Integumentary System Flashcards

Question

Stage 2 Pressure Ulcer characteristics

Answer 1

Partial-thickness skin loss with exposed dermis * exposed dermis, serum filled blister, not deep *pink/red moist wound bed. * intact or ruptured serum-filled blister * Adipose is not visible and deeper tissue are not visible

Answer 2

Full-thickness skin loss * Adipose tissue is visible and granulation tissue or epibole are often present * Slough and/or eschar may be visible * Slough is an automatic stage 3 * Fascia, muscle, tendon, ligament, cartilage, and/or bone are not exposed

Answer 3

Full thickness skin and tissue loss * Exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone in ulcer * Major pressure injury * Slough or eschar obscures the extent of tissue loss this is an unstageable pressure injury

Answer 4

Obscured full-thickness skin and tissue loss * Full thickness skin and tissue loss * Extent cannot be confirmed because it is obscured by slough or eschar * Will reveal stage 3 or 4 * Stable eschar on the heel or ischemic limb should not be softened or removed

Answer 5

* Intact or non-intact skin * Results from intense and/or prolonged pressure and shear forces at bone-muscle interface * May evolve rapidly * May resolve without tissue loss

Answer 6

0 - No open lesion, but may possess pre-ulcerative lesions; healed ulcers; presence of bony deformity 1 - Superficial ulcer not involving subcutaneous tissue 2 - Deep ulcer with penetration through the subcutaneous tissue; potentially exposing bone, tendon, ligament or joint capsule 3 - Deep ulcer with osteitis, abscess or osteomyelitis 4 - Gangrene of digit 5 - Gangrene of foot requiring disarticulation Used to classify diabetic foot ulcers

Answer 7

Caused by conduction or convection. Examples include burns resulting from contact with a hot liquid, fire or steam.

Answer 8

* Caused by the passage of electrical current through the body. * Typically there is an entrance and an exit wound. * Complications can include cardiac arrhythmias, respiratory arrest, renal failure, neurological damage, and fractures. * Example: a lightning strike is an example of an electrical burn

Answer 9

* Occurs when certain chemical compounds come in contact with the body. * The reaction will continue until the chemical compound is diluted at the site of contact. * Compounds that cause chemical burns include sulfuric acid, lye, hydrochloric acid, and gasoline.

Answer 10

* Occurs most commonly with exposure to external beam radiation therapy. * DNA is altered in exposed tissues and ischemic injury may be irreversible. * Complications may include severe blistering and desquamation, non-healing wounds, tissue fibrosis, permanent discoloration, and new malignancies.

Answer 11

The area of the burn that received the most severe injury with irreversible cell damage.

Answer 12

The area of less severe injury that possesses reversible damage and surrounds the zone of coagulation.

Answer 13

The area surrounding the zone of stasis that presents with inflammation, but will fully recover without any intervention or permanent damage.

Answer 14

* A superficial burn involves only the outer epidermis. * The involved area may be red with slight edema. * Healing occurs without peeling or evidence of scarring in two to five days. * Goal: provide a wound environment which promotes re-epithelialization. (can be through moisturizing cream)

Answer 15

* A superficial partial-thickness burn involves the epidermis and the upper portion of the dermis. * The involved area may be extremely painful and exhibit blisters. * Healing occurs with minimal to no scarring in 5-21 days. * Goal: prepare wound for primary healing. Such as wound cleansing and debridement of the larger, more fragile blisters.

Answer 16

* Involves complete destruction of the epidermis and the majority of the dermis. * May appear to be discolored with broken blisters and edema. * Damage to nerve endings may result in only moderate levels of pain. * Hypertrophic or keloid scarring may occur. In the absence of infection, * Healing will occur in 21-35 days. * Goal: prepare wound for primary healing. Such as wound cleansing and debridement of the larger, more fragile blisters

Answer 17

* Complete destruction of the epidermis and dermis along with partial damage to the subcutaneous fat layer. * Presents with eschar formation and minimal pain. * Require grafts and are susceptible to infection. * Healing time varies significantly with smaller areas healing in a matter of weeks, with or without grafting, and larger areas requiring grafting and potentially months to heal. * Goal for PT: prepare wound for sx by controlling infection (by antimicrobial topical agents and proper wound cleansing). Treated in the operating room with surgical incision and skin grafting.

