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Integumentary I Flashcards

1
Q

Integumentary I

Reconstruction Aides became

A

Physical Therapists

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2
Q

Integumentary I

Bioburden of Tissues is defined as

A

the number of bacteria living on a surface that has not been sterilized.

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3
Q

Integumentary I

Surgical or Traumatic Wounds. These wounds heal in a timely manner and go through an expected course of tissue repair:

A

Acute Wounds

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4
Q

Integumentary I

Wounds that fail to heal in an expected time frame. Examples are but not limited to wounds of arterial, venous or neuropathic nature (or anything that increases healing time)

A

Chronic Wounds

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5
Q

Integumentary I

epidermis and part of dermis wound =

A

Partial Thickness

(may heal from the center and edges)

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6
Q

Integumentary I

through dermis and may extend into subcutaneous tissue, muscle and bone

A

Full Thickness

(may heal from the edges)

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7
Q

Integumentary I

Describe the 3 types of wound repair

A
  • Primary intention: sutures
  • Secondary intention: no sutures, skin approximation
  • Tertiary intention (delayed primary): leave the wound open
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8
Q

Integumentary I

Four Phases of Acute Wound Healing

A
  1. Hemostasis
  2. Inflammatory
  3. Proliferative
  4. Maturation
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9
Q

Integumentary I

  • Initial reaction after wounding.
  • Characterized by platelet aggregation and vasoconstriction.
  • Exposed subendothelial collagen attracts platelets to create a stable plug.
  • Activated platelets releases chemotactic factors
A

Hemostasis Phase

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10
Q

Integumentary I

  • Vasodilation allows for cells and factors to infiltrate tissues and clear debris and bacteria
  • Predominated by neutrophils within the first 3 -24 hours
  • Superseded by macrophages: the most important regulatory cell of this phase
    • Phagocytose
    • Release collagenase/elastase
    • Release factors to attract endothelial cells, fibroblasts and smooth muscle cells
A

Inflammation phase

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11
Q

Integumentary I

  • Predominated by cellular activity to repair traumatized or lost tissue by:
    • Neovascularization
    • Fibroplasia
    • Reepithelialization​
A

Proliferative Phase

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12
Q

Integumentary I

Neovascularization occurs in what phase of wound healing?

A
  • In the proliferative phase of wound healing
  • Growth factors, low oxygen tension and lactic acid promote angiogenesis
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13
Q

Integumentary I

Fibroplasia occurs in what phase of wound healing?

A
  • In the proliferative phase
  • Formation of granulation tissue:
    • Dense vascular network
    • Fibroblasts and ground substance (extracellular matrix):
      • Matrix contain collagen and elastin
  • Wound contraction
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14
Q

Integumentary I

Wound contraction occurs in what phase of wound healing?

A

in the fibroplasia stage of the proliferative phase

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15
Q

Integumentary I

formation of granulation tissue occurs in what phase of wound healing?

A

in the fibroplasia stage of the proliferative phase

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16
Q

Integumentary I

Keratinocyte migration (From wound edge vs within wound) occurs in what phase of wound healing?

A

in the re-epithelialization stage of the proliferative phase

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17
Q

Integumentary I

  • Lasts up to a year or more
  • Fibers reoriented
  • Extracellular matrix consistency changes
  • Wound strength reaches up to 80% of preinjured state
A

Remodeling Phase

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18
Q

Integumentary I

What is the most predominant cell in the inflammatory phase?

A

Macrophages (the most important regulatory cell of this phase)

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19
Q

Integumentary I

What is the most predominant cell in the inflammatory phase within the first 3-24h?

A

neutrophils

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20
Q

Integumentary I

serum albumin level gives nutritional state in past _____

A

2 to 3 weeks

(18-day half-life)

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21
Q

Integumentary I

serum albumin of less than 3.5g/dL

A

protein malnutrition, indicative of poor nutritional status

delays healing

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22
Q

Integumentary I

serum prealbumin level gives nutritional state in past _____

A

2-3 days

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23
Q

Integumentary I

Protein depletion prolongs inflammatory response, in turn decreases _______

A

fibroplasia

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24
Q

Integumentary I

Prolonged protein depletion results in __________ with secondary edema. Edema causes decreased diffusion of nutrients and absorption for use

A

hypoalbuminemia

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25
Q

Integumentary I

Essential fatty acids required for balanced mediation of _______

A

inflammatory response

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26
Q

Integumentary I

Fat is a major provider of dietary energy and the primary source of stored energy and essential fatty acids. Adequate fat, along with carbohydrates prevent the use of _________ to provide energy and spare them for tissue healing instead.

A

proteins

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27
Q

Integumentary I

__________ is the primary source of energy for healing

A

Glucose

  • Used for leukocyte activity and phagocyte function
  • Used by fibroblasts for tissue repair
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28
Q

Integumentary I

Adaptive hyperglycemia after wounding is the body’s attempt to match _______ _______ ________ of the wound processes.

