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Specific Systems > Integumentary II > Flashcards

Integumentary II Flashcards

1
Q

Integumentary II

Odorous wound → (objective?)

A

Charcoal based, antiseptics

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2
Q

Integumentary II

Undermined / tunneled → (objective?)

A

lightly pack wound

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3
Q

Integumentary II

Bone/tendon exposure → (objective?)

A

Protect and keep moist (contact layer)

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4
Q

Integumentary II

Flap/graft exposure → (objective?)

A

Protect and keep moist (contact layer)

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5
Q

Integumentary II

Necrotic → (objective?)

A

debride

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6
Q

Integumentary II

granulating/epithelializing → (objective?)

A

protect and keep moist

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7
Q

Integumentary II

infected wound → (objective?)

A

antiseptics/antibiotics

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8
Q

Integumentary II

heavily draining wound → (objectives?)

A

absorb

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9
Q

Integumentary II

sharp debridement

A

Removal of nonviable tissue only done by PT’s PA’s, some RN’s

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10
Q

Integumentary II

is sharp debridement selective or non-selective form of debridement?

A

selective

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11
Q

Integumentary II

contraindications to sharp debridement

A
  • Arterial insufficiency ABI <0.5 ™
  • Gangrene
  • Stable heel ulcers
  • Unidentifiable structures
  • Terminally ill
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12
Q

Integumentary II

key to comfort in debridement

A

Know your anatomy

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13
Q

Integumentary II

Autolytic debridement

A

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

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14
Q

Integumentary II

surgical debridement is selective or non-selective

A

non-selective

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15
Q

Integumentary II

Reasons to stop sharps debridement:

A
  • ™  Clinician/patient fatigue
  • ™  Bleeding
  • ™  Pain
  • ™  To viable tissue
  • ™  Location of fascial plane
  • ™  Location of named structure
  • ™  High anxiety level
  • ™  Achieved set time limit
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16
Q

Integumentary II

How to stop bleeding:

A
  • ™  Pressure x 10 min
  • ™  Elevation
  • ™  Calcium alginate
  • ™  Xylocaine jelly-vasoconstrictor
  • ™  Nitrate sticks-cauterizes tissue
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17
Q

Integumentary II

Wound is lightly scrubbed of surface debris and loose lying slough

A

mechanical debridement: scrubbing

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18
Q

Integumentary II

is scrubbing a selective or nonselective type of debridement

A

nonselective

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19
Q

Integumentary II

Wet to dry dressing is a form of debridement.
Is it a selective or non-selective form of debridement?

A

Non-selective (adheres to both necrotic tissue and viable tissue)

can be painful

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20
Q

Integumentary II

wet to dry dressing is occlusive or non-occlusive?

A

non-occlusive

“that’s what you want for infected wounds”

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21
Q

Integumentary II

can you use wet to dry dressing in infected wounds?

A

yes! non-occlusive dressing are for infections

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22
Q

Integumentary II

is Hydrotherapy / Whirlpool selective or non-selective form of debridement?

A

non-selective

  • Softens eschar and slough
  • To clean dirt, foreign materials or residues from topical agents in the wound
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23
Q

Integumentary II

Syringe and needle irrigations vs. Pulsatile lavage

A

Forced Irrigations

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24
Q

Integumentary II

Forced Irrigations are selective or non-selective?

A

non-selective debridement

  • painful, costly, harmful to granulation and epithelial tissue
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25
Q

Integumentary II

Hydrotherapy / Whirlpool
Systemic effects include:

A
  • ↑’d HR, RR
  • Sedation, analgesia, muscle relaxation
  • Changes in thermoregulatory system
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26
Q

Integumentary II

Enzymatic Debridement (Collagenase Santyl)

A

Digests necrotic collagen and collagen anchoring necrotic tissue to wound base

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27
Q

Integumentary II

is enzymatic debridement (Collagenase Santyl) selective or non-selective?

A

selective debridement

  • Should not be used with ointments containing heavy metals (Silver Sulfadiazine “Silvadene”, “Acticoat”, etc..)
  • Liquifies necrotic tissue
  • Slower than surgical/sharp
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28
Q

Integumentary II

Autolytic Debridement is selective or non-selective

A

Most selective form of debridement

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29
Q

Integumentary II

Uses body’s own macrophage, neutrophil, and other phagocytic cells to digest necrotic tissue

A

Autolytic Debridement

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30
Q

Integumentary II

can you do autolytic debridement on infected wounds?