Answer 18

* Complete destruction of the epidermis, dermis, and subcutaneous tissue. * Involve muscle and bone and as a result, often require multiple surgical interventions and extensive healing time.

Answer 19

* clear, light color * thin, watery consistency * normal in healthy healing wound * in inflammatory and proliferative phase of healing

Answer 20

* red color * thin, watery consistency * pressure of blood that may become brown if allowed to dehydrate * indicative of new blood vessel growth or disruption of blood vessels

Answer 21

* light red or pink color (PTFE says light brown) * thin, watery consistency * normal in healthy healing wound * inflammatory and proliferative phase

Answer 22

* cloudy or opaque * yellow or tan color and thin, watery consistency. * early warning sign of impending infection * always abnormal

Answer 23

* yellow or green color * thick, viscous consistency * indicator of wound infection * always abnormal

Answer 24

* Excision of nonviable tissue using scalpel, forceps, or scissors * Indicated for removing eschar, loose slough, or adherent fibrin * for large amounts of thick, adherent, necrotic tissue. * may also be used with cellulitis or sepsis * PT can perform

Answer 25

* Type of mechanical debridement; Nonselective * Removal of necrotic tissue using some source of mechanical energy (let moistened gauze dry and then is removed * For moderate amounts of exudate and necrotic tissue * Indication when risk of harming healthy tissue doesn’t exceed benefit of removal of necrotic material * May dry out wound bed, often may be more costly and expensive * Removal of dry dressing from granulation can cause bleeding and be extremely painful

Answer 26

* Use of moisture-retentive dressing to facilitate body’s own enzymes to breakdown tissue. (Uses the body's own endogenous mechanisms to facilitate healing) * Conservative * Not for use with infected wounds, no occlusion * Hydrogels, hydrocolloids, alginates, transparent films * Selective * moist wound environment that rehydrates necrotic tissue and eschar that facilitates enzymatic digestion of the nonviable tissues. * takes longer period of time to heal

Answer 27

* Selective and uses topical enzymes to emulsify dead, nonviable tissue * Collagenases, fibriolysins, and proteolytic enzymes * Generally slower than sharps, faster than autolytic * Less traumatic and painful

Answer 28

* softens and loosens adherent necrotic tissue * side effects: maceration of viable tissue, edema from dependent positioning, and systemic effects such as hypotension

Answer 29

Indications * Chronic or acute wounds which cannot be closed by primary intention (dehisced surgical incisions, full-thickness wounds, partial-thickness burns, heavily draining granular wounds, flaps, grafts, and most ulcer types. Contraindications * Malignancy within the wound, insufficient vascularity to sustain wound healing, large amounts of necrotic tissue with eschar present, untreated osteomyelitis, fistulas to organs or body cavities, exposed arteries or veins, and uncontrolled pain. Advantages * Provides management of wound drainage * Maintains a moist wound environment * Decreases interstitial edema * Decreases bacterial colonization * Increases capillary blood flow * Increases granular tissue formation * Enhances epithelial cell migration Disadvantages * Requires special supplies and training * Treatment can be painful * Not reimbursed in acute or long-term care settings

Answer 30

* Inhalation of 100% oxygen at pressures greater than one atmosphere. * delivered in a closed chamber typically at pressures 2-3x that of the atmosphere -- effectively reducing edema and hyperoxygenating tissues. Indications * Osteomyelitis, diabetic wounds, crush injuries, compartment syndromes, necrotizing soft tissue infection, thermal burns, radiation necrosis, and compromised flaps and grafts. Contraindications * Terminal illness, untreated pneumothorax, active malignancy, pregnancy, seizure disorder, emphysema, and use of certain chemotherapy agents. Advantages * Antibiotic effects * Stimulation of fibroblast production and collagen synthesis * Stimulation of growth factor release and epithelialization Disadvantages * Specialized equipment is not widely available * Cannot be used with active malignancy