A

increased glucose requirement

(Hyperglycemia from DM, however, retards neutrophil production and migration, affecting inflammatory process)

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29
Q

Integumentary I

Functions as a constituent in enzyme systems to metabolize fats and carbohydrates to synthesize nucleic acids and proteins

A

Zinc

  • Also a constituent of immune systems and collagen formation for increased tensile strength
  • Zinc supplementation only works in presence of actual zinc deficiency
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30
Q

Integumentary I

Essential in transport of oxygen via hemoglobin in blood

A

iron

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31
Q

Integumentary I

Important nutrients in wound healing

A
  • Proteins
  • Fats and fatty acids
  • Carbohydrates
  • Trace elements: zinc, copper, iron
  • Vitamins, A, B complex, C, E.
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32
Q

Integumentary I

Serum Pre-albumin of < 20mg/dL indicative of

A

poor nutritional status

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33
Q

Integumentary I

Total Lymphocyte Count Normal =

A

2000-2500/μL

  • Elevated TLC: from infection or leukemia
  • Decreased TLC: from chemo, RT, chronic steroid use or
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34
Q

Integumentary I

Factors Impeding Wound Healing

A
  • Local Factors
  • Systemic Factors
  • Clinician Induced Factors
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35
Q

Integumentary I

Local Factors Impeding Wound Healing

A
  • Bio-burden
  • Tissue perfussion
  • Eschar / Desiccation
  • Foreign bodies
  • Pressure/shear/friction/moisture
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36
Q

Integumentary I

105/gm of tissue =

A

clinical infection

(depending on the host’s capability of fighting the infection)

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37
Q

Integumentary I

true or false: all wounds are contaminated

A

true

105/gm of tissue = clinical infection

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38
Q

Integumentary I

Bio-burden

A

the amount of “bugs” at the wound site

39
Q

Integumentary I

Macrocirculation vs. Microcirculation

A
  • Palpating a pulse doesn’t mean a wound will heal (macrocirculation)
  • Tissues at the capillary level (microcirculation)
  • ↓ Macro → ↓ Micro
  • (+) Macro ≠ (+) Micro
  • Microcirculatory issues
40
Q

Integumentary I

Eschar / Desiccation

A
  • drying
  • Poor environment for cell function
  • Death of cells
  • Inactivation of growth factors
  • ↓’d epithelial migration
41
Q

Integumentary I

force responsible for undermining of wounds

42
Q

Integumentary I

pressure Ischemia within____ hrs

43
Q

Integumentary I

pressure necrosis after ___ hours

44
Q

Integumentary I

Systemic Factors Impeding Wound Healing

A
  • Stress
  • Obesity
  • Temperature
  • Comorbidities
  • Nutrition
  • Age
  • Medication
  • Topical agents
45
Q

Integumentary I

the dermis may be ripped from the epidermis from

46
Q

Integumentary I

how does diabetes affect wound healing?

A
  • Vascular Insufficiency
  • Impaired inflammatory response
  • Neuropathy
47
Q

Integumentary I

Clinician-induced Factors Impeding Wound Healing

A
  • Medications
  • Topical agents
  • modalities (over-utilization)
  • dressings
  • infection control
48
Q

Integumentary I

how does whirlpool utilization affect wound healing?

A
  • Toxic additives
  • WP pressures > 8 – 15psi harmful to granulating tissues
  • Increased edema:
    • Dependent position
    • Warm temperatures
  • Increased metabolic rates
49
Q

Integumentary I

Wound infections delay wound healing by affecting ______________

A

collagen metabolism

– decreases synthesis and increases lysis (disintegration) of collagen.

50
Q

Integumentary I

infection effects are related to toxins, enzymes, and

A

wastes from bacteria deposited into environment

51
Q

Integumentary I

Infections decreases the amount of ________for collagen synthesis and for oxidative killing by neutrophils

52
Q

Integumentary I

When it comes to wound mgmt, the goal of health care team is:

A
  • To prevent bacterial contamination of wounds
  • To deal with present infections
  • To prevent contamination of themselves and of other patients when caring for other patients with infections.
53
Q

Integumentary I

First line of (infection) defense

A
  • Skin
  • Mucous membranes
  • Flushing of tears and urine and acidity of stomach
54
Q

Integumentary I

how does the skin creates the 1st line of defense against wound infections?

A
  • Outermost keratinized layer, dryness, desquamation, high salt content
  • Low pH from Lactic acid and fatty acids created by sebaceous and sweat gland
  • Endogenous flora normally occupying skin niches
55
Q

Integumentary I

Second line of defense against infections

A
  • Cellular response of Leukocytes and Monocytes
    • Produces the classic signs of inflammation:
      Redness
      Swelling
      Pain
      Heat
56
Q

Integumentary I

Third line of Defense agains infections

A

Immune system (Humoral Response, Cell-mediated response)

57
Q

Integumentary I

Bioburden is normally defined as

A

the number of bacteria living on a surface that has not been sterilized.

