Integumentary I Flashcards
1
Q
Integumentary I
Reconstruction Aides became
A
Physical Therapists
2
Q
Integumentary I
Bioburden of Tissues is defined as
A
the number of bacteria living on a surface that has not been sterilized.
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
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
5
Q
Integumentary I
epidermis and part of dermis wound =
A
Partial Thickness
(may heal from the center and edges)
6
Q
Integumentary I
through dermis and may extend into subcutaneous tissue, muscle and bone
A
Full Thickness
(may heal from the edges)
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
8
Q
Integumentary I
Four Phases of Acute Wound Healing
A
- Hemostasis
- Inflammatory
- Proliferative
- Maturation
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
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- Superseded by macrophages: the most important regulatory cell of this phase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
11
Q
Integumentary I
-
Predominated by cellular activity to repair traumatized or lost tissue by:
- Neovascularization
- Fibroplasia
- Reepithelialization
A
Proliferative Phase
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
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
14
Q
Integumentary I
Wound contraction occurs in what phase of wound healing?
A
in the fibroplasia stage of the proliferative phase
15
Q
Integumentary I
formation of granulation tissue occurs in what phase of wound healing?
A
in the fibroplasia stage of the proliferative phase
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
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
18
Q
Integumentary I
What is the most predominant cell in the inflammatory phase?
A
Macrophages (the most important regulatory cell of this phase)
19
Q
Integumentary I
What is the most predominant cell in the inflammatory phase within the first 3-24h?
A
neutrophils
20
Q
Integumentary I
serum albumin level gives nutritional state in past _____
A
2 to 3 weeks
(18-day half-life)
21
Q
Integumentary I
serum albumin of less than 3.5g/dL
A
protein malnutrition, indicative of poor nutritional status
delays healing
22
Q
Integumentary I
serum prealbumin level gives nutritional state in past _____
A
2-3 days
23
Q
Integumentary I
Protein depletion prolongs inflammatory response, in turn decreases _______
A
fibroplasia
24
Q
Integumentary I
Prolonged protein depletion results in __________ with secondary edema. Edema causes decreased diffusion of nutrients and absorption for use
A
hypoalbuminemia
25
# Integumentary I
Essential fatty acids required for balanced mediation of \_\_\_\_\_\_\_
inflammatory response
26
# 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.
**proteins**
27
# Integumentary I
\_\_\_\_\_\_\_\_\_\_ is the primary source of energy for healing
**Glucose**
* Used for leukocyte activity and phagocyte function
* Used by fibroblasts for tissue repair
28
# Integumentary I
**Adaptive hyperglycemia** after wounding is the body’s attempt to match _______ \_\_\_\_\_\_\_ ________ of the wound processes.
increased glucose requirement
(Hyperglycemia from DM, however, retards neutrophil production and migration, affecting inflammatory process)
29
# Integumentary I
Functions as a constituent in enzyme systems to metabolize fats and carbohydrates to synthesize nucleic acids and proteins
**Zinc**
* Also a constituent of immune systems and collagen formation for increased tensile strength
* Zinc supplementation only works in presence of actual zinc deficiency
30
# Integumentary I
Essential in transport of oxygen via hemoglobin in blood
iron
31
# Integumentary I
Important nutrients in wound healing
* Proteins
* Fats and fatty acids
* Carbohydrates
* Trace elements: zinc, copper, iron
* Vitamins, A, B complex, C, E.
32
# Integumentary I
Serum Pre-albumin of **\< 20mg/dL** indicative of
poor nutritional status
33
# Integumentary I
Total Lymphocyte Count **Normal** =
**2000-2500/μL**
* Elevated TLC: from infection or leukemia
* Decreased TLC: from chemo, RT, chronic steroid use or
34
# Integumentary I
Factors Impeding Wound Healing
* **Local Factors**
* **Systemic Factors**
* **Clinician Induced Factors**
35
# Integumentary I
**Local Factors** Impeding Wound Healing
* Bio-burden
* Tissue perfussion
* Eschar / Desiccation
* Foreign bodies
* Pressure/shear/friction/moisture
36
# Integumentary I
105/gm of tissue =
clinical infection
(depending on the host's capability of fighting the infection)
37
# Integumentary I
true or false: all wounds are contaminated
**true**
105/gm of tissue = clinical infection
38
# Integumentary I
Bio-burden
the amount of "bugs" at the wound site
39
# Integumentary I
Macrocirculation vs. Microcirculation
* Palpating a pulse doesn't mean a wound will heal (macrocirculation)
* Tissues at the capillary level (microcirculation)
* ↓ Macro → ↓ Micro
* (+) Macro ≠ (+) Micro
* Microcirculatory issues
40
# Integumentary I
Eschar / Desiccation
* drying
* Poor environment for cell function
* Death of cells
* Inactivation of growth factors
* ↓’d epithelial migration
41
# Integumentary I
force responsible for undermining of wounds
**shear**
42
# Integumentary I
pressure Ischemia within\_\_\_\_ hrs
**2-6**
43
# Integumentary I
pressure necrosis after ___ hours
**6**
44
# Integumentary I
Systemic Factors Impeding Wound Healing
* Stress
* Obesity
* Temperature
* Comorbidities
* Nutrition
* Age
* Medication
* Topical agents
45
# Integumentary I
the dermis may be ripped from the epidermis from
**friction**
46
# Integumentary I
how does diabetes affect wound healing?
* Vascular Insufficiency
* **Impaired inflammatory response**
* Neuropathy
47
# Integumentary I
**Clinician-induced Factors** Impeding Wound Healing
* Medications
* Topical agents
* modalities (over-utilization)
* dressings
* infection control
48
# Integumentary I
how does whirlpool utilization affect wound healing?
