Integumentary System

Question 1

what is herpes zoster vs herpes 1 and herpes 2

Answer 1

herpes zoster is the shingles virus that follows a dermatomal pattern, typically T11-T12. Burning, tingling, one sided pain typically occurs. The rash is painful!

Herpes 1(simplex) is what you get with a cold sore by contact. no clue contact and antiviral medication

Herpes 2 is genital herpes from sexual contact.

Question 2

when someone is independent with transfers and is unable to walk, what would be the more likely cause of ischial tuberosity ulcers, friction or tissue loading

Answer 2

tissue loading. They can transfer independently do that makes it less likely to be friction. However, the pt is not walking so pressure builds from prolonged sitting.

Question 3

Serous drainage is

Answer 3

a clear, watery drainage.

Question 4

Chylous drainage is

Answer 4

milky and white, usually after abdominal surgeries due to the damage or trauma to the cisterna chyli or adjacent lymphatic trunks

Question 5

sanguineous drainage is usually

Answer 5

thin and bloody, post surgery at surgical sites

Question 6

purulent drainage is

Answer 6

thick and has an odor and has large amount of bacteria inside of it

Question 7

staging of pressure injuries stage 1

Answer 7

stage 1: nonblanchable erythema of intact skin. may have temperature changes, and tissues can be firm or boggy, can be painful or itchy. redness not always visible (darker skin).

Question 8

staging of pressure injuries stage 2

Answer 8

partial thickness skin loss, with the epidermis or dermis or both. superficial ulcer. shows as blister, abrasion or shallow crater.

Question 9

staging of pressure injuries stage 3

Answer 9

full thickness, damage/necrosis of subcutaneous tissue. may go to underlying fascia (not through). deep crater

Question 10

staging of pressure injuries stage 4

Answer 10

full thickness, extensive destruction, tissue necrosis, damage to muscle bone or supporting structures. undermining and sinus tracts may be here

Question 11

unstageable pressure injury

Answer 11

tissue depth obscured to eschar or slough or both. extent of damage cannot be determined.

Question 12

deep tissue injury

Answer 12

discoloration of tissue like a bruise that is not reversible and will likely progress to a full thickness injury.

Question 13

differentiate between an arterial and a venous wound

Answer 13

arterial wounds typically on the dorsum of the foot, lateral leg and toes. painful with leg elevation. no drainage. edema in dependent positions. deep can go to tendons or bones.
venous is usually around the distal lower leg or medial malleolus and the wound is irregular shaped, shallow and dark pigmentation. dependent position causes pain in the wound. edema presents. little pain.

Question 14

describe how elevation and dependency differ between arterial and venous wounds

Answer 14

in arterial wounds, the pain will be increased with elevation and there will be swelling/edema in the dependent position.
venous, the pain increase with dependent position. the legs are comfy with elevation.

Question 15

where are neuropathic ulcers usually found

Answer 15

in the forefoot area, specifically on the metatarsal heads, toes, or over an area of increased weight-bearing that may be present because of a foot deformity. Neuropathic ulcers are typically not found on the leg.

Question 16

pressure injuries are typically found over

Answer 16

bony prominences

Question 17

what size moles should be inspected carefully

Answer 17

anything with a diameter bigger than 0.25 inches.

Question 18

A single lesion with more than one shade of black, brown, or blue may be a sign of …

Answer 18

malignant melanoma

Question 19

malignant melanomas have what kind of edges

Answer 19

uneven and notched.

Question 20

differentiate between the 3 types of wound intentions

Answer 20

primary: the wound is sutured or stapled shut after surgery, or a wound like a partial thickness or ulcer can heal on its own by tissue approximation.
Secondary: this is when there are any of the 4 ulcers, full thickness kinds of wounds where there is no approximation. This also happens with necrosis or debris in the wounds
tertiary: this happens when there is a delayed primary intention. Surgery that cannot be sutured up right away due to risk of sepsis or dehiscence.

Question 21

timeline of healing phases

Answer 21

inflammation (0-10 days)
proliferation (3-21 days)
maturation (7 days - 2 years)

Question 22

what is an alginate

Answer 22

a highly absorptive and highly permeable and non-occlusive dressing that is used for partial or full thickness burns that are infected/ave a lot of drainage.

