cons=can dry wound bed, need 2ndary film on top

Question 11

Foam dressing pro/cons

Answer 11

pros=absorb high exudate, padding
cons=need 2ndary dressing, don’t use with dry eschar wounds

Question 12

Hydrocolloid dressing por/cons

Answer 12

Maintains moist area, bacterial barrior, autolytic debridment
cons=not for infected wounds, lack of absorbtion

Question 14

An Unna Boot is a kind of what dressing?

Answer 14

semi rigid dressing impregnated with ointments
commonly used for venous insuffiency & edema control

Question 15

What meds when used with ionto help wound healing?

Answer 15

Zinc or histamine

Question 16

When placing HVAC on a wound what does the anode and cathode do/attract?

Answer 16

Anode (+)–>promotes cell migration
cathode (-)–>used to promote granulation, control inflammation

Question 17

List phases of wound healing

Answer 17

Inflammatory: 0-5 days (redness/heat/swelling/pain, loss of function)
Proliferative: 3-21 days (granulation buds, wound contraction)
Maturation: 14 days to 2 years (collagen replacement, scar healing)

Question 18

Wound healing can be delayed to these intrinsic & extrinsic factors

Answer 18

intrinsic=aging, other disease, circulatory issues, malnutrition
Extrinsic=meds (steroids), necrotic tissue, wrong dressing

Question 19

you see a tissue 10 days post injury that is a beefy red appearance, what should you do?

Answer 19

Nothing, this is a normal phase of healing that shows healthy healing

Question 20

List characteristics of stage 1-4 pressure ulcer

Answer 20

Stage 1=nonbankable, reversible with help
stage 2=partial thickness skin loss (epidermis & dermis), abrasion/blister
3=full thickness skin loss into fat layer (NOT fascia)
4=full thickness skin loss into muscles (tendon/capsule often exposed)
5=unstageable=wound is covered in necrotic tissue and can’t ID what stage

Question 21

Tx for stage 1-5 ulcers

Answer 21

1=pressure/friction & moisture alleviating measures
2=dermis exposure; apply appropriate dressing
3=debride if needed, proper dressing
4=surgery/grafting common

Question 22

List parts of venous insuffiency & Tx

Answer 22

Will have good distal pulses,
edema present, skin is stained (hemosiderin staining)
*ulcers on medial ankle
Tx: control edema (unna boot/compression), active exercises

Question 23

List parts of AI ulcers & Tx

Answer 23

deep & painful ulcers
skin=pale & cold
*on lateral malleous & toes
Tx=bed rest & wound care
ABI

Question 24

Burn wound stages (3)-describe them

Answer 24

zone of coagulation=cells are irreversibly damaged & skin death (middle part)
zone of stasis=injured cells that may die soon if no Tx
zone of hyperemia=outside? (minimal cell damage)

Question 25

A patient has a deep partial thickness burn will they sweat and grow hair in the future?

Answer 25

NO! They will be gone

Question 26

Describe 4 burn stages

Answer 26

superficial burn (1st degree): damage to epidermis, some peeling of skin
Ex:=sunburn
2nd degree (superficial partial thickness)-damage to upper dermis & epidermis
Ex: blisters
2nd degree (deep partial thickness)
nerve follicles and sweat glands destroyed
3rd degree: (full thickness)-complete destruction of tissue

Question 27

A patient with burns to thier chest would limit what in a patient?

Answer 27

Increased metabolic rate (nutirtion is critical), decreased chest wall excursion