58
Q

Integumentary I

Sources of Microorganisms:

A
  • Endogenous:
    • Normal flora of skin
    • Primes immune system
    • Excludes more pathogenic microorganisms
  • Exogenous:
    • From direct and indirect contact (touching the bed, wheelchair, etc)
59
Q

Integumentary I

Bioburden of Tissues, contamination

A
  • On surface, already on skin
    • “SKIN HAS BUGS”
  • Non proliferating
  • No delays in healing
60
Q

Integumentary I

Bioburden of Tissues, Colonization

A
  • On surface
  • Proliferating
  • Delayed healing
61
Q

Integumentary I

Bioburden of Tissues, infection

A
  • In deeper tissues
  • Proliferating
  • Delayed healing
62
Q

Integumentary I

Inflammed vs. Infected

63
Q

Integumentary I

Name 2 local factors that impede wound healing

A
  • Infection
  • Protein malnutrition
64
Q

Integumentary I

Serum pre-albumin of 15mg/dL is indicative adequate long term nutrition: True or False

A

false!

albumin 3.5 is long term indicative of long term adequate nutrition

65
Q

Integumentary I

What is not a sign of wound infection?

a.   Necrotic tissue
b.   Purulent drainage
c.   Fever
d.   Increased intense redness

A

a. necrotic tissue

66
Q

Integumentary I

Wound extends through both epidermis and dermis. It may involve subcutaneous tissues, muscle and possibly bone.

A

Full thickness

67
Q

Integumentary I

Wound Depth Classification by Staging System is used only for what type of wounds?

A

for pressure injuries only

68
Q

Integumentary I

Nonblanchable erythema of intact skin usually over a bony prominence

69
Q

Integumentary I

Partial thickness skin loss involving epidermis and/or dermis. Does not go through dermis. Clinically presents as a blister (intact or open/ruptured serum filled), abrasion, or shallow crater,

70
Q

Integumentary I

Full thickness skin loss involving damage to subcutaneous tissue. It may extend to fascia but not through it. May have undermining or tunneling

71
Q

Integumentary I

Full thickness skin loss with extensive tissue destruction. Damage extended to muscle, bone, tendons and joint capsule.

72
Q

Integumentary I

Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer or cooler as compared to adjacent tissue

A

Suspected Deep Tissue Injury

73
Q

Integumentary I

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.

A

Unstageable

74
Q
A

75-80% white necrotic tissue

75
Q

Integumentary I

0 - ¼” Pitting - Indentation barely detectable

76
Q

Integumentary I

¼”- ½” Pitting - Slight indentation visible, returns to normal < 15 sec

77
Q

Integumentary I

½” – 1” Pitting - Deeper indentation returns to normal < 30 sec

78
Q

Integumentary I

> 1” Pitting - Indentation lasts > 30 sec

79
Q

Integumentary I

exudates

A
  1. Sanguinous
  2. Serous
  3. Serosanguinous
  4. Purulent (thicker; bacteria, dead cells)
  5. Foul purulent
  6. Other (bilious, enteric)
80
Q

Integumentary I

Wound infection is defined as bacterial colonization of

A

> 105 /gram of tissue

100.000

81
Q

Integumentary I

arterial pulse of 1+

A

barely perceptible

82
Q

Integumentary I

arterial pulse of 2+

A

diminished

83
Q

Integumentary I

arterial pulse of 3+

84
Q

Integumentary I

arterial pulse of 4+

A

stronger than normal, possible aneurysm

85
Q

Integumentary I

Protective sensation examination use a…

A

10g nylon monofilament

86
Q

Integumentary I

  • Assesses relative flow of blood. Movement of blood cells causes shift in signal frequency which is audible to the examiner. Normal should sound pulsatile.
  • is an ultrasound exam of the arteries located in your arms or legs. High frequency sound waves are used to obtain images of structures inside the body. Ultrasound imaging can help the radiologist see and evaluate arterial blockages, such as plaque in arteries.
  • It assess the site of blockage.
A

Arterial Doppler

87
Q

Integumentary I

Ratio of systolic pressure of posterior tibial artery to brachial artery

A

Ankle Brachial Index

88
Q

Integumentary I

ABI > 1.0

A

No arterial occlusive disease Pathological if diabetic

89
Q

Integumentary I

ABI of 0.8-1.0

A

Minimal symptoms Intermittent claudication

90
Q

Integumentary I

ABI of 0.5-0.8

A

Ischemic rest pain

91
Q

Integumentary I

ABI of < 0.5

A

Tissue necrosis

92
Q

Integumentary I

Trancutaneous Partial Pressure of Oxygen (TcPo2)

A
  • Assesses arterial microcirculation with O2 sensitive probes and heating element to warm skin to 41-44 C.
  • Cutaneous capillaries are dilated for perfusion and O2 readings are taken.
93
Q

Integumentary I

What differentiates a Stage 1 Pressure Ulcer from a Suspected Deep Tissue Injury?

A

in a Deep Tissue Injury the skin is instact

94
Q

Integumentary I

What does the presence or absence of wound epithelialization represent?

A

presence = healing

absence = not healing

Specific Systems (9 decks)

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