Integumentary II Flashcards
Integumentary II
Odorous wound → (objective?)
Charcoal based, antiseptics
Integumentary II
Undermined / tunneled → (objective?)
lightly pack wound
Integumentary II
Bone/tendon exposure → (objective?)
Protect and keep moist (contact layer)
Integumentary II
Flap/graft exposure → (objective?)
Protect and keep moist (contact layer)
Integumentary II
Necrotic → (objective?)
debride
Integumentary II
granulating/epithelializing → (objective?)
protect and keep moist
Integumentary II
infected wound → (objective?)
antiseptics/antibiotics
Integumentary II
heavily draining wound → (objectives?)
absorb
Integumentary II
sharp debridement
Removal of nonviable tissue only done by PT’s PA’s, some RN’s
Integumentary II
is sharp debridement selective or non-selective form of debridement?
selective
Integumentary II
contraindications to sharp debridement
- Arterial insufficiency ABI <0.5
- Gangrene
- Stable heel ulcers
- Unidentifiable structures
- Terminally ill
Integumentary II
key to comfort in debridement
Know your anatomy
Integumentary II
Autolytic debridement
In biology, autolysis, more commonly known as self-digestion, refers to the destruction of a cell through the action of its own enzymes. It may also refer to the digestion of an enzyme by another molecule of the same enzyme
Integumentary II
surgical debridement is selective or non-selective
non-selective
Integumentary II
Reasons to stop sharps debridement:
- Clinician/patient fatigue
- Bleeding
- Pain
- To viable tissue
- Location of fascial plane
- Location of named structure
- High anxiety level
- Achieved set time limit
Integumentary II
How to stop bleeding:
- Pressure x 10 min
- Elevation
- Calcium alginate
- Xylocaine jelly-vasoconstrictor
- Nitrate sticks-cauterizes tissue
Integumentary II
Wound is lightly scrubbed of surface debris and loose lying slough
mechanical debridement: scrubbing
Integumentary II
is scrubbing a selective or nonselective type of debridement
nonselective
Integumentary II
Wet to dry dressing is a form of debridement.
Is it a selective or non-selective form of debridement?
Non-selective (adheres to both necrotic tissue and viable tissue)
can be painful
Integumentary II
wet to dry dressing is occlusive or non-occlusive?
non-occlusive
“that’s what you want for infected wounds”
Integumentary II
can you use wet to dry dressing in infected wounds?
yes! non-occlusive dressing are for infections
Integumentary II
is Hydrotherapy / Whirlpool selective or non-selective form of debridement?
non-selective
- Softens eschar and slough
- To clean dirt, foreign materials or residues from topical agents in the wound
Integumentary II
Syringe and needle irrigations vs. Pulsatile lavage
Forced Irrigations
Integumentary II
Forced Irrigations are selective or non-selective?
non-selective debridement
- painful, costly, harmful to granulation and epithelial tissue
Integumentary II
Hydrotherapy / Whirlpool
Systemic effects include:
- ↑’d HR, RR
- Sedation, analgesia, muscle relaxation
- Changes in thermoregulatory system
Integumentary II
Enzymatic Debridement (Collagenase Santyl)
Digests necrotic collagen and collagen anchoring necrotic tissue to wound base
Integumentary II
is enzymatic debridement (Collagenase Santyl) selective or non-selective?
selective debridement
- Should not be used with ointments containing heavy metals (Silver Sulfadiazine “Silvadene”, “Acticoat”, etc..)
- Liquifies necrotic tissue
- Slower than surgical/sharp
Integumentary II
Autolytic Debridement is selective or non-selective
Most selective form of debridement
Integumentary II
Uses body’s own macrophage, neutrophil, and other phagocytic cells to digest necrotic tissue
Autolytic Debridement
Integumentary II
can you do autolytic debridement on infected wounds?
no
Integumentary II
The key to the Autolytic Debridement technique is
keeping the wound moist as these dressings are occlusive, which helps to saturate the wound. These dressings help trap wound fluid that contains the growth factors, enzymes and immune cells that promote wound healing. Autolytic debridement is more selective than any other debridement method but it also takes the longest time to work. It is inappropriate for wounds that have become infected. Patients usually change these dressings every two to three days. It is necessary to take precautions to protect the periwound from maceration.
Integumentary II
Maggot Debridement Therapy
selective or non-selective?
- Selective debridement
- Medicinal use of live maggots (fly larvae) “Green Bottle Fly”
- Dissolves dead and infected tissue
- Kills bacteria
- Promotes fibroblasts
Integumentary II
Primary and secondary dressings:
- PRIMARY: direct contact with the wound; protects & atraumatic; non-adherent; maintains wound bed-dressing interface moist.