A

no

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31
Q

Integumentary II

The key to the Autolytic Debridement technique is

A

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.

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32
Q

Integumentary II

Maggot Debridement Therapy

selective or non-selective?

A
  • Selective debridement
  • Medicinal use of live maggots (fly larvae) “Green Bottle Fly”
  • Dissolves dead and infected tissue
  • Kills bacteria
  • Promotes fibroblasts
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33
Q

Integumentary II

Primary and secondary dressings:

A
  1.  PRIMARY: direct contact with the wound; protects & atraumatic; non-adherent; maintains wound bed-dressing interface moist.
  2. SECONDARY: On top of 1ry dressing; augments 1ry dressing function; provides moisture retention of 1ry dressing; secures 1ry dressing in place
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34
Q

Integumentary II

Non-Occlusive dressings are indicated for…

A
  • As Primary Dressing
  • Acute surgical
  • Wound Infection
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35
Q

Integumentary II

non-occlusive dressings samples

A
  • Gauze
  • Alginates
  • Hydrofibers
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36
Q

Integumentary II

what is the only difference between semi-occlusive and occlusive dressings?

A
  • the semi-occlusive allows vapor and gases exchanges
  • the occlusive doesn’t
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37
Q

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

A

Hydrocolloids

occlusive dressing

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38
Q

Integumentary II

For Autolytic Debridement use occlusive or non-occlusive dressing?

A

can use semi-occlusive and occlusive

39
Q

Integumentary II

Moderately - Highly Absorbent Dressings

A
  • Gauze
  • Alginates
  • Hydrofiber
  • Foams
  • Wound Fillers
40
Q

Integumentary II

Low-no absorbency dressings

A
  • Transparent Films
  • Hydrocolloids
  • Impregnated Gauze
41
Q

Integumentary II

hydrating dressings

A

hydrogel

42
Q

Integumentary II

antimicrobial dressing

A
  • Silver-based
  • Iodine-based
  • Honey-based
  • Topical Antibacterials
43
Q

Integumentary II

an enzymatic debrider

A

Collagenase Santyl

44
Q

Integumentary II

Wound Stimulating dressings

A
  • Collagens
  • Growth Factors
  • Biologicals
  • Hypertonic Saline
45
Q

Integumentary II

Which of the following is not a semi-permeable dressing?
™  Foams, Films, Alginates, Impregnated gauze or Hydrogels?

A

hydrogel

46
Q

Integumentary II

Pop: which of the following is not a permeable dressing?
A. hydrocolloid B. films C. Impregnated gauze D. alginates

A

A. hydrocolloid is not permeable

47
Q

Integumentary II

Opposes the hydrostatic pressure inside vessel from driving fluid out of vessel

A

compression

48
Q

Integumentary II

benefits of compression

A
  • Improve fluid balance
  • Improve venous and lymphatic return
  • Modify scar tissue formation
  • Limits size and shape of tissues
  • Increases tissue temperatures
49
Q

Integumentary II

Elastic (Long Stretch) …

A

low working (with activity) pressure

high rest pressure

50
Q

Integumentary II

Inelastic (short stretch) have a…

A

high working (with activity) pressure

low resting pressure

51
Q

Integumentary II

Unna Boot

A
  • Short Stretch ™
  • Paste bandage
  • Semi-Rigid / non-compliant
  • Works when calf muscle pump utilized:
    • ™  During exercise
    • ™  During effective ambulation
52
Q

Integumentary II

Damage to epidermis only; presents as dry, red and painful

A

First Degree Burns

53
Q

Integumentary II

all of epidermis and varying thickness of dermis; ™presents as  painful, blistering, moist, red and blanchable

A

second degree burn

54
Q

Integumentary II

Second-degree burns types:

A
  • 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
55
Q

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

A

C. Deep partial-thickness injury

56
Q

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)

A

third degree

57
Q

Integumentary II

Damage extends to deep structures (fascia, muscle, tendon, bone, etc)

A

Fourth-degree burns

58
Q

Integumentary II

Extent of Burns

A

 Rule of Nines

59
Q

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

A

B.