Answer 31

* Used in wound healing are derived from naturally occurring protein factors. * Facilitate healing by stimulating the activity of specific cell types (e.g, neutrophils, endothelial cells, fibroblasts). * Only a limited number of growth factors have been approved by the Food and Drug Administration for topical wound healing applications. Indications * Neuropathic ulcers extending into or through subcutaneous tissue with adequate circulation to sustain wound healing. Contraindications * Wounds closed by primary intention, patients with known hypersensitivity to any component of the product or a history of neoplasm at the application site. Advantages: * Adjunct to promote wound healing environment * Increases growth rate of new tissue * Promotes cell division Disadvantages * Costly * Poor reimbursement * Additional research is needed * Secondary dressing required * Requires refrigeration * Limited approval by the FDA

Answer 32

* derived from a seaweed extraction (calcium salt component of alginic acid.) * Alginates are highly absorptive, but are also highly permeable and non-occlusive. * Require a secondary dressing. * Act as a hemostat and create a hydrophilic gel through the interaction of calcium ions in the dressing and sodium ions in the wound exudate. Indications * Partial or full-thickness draining wounds such as pressure or venous insufficiency ulcers. * Often used on infected wounds due to the likelihood of excessive drainage. Advantages * High absorptive capacity * Enables autolytic debridement * Offers protection from microbial contamination Can be used on infected or non-infected wounds * Non-adhering to wound Disadvantages * May require frequent dressing changes based on level of exudate * Requires a secondary dressing * Cannot be used on wounds with an exposed tendon, joint capsule or bone

Answer 33

* Comprised of a hydrophilic polyurethane base that contacts the wound surface and a hydrophobic outer layer. * Allow exudate to be absorbed into the foam through the hydrophilic layer. * Most commonly available in sheets or pads with varying degrees of thickness. Indications * Used to provide protection and absorption over partial and full-thickness wounds with varying levels of exudate. * Also be used as secondary dressings over amorphous hydrogels. Advantages * Provides a moist environment for wound healing * Available in adhesive and non-adhesive forms * Provides prophylactic protection and cushioning * Encourages autolytic debridement * Provides moderate absorption Disadvantages * May tend to roll in areas of excessive friction * Adhesive form may traumatize periwound area upon removal * Lack of transparency makes inspection of wound difficult

Answer 34

* Yarn or thread and are the most readily available dressing used in inpatient environments. * Impregnated gauze: various materials such as petrolatum, zinc or antimicrobials have been added. Indications * Infected or non-infected wounds of any size. * Wet-to-wet, wet-to-moist or wet-to-dry debridement. Advantages * Readily available and cost effective short-term dressings * Can be used alone or in combination with other dressings and topical agents * Can modify number of layers to accommodate for changing wound status * Can be used on infected or non-infected wounds Disadvantages * Has a tendency to adhere to the wound bed traumatizing viable tissue on removal * Highly permeable * Requires frequent dressing changes * Prolonged use decreases cost effectiveness * Increased infection rate compared to occlusive dressings

Answer 35

* Consist of gel-forming polymers (e.g., carboxymethylcellulose, gelatin, pectin) backed by a strong film or foam adhesive. * Anchors to the intact surrounding skin (not the wound). * Absorb exudate by swelling into a gel-like mass and vary in permeability, thickness, and transparency. Indications * Partial and full-thickness wounds. The dressings can be used effectively with granular or necrotic wounds. Advantages * Provides a moist environment for wound healing * Enables autolytic debridement * Offers protection from microbial contamination * Provides moderate absorption * Does not require a secondary dressing * Provides a waterproof surface Disadvantages * May traumatize surrounding intact skin upon removal * May tend to roll in areas of excessive friction * Cannot be used on infected wounds

Answer 36

* Varying amounts of water and gel-forming materials such as glycerin. Indications * Moisture retentive and commonly used on superficial and partial-thickness wounds (e.g., abrasions, blisters, pressure ulcers) that have minimal drainage. Advantages * Provides a moist environment for wound healing * Enables autolytic debridement * May reduce pressure and diminish pain * Can be used as a coupling agent for ultrasound * Minimally adheres to wound * Some products have absorptive properties Disadvantages * Potential for dressings to dehydrate * Cannot be used on wounds with significant drainage * Typically REQUIRE a SECONDARY DRESSING