- SECONDARY: On top of 1ry dressing; augments 1ry dressing function; provides moisture retention of 1ry dressing; secures 1ry dressing in place
Integumentary II
Non-Occlusive dressings are indicated for…
- As Primary Dressing
- Acute surgical
- Wound Infection
Integumentary II
non-occlusive dressings samples
- Gauze
- Alginates
- Hydrofibers
Integumentary II
what is the only difference between semi-occlusive and occlusive dressings?
- the semi-occlusive allows vapor and gases exchanges
- the occlusive doesn’t
Integumentary II
a substance that forms a gel in the presence of water, examples of which are used in surgical dressings and in various industrial applications
Hydrocolloids
occlusive dressing
Integumentary II
For Autolytic Debridement use occlusive or non-occlusive dressing?
can use semi-occlusive and occlusive
Integumentary II
Moderately - Highly Absorbent Dressings
- Gauze
- Alginates
- Hydrofiber
- Foams
- Wound Fillers
Integumentary II
Low-no absorbency dressings
- Transparent Films
- Hydrocolloids
- Impregnated Gauze
Integumentary II
hydrating dressings
hydrogel
Integumentary II
antimicrobial dressing
- Silver-based
- Iodine-based
- Honey-based
- Topical Antibacterials
Integumentary II
an enzymatic debrider
Collagenase Santyl
Integumentary II
Wound Stimulating dressings
- Collagens
- Growth Factors
- Biologicals
- Hypertonic Saline
Integumentary II
Which of the following is not a semi-permeable dressing?
Foams, Films, Alginates, Impregnated gauze or Hydrogels?
hydrogel
Integumentary II
Pop: which of the following is not a permeable dressing?
A. hydrocolloid B. films C. Impregnated gauze D. alginates
A. hydrocolloid is not permeable
Integumentary II
Opposes the hydrostatic pressure inside vessel from driving fluid out of vessel
compression
Integumentary II
benefits of compression
- Improve fluid balance
- Improve venous and lymphatic return
- Modify scar tissue formation
- Limits size and shape of tissues
- Increases tissue temperatures
Integumentary II
Elastic (Long Stretch) …
low working (with activity) pressure
high rest pressure
Integumentary II
Inelastic (short stretch) have a…
high working (with activity) pressure
low resting pressure
Integumentary II
Unna Boot
- Short Stretch
- Paste bandage
- Semi-Rigid / non-compliant
- Works when calf muscle pump utilized:
- During exercise
- During effective ambulation
Integumentary II
Damage to epidermis only; presents as dry, red and painful
First Degree Burns
Integumentary II
all of epidermis and varying thickness of dermis; presents as painful, blistering, moist, red and blanchable
second degree burn
Integumentary II
Second-degree burns types:
- Superficial partial-thickness wound: painful, blistering, moist, red and blanchable
- Deep partial-thickness wound: (most of dermis is destroyed) relatively insensate, (+) pressure sensation, no blistering
Integumentary II
Pt presents with the epidermis and most of the dermis in the skin destroyed after a contact burn with an industrial oven. Pt has relatively low pain and no blisters with intact pressure sensation. This is a
A. Superficial partial thickness injury
B. First degree Burn
C. Deep partial-thickness injury
D. Third degree burn
C. Deep partial-thickness injury
Integumentary II
Full-thickness injuries: entire thickness of skin affected Insensate, no blistering, thick adherent eschar, no blanching. Can be any color (white, tan, black, brown, or red)
third degree
Integumentary II
Damage extends to deep structures (fascia, muscle, tendon, bone, etc)
Fourth-degree burns
Integumentary II
Extent of Burns
Rule of Nines
Integumentary II
Pt present with a burn that occupies the front aspect of the trunk, the entire left lower extremity, and half the of the left upper extremity. This represents:
A. 36% of total body surface
B. 40.5% of total body surface
C. 45% of total body surface
D. 50% of total body surface
B.
Integumentary II
Extend of Burns: Lund-Browder Method
- Age specific
- Accounts for changes in body growth of children
Integumentary II
extent of burns: palm method
- Hand of patient with fingers adducted represents 1% of TBSA
Integumentary II
s/p plastic surgery (skin grafting)
- COMPLETE AND STRICT BEDREST X 5 DAYS
- POD # 5 Graft / flap assessment for take: graft take assessed by percentage of adherence
Integumentary II
wound scarring borders raised but stays within wound borders
hypertrophic scarring
Integumentary II
wound scarring raised and goes beyond wound borders
keloid
Integumentary II
how long does the remodeling phase of wound healing last?