* Toxic additives
* **WP pressures \> 8 – 15psi harmful to granulating tissues**
* Increased edema:
* Dependent position
* Warm temperatures
* Increased metabolic rates
49
# Integumentary I
Wound infections delay wound healing by affecting \_\_\_\_\_\_\_\_\_\_\_\_\_\_
**collagen metabolism**
– decreases synthesis and increases lysis (disintegration) of collagen.
50
# Integumentary I
infection effects are related to toxins, enzymes, and
wastes from bacteria deposited into environment
51
# Integumentary I
Infections decreases the amount of \_\_\_\_\_\_\_\_for collagen synthesis and for oxidative killing by neutrophils
**oxygen**
52
# Integumentary I
When it comes to wound mgmt, the goal of health care team is:
* 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
# Integumentary I
First line of (infection) defense
* Skin
* Mucous membranes
* Flushing of tears and urine and acidity of stomach
54
# Integumentary I
how does the skin creates the 1st line of defense against wound infections?
* 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
# Integumentary I
**Second line of defense** against infections
* Cellular response of Leukocytes and Monocytes
* Produces the classic signs of inflammation:
**Redness
Swelling
Pain
Heat**
56
# Integumentary I
Third line of Defense agains infections
Immune system (Humoral Response, Cell-mediated response)
57
# Integumentary I
Bioburden is normally defined as
the number of bacteria living on a surface that has not been sterilized.
58
# Integumentary I
Sources of Microorganisms:
* **Endogenous:**
* Normal flora of skin
* Primes immune system
* Excludes more pathogenic microorganisms
* **Exogenous:**
* From direct and indirect contact (touching the bed, wheelchair, etc)
59
# Integumentary I
Bioburden of Tissues, **contamination**
* On surface, already on skin
* "SKIN HAS BUGS"
* Non proliferating
* **No delays in healing**
60
# Integumentary I
Bioburden of Tissues, **Colonization**
* On surface
* Proliferating
* Delayed healing
61
# Integumentary I
Bioburden of Tissues, **infection**
* In deeper tissues
* Proliferating
* Delayed healing
62
# Integumentary I
Inflammed vs. Infected
63
# Integumentary I
Name 2 local factors that impede wound healing
* Infection
* Protein malnutrition
64
# Integumentary I
Serum pre-albumin of 15mg/dL is indicative adequate long term nutrition: True or False
**false!**
**albumin** 3.5 is long term indicative of long term adequate nutrition
65
# Integumentary I
What is not a sign of wound infection?
a. Necrotic tissue
b. Purulent drainage
c. Fever
d. Increased intense redness
**a. necrotic tissue**
66
# Integumentary I
Wound extends through both epidermis and dermis. It may involve subcutaneous tissues, muscle and possibly bone.
**Full thickness**
67
# Integumentary I
Wound Depth Classification by **Staging System** is used only for what type of wounds?
for **pressure** injuries only
68
# Integumentary I
Nonblanchable erythema of intact skin usually over a bony prominence
**Stage 1**
69
# 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,
**Stage II**
70
# 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
**Stage III**
71
# Integumentary I
Full thickness skin loss with extensive tissue destruction. Damage extended to **muscle**, **bone**, **tendons** and **joint capsule.**
**Stage IV**
72
# 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
Suspected **Deep Tissue Injury**
73
# 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.
**Unstageable**
74
75-80% white necrotic tissue
75
# Integumentary I
0 - ¼” Pitting - Indentation barely detectable
grade 1+
76
# Integumentary I
¼”- ½” Pitting - Slight indentation visible, returns to normal \< 15 sec
**grade 2+**
77
# Integumentary I
½” – 1” Pitting - Deeper indentation returns to normal \< 30 sec
**grade 3+**
78
# Integumentary I
\> 1” Pitting - Indentation lasts \> 30 sec
**grade 4**
79
# Integumentary I
exudates
1. Sanguinous
2. Serous
3. Serosanguinous
4. **Purulent (thicker; bacteria, dead cells)**
5. Foul purulent
6. Other (bilious, enteric)
80
# Integumentary I
Wound infection is defined as bacterial colonization of
**\> 105 /gram of tissue**
**100.000**
81
# Integumentary I
arterial pulse of 1+
barely perceptible
82
# Integumentary I
arterial pulse of 2+
diminished
83
# Integumentary I
arterial pulse of 3+
**normal**
84
# Integumentary I
arterial pulse of 4+
stronger than normal, possible aneurysm
85
# Integumentary I
Protective sensation examination use a...
10g nylon monofilament
86
# 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.
**Arterial Doppler**
87
# Integumentary I
Ratio of systolic pressure of posterior tibial artery to brachial artery
Ankle Brachial Index
88
# Integumentary I
ABI \> 1.0
No arterial occlusive disease Pathological if diabetic
89
# Integumentary I
ABI of **0.8-1.0**
Minimal symptoms Intermittent claudication
90
# Integumentary I
ABI of **0.5-0.8**
Ischemic rest pain
91
# Integumentary I
ABI of **\< 0.5**
**Tissue necrosis**
92
# Integumentary I
Trancutaneous Partial Pressure of Oxygen (TcPo2)
* **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
# Integumentary I
What differentiates a Stage 1 Pressure Ulcer from a Suspected Deep Tissue Injury?
in a Deep Tissue Injury the skin is instact
94
# Integumentary I
What does the **presence** or absence of wound epithelialization represent?
presence = healing
absence = not healing