Question 23

can alginates be used on wounds with deep structures present?

Answer 23

no

Question 24

you have a patient with an infected venous ulcer wound with a lot of exudate. The pt states that the ulcer bleeds a lot too. What kind of dressing may be appropriate

Answer 24

alginate, because it is absorptive and occlusive but still non-permeable. will help keep microbes out and will help to keep the wound bed dry.

Question 25

Wagner Ulcer classification

Answer 25

0: no open lesion, pre-ulcerative lesions, healed ulcers, presence of bony deformity
1: superficial ulcer
2: deep ulcer potentially exposing bone, tendon, ligament due to through subcutaneous tissue
3: deep ulcer with osteomyelitis, osteitis, abscess
4: gangrene of digit
5: gangrene of foot (disarticulation required)

Question 26

superficial burn

Answer 26

this is just the epidermis outer layer with redness and very little edema. there will be no peeling of the skin here.

Question 27

superficial partial thickness

Answer 27

epidermis and upper dermis that will result in redness and blanching, but with brisk capillary refill. There will be weeping blisters and there will be pain and sensitivity and changes in temperature

Question 28

deep partial thickness

Answer 28

severe burn to epidermis and dermis with nerve damage, hair follicle damage and swear gland issues. red, waxy, white will popped blisters, wet. There will be blanching but poor cap refill. This results in ability to sense pressure, but not light touch or not pin prick

Question 29

full thickness

Answer 29

goes through epidermis, dermis, subcutaneous and you will have white charred dark tan or black skin. there is no blanching and no cap refill and the skin is dry and leathery. But little pain because nerve ending destroyed.

Question 30

subdermal burn

Answer 30

destruction of dermis, epidermis, subcutaneous and maybe to bone muscle. From prolonged flame or electrical burn. This might need amputation. the vascular system is messed up too.

Question 31

why is sharp debridement contraindicated for dry eschar on a heel

Answer 31

because the dry eschar may be acting as a barrier protective barrier for the wound.

Question 32

what is Larval therapy

Answer 32

using maggots for debridement

Question 33

what type of dressing is recommended for diabetic ulcer healing

Answer 33

hydrogel

Question 34

what is the Barden scale

Answer 34

assess risk of skin breakdown, looks at mobility, activity, sensation, moisture, nutrition, friction, and shear

Question 35

Morse scale looks at

Answer 35

fall risk

Question 36

undermining is

Answer 36

horizontal erosion under a wound.

Question 37

tunneling is

Answer 37

vertical erosion

Question 38

serosanguinous vs sanguinous

Answer 38

serosanguinous: pink and watery.

Sanguinous is red and watery

Question 39

keloid vs hypertrophic scar

Answer 39

keloid extends beyond the original boundaries of the burn/injury
hypertrophic stays within the boundaries.

Question 40

if you have a wound with granulation tissue and with slough, and you are trying to get rid of just slough, what do you do

Answer 40

selective debridement like with an enzyme, so something like collagenase.

Question 41

granulation and epithelialization means the wound is healing…

Answer 41

well

Question 42

is deep manual pressure good for pushing edema out when you have acute wounds in the legs

Answer 42

no, it is too aggressive and can damage capillaries down there.

Question 43

do opioid medications delay wound healing?

Answer 43

no correlation.

Question 44

can hydrogen peroxide be used with granulation wounds and non infected wounds

Answer 44

no because the oxygen reacts with the hydrogen peroxide making bubbles, which is a form of non selective debridement and therefore might hurt the kind of wound descried.

Question 45

charcoal is used on a wound when there is

Answer 45

an odor

Question 46

silver is used on a wound when there is

Answer 46

bacteria, since it is selectivity toxic to bacteria

Question 47

how do you take LE edema measurements

Answer 47

start at the floor in a weight bearing position and take a measurement every centimeter from the floor to the groin.

Question 48

what condition is hallmarked by silver scaled papules and plaques in the scalp, elbows, knees, back, and buttocks

Answer 48

psoriasis

Question 49

psoriasis is commonly associated with erosive arthritis of what joints

Answer 49

the DIP joints on the hand