60
Q

Integumentary II

Extend of Burns: Lund-Browder Method

A
  • Age specific
  • Accounts for changes in body growth of children
61
Q

Integumentary II

extent of burns: palm method

A
  • Hand of patient with fingers adducted represents 1% of TBSA
62
Q

Integumentary II

s/p plastic surgery (skin grafting)

A
  • COMPLETE AND STRICT BEDREST X 5 DAYS
  • POD # 5 Graft / flap assessment for take: graft take assessed by percentage of adherence
63
Q

Integumentary II

wound scarring borders raised but stays within wound borders

A

hypertrophic scarring

64
Q

Integumentary II

wound scarring raised and goes beyond wound borders

A

keloid

65
Q

Integumentary II

how long does the remodeling phase of wound healing last?

A

1-2 years

66
Q

Integumentary II

Wound strength reaches 80% of pre-wounded state in the _______ phase

A

remodeling

67
Q

Integumentary II

Absent signs of inflammation in the inflammatory phase

A

spells trouble

68
Q

Integumentary II

Incisional wound in the Inflammatory phase
type of drainage

A

Sanguinous to serosanguinous

69
Q

Integumentary II

Incisional wound in the inflammatory phase; approximation of wound edges should be

A

Epithelialization
™  No tension on sutures

70
Q

Integumentary II

Incisional wound in proliferative phase → presence of ______

A

Healing Ridge

  • Firmness along incision extending 1 cm on either side from deposition of new collagen
  • Appears by postop day 5-9
71
Q

Integumentary II

Incisional wound in proliferative phase drainage

A

should be serosanguinous → serous → nil

72
Q

Integumentary II

Negative Pressure Wound Therapy (NPWT) benefits

A
  • 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
73
Q

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”)

A

Non-contact Normothermic Wound Therapy​​

74
Q

Integumentary II

Non-contact Normothermic Wound Therapy affects healing by

A
  • ™ ↑ tissue perfusion from microvasculature
  • ↑ PO2 ™of subcutaneous tissue
  • ↓ Affinity of O2 to Hb
  • ↑ Bacterial killing by neutrophils ™
  • ↓ Tissue vulnerability to infection
75
Q

Integumentary II

Electrical Stimulation

A
  1. Intact skin with has negative charge
  2. After wounding, Na+ escapes and current flows into the wound.
  3. Galvanotaxis: mvmt of cells based on charge
76
Q

Integumentary II

movement of an organism or any of its parts in a particular direction in response to an electric current

A

Galvanotaxis

77
Q

Integumentary II

electrical stimulation: inflammatory phase

A

(+)

78
Q

Integumentary II

electrical stimulation; proliferative phase

A

negative

[Fibroblast (+)]

79
Q

Integumentary II

electrical stimulation: remodeling phase

A

negative

80
Q

Integumentary II

how does high-frequency ultrasound work in wounds?

A

Non-thermal effects, through acoustic streaming, affect cellular membrane permeability

81
Q

Integumentary II

how does low-frequency ultrasound works in treating wounds?

A

mechanical debridement of necrotic tissue

82
Q

Integumentary II

indications for low-frequency ultrasound to wound tx

A
  • infected wounds
  • impaired circulation
  • necrotic wounds
83
Q

Integumentary II

what is the main effect of ultraviolet C for wound tx?

A

inhibiting DNA synthesis in bacteria

84
Q

Integumentary II

how does Hyperbaric Oxygen Therapy work in wound healing?

A
  • by having patient breathe in 100% O2 at elevated atmospheric pressures
  • Stimulates healing by providing more oxygen to macrophages, neutrophils and fibroblasts
85
Q

Integumentary II

how does Cold Laser (Low Level Laser Therapy) work in wound healing?

A
  • Changes in membrane permeability
  • Increased ATP levels
  • increased DNA production
86
Q

Integumentary II

Arterial exam tests

A
  • 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 )
87
Q

Integumentary II

venous exams tests

A
  • Venous doppler
  • Percussion test
  • Trendelemburg test
  • Cuff test
88
Q

Integumentary II

In a Venous Doppler test compression of vein proximally should result in

A

no change in flow if venous valves are patent

89
Q

Integumentary II

In a Venous Doppler test compression of vein distally should result in

A

increased flow

90
Q

Integumentary II

Tapping proximally on saphenous vein should have no detectable changes on probe distally if valves are patent

A

Percussion Test

91
Q

Integumentary II

Venous Filling Time test

A
  • 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
92
Q

Integumentary II

Trendelenburg test

A
  • 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.
93
Q

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.

A

C.

94
Q

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.

A

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