1-2 years
Integumentary II
Wound strength reaches 80% of pre-wounded state in the _______ phase
remodeling
Integumentary II
Absent signs of inflammation in the inflammatory phase
spells trouble
Integumentary II
Incisional wound in the Inflammatory phase
type of drainage
Sanguinous to serosanguinous
Integumentary II
Incisional wound in the inflammatory phase; approximation of wound edges should be
Epithelialization
No tension on sutures
Integumentary II
Incisional wound in proliferative phase → presence of ______
Healing Ridge
- Firmness along incision extending 1 cm on either side from deposition of new collagen
- Appears by postop day 5-9
Integumentary II
Incisional wound in proliferative phase drainage
should be serosanguinous → serous → nil
Integumentary II
Negative Pressure Wound Therapy (NPWT) benefits
- Removal of excess interstitial fluid
- Increased local vascularity
- Decreased bacterial colonization
- Increased rate of granulation tissue formation
- Maintenance of a moist environment
- Increased rate of contraction
- Increased rate of epitheliazation
Integumentary II
Type of dressing modality that consists of a non-contact wound cover with a 38 C (100.4 F) warming card controlled by a temperature unit.
(“Tipi tent”)
Non-contact Normothermic Wound Therapy
Integumentary II
Non-contact Normothermic Wound Therapy affects healing by
- ↑ tissue perfusion from microvasculature
- ↑ PO2 of subcutaneous tissue
- ↓ Affinity of O2 to Hb
- ↑ Bacterial killing by neutrophils
- ↓ Tissue vulnerability to infection
Integumentary II
Electrical Stimulation
- Intact skin with has negative charge
- After wounding, Na+ escapes and current flows into the wound.
- Galvanotaxis: mvmt of cells based on charge
Integumentary II
movement of an organism or any of its parts in a particular direction in response to an electric current
Galvanotaxis
Integumentary II
electrical stimulation: inflammatory phase
(+)
Integumentary II
electrical stimulation; proliferative phase
negative
[Fibroblast (+)]
Integumentary II
electrical stimulation: remodeling phase
negative
Integumentary II
how does high-frequency ultrasound work in wounds?
Non-thermal effects, through acoustic streaming, affect cellular membrane permeability
Integumentary II
how does low-frequency ultrasound works in treating wounds?
mechanical debridement of necrotic tissue
Integumentary II
indications for low-frequency ultrasound to wound tx
- infected wounds
- impaired circulation
- necrotic wounds
Integumentary II
what is the main effect of ultraviolet C for wound tx?
inhibiting DNA synthesis in bacteria
Integumentary II
how does Hyperbaric Oxygen Therapy work in wound healing?
- by having patient breathe in 100% O2 at elevated atmospheric pressures
- Stimulates healing by providing more oxygen to macrophages, neutrophils and fibroblasts
Integumentary II
how does Cold Laser (Low Level Laser Therapy) work in wound healing?
- Changes in membrane permeability
- Increased ATP levels
- increased DNA production
Integumentary II
Arterial exam tests
- Claudication time
- Rubor of dependency (lower leg and record time to return skin color to foot)
- Capillary refill test
- Venous filling time (lower leg and record time for veins on dorsum of foot to refill )
Integumentary II
venous exams tests
- Venous doppler
- Percussion test
- Trendelemburg test
- Cuff test
Integumentary II
In a Venous Doppler test compression of vein proximally should result in
no change in flow if venous valves are patent
Integumentary II
In a Venous Doppler test compression of vein distally should result in
increased flow
Integumentary II
Tapping proximally on saphenous vein should have no detectable changes on probe distally if valves are patent
Percussion Test
Integumentary II
Venous Filling Time test
- Assesses arterial flow by evaluating the time it takes to fill veins after emptying
- Pt in supine, elevate leg for one minute
- Lower leg and record time for veins on dorsum of foot to refill
- With A.I., it may take longer than 30 sec. or more
Integumentary II
Trendelenburg test
- Pt in supine, leg elevated to 60◦
- Rubber tubing applied on thigh
- Pt stands and venous filling noted dorsum of foot(should be slow)
- If superficial veins fill rapidly with tourniquet in place, communicating (deep) vein valves are incompetent.
- After releasing turniquet, if additional filling occurs, saphenous vein valves are incompetent.
Integumentary II
A therapist is performing the trendelenberg test on a pt. After lowering the leg with a tourniquet in place the therapist notices superficial veins filling rapidly. After releasing the tourniquet no additional filling occurs.
A. Communicating valves are intact, saphenous valves vein valves are incompetent.
B. Deep veins valves are incompetent, superficial valves are incompetent.
C. Communicating veins valves are incompetent, saphenous valves are intact.
D. Deep vein valves are intact, superficial valves are intact.
C.
Integumentary II
In the question above, after lowering the leg with a tourniquet in place the therapist notices superficial veins staying the same, but after releasing the tourniquet filling occurs rapidly:
A. Communicating valves are intact, saphenous valves vein valves are incompetent.
B. Deep veins valves are incompetent, superficial valves are incompetent.
C. Communicating veins valves are incompetent, saphenous valves are intact.
D. Deep vein valves are intact, superficial valves are intact.