Answer 37

* Water-resistant adhesives. * Permeable to vapor and oxygen, but are largely impermeabe to bacteria and water. * Highly elastic, conform to a variety of body contours, and allow easy visual inspection of the wound since they are transparent. Indications * Superficial or partial-thickness wounds with minimal drainage (e.g., scalds, abrasions, lacerations). Advantages * Provides a moist environment for wound healing * Enables autolytic debridement * Allows visualization of the wound * Resistant to shearing and frictional forces * Cost effective over time Disadvantages * Excessive exudate accumulation can result in periwound maceration * Adhesive may traumatize periwound area upon removal * Cannot be used on infected wounds

Answer 38

* Fast spreading inflammation that occurs as a result of a bacterial infection of the skin and connective tissues. *Can develop anywhere under the skin, but will typically affect the extremities. Etiology - Cellulitis is caused by particular bacterial infections including streptococci or staphylococci. - Predisposing factors to cellulitis include an increased age, immunosuppression (from meds or medical conditions (HIV or leukemia), trauma, the presence of wounds or venous insufficiency. - DM may develop cellulitis without identifiable cause Signs and Symptoms - Symptoms may include localized redness that may spread quickly, warmth, weeping, and serous drainage, tenderness to palpation, edema that progressively worsens (red streaks leading away from primary site of infection - May develop systemic signs if condition worsens: chills, fever, and malaise. Treatment - A patient with suspected cellulitis should be immediately referred to a physician for further assessment. - Requires pharmacological intervention using systemic antibiotics. * Differential diagnosis should attempt to rule out deep vein thrombosis and contact dermatitis. * Cellulitis can lead to sepsis or gangrene if not properly treated. * Repeated cellulitis infection s and the associated edema can cause permanent damage to the lymphatic system.

Answer 39

* Superficial irritation of the skin resulting from localized irritation (e.g., poison ivy, latex, soap, jewelry sensitivity). * Acute or chronic based on exposure to the precipitating agent. Etiology - occurs with exposure to mechanical, chemical, environmental or biological agents. Nickel, rubber, latex, and topical antibiotics are common precipitating agents. Signs and Symptoms - Patients experience intense itching, burning, and red skin in areas corresponding to the location of the topical irritation. - Edema may also occur in the area of sensitivity and symptoms can expand beyond the initial point of topical irritation. Treatment - The focus of treatment should be on identifying and removing the source of irritation. - Topical steroid application is commonly employed. Acute lesions should resolve with treatment once exposure to the external irritant has been removed.

Answer 40

* aka dermatitis * describe a group of disorders that cause chronic skin inflammation typically due to an immune system abnormality, allergic reaction or external irritant. Etiology - based on the particular form of the disorder. - Infants and children are at higher risk for eczema, however, many outgrow the condition with age. - The geriatric population is also at an increased risk for many forms of eczema. Signs and Symptoms - Red or brown-gray, itchy, lichenified skin plaques that may be exacerbated by some topical agents such as soaps and lotions. - younger: frequently experience oozing and crusting of the patchy areas of irritation. Treatment - Pharmacological interventions are variable ranging from topical or oral corticosteroids to oral antibiotics and antihistamines. Cold compresses and other modalities may assist with reducing the itching. Stress management techniques and avoidance of extreme temperatures should be employed to avoid potential exacerbations of the condition.

Answer 41

* "dry" when there is a loss of vascular supply resulting in local tissue death. * Fingers, toes, and limbs are most often affected. * hardened tissue is not painful, however, there may be significant pain at the line of demarcation. * Typically develops slowly and in some cases results in auto-amputation. Etiology - Occurs most commonly in blood vessel disease, such as DM or atherosclerosis. - Can progress to wet gangrene if infection occurs. Signs and Symptoms - Dark brown or black nonviable tissue that eventually becomes a hardened mass (mummified). - The patient may complain of cold or numb skin and they may present with pain. Treatment - Serious medical condition and requires immediate medical intervention. Depending on the severity, gangrene is treated by pharmacological intervention, surgery, and hyperbaric oxygen therapy.

Answer 42

* associated bacterial infection in the affected tissue. * may develop as a complication of an infected untreated wound. * Swelling resulting from the bacterial infection causes a sudden stoppage of blood flow. Etiology - Can develop after a severe burn, frostbite or injury and requires immediate treatment since it tends to spread very quickly and can be fatal. - Cessation of blood flow that starts a chain of events including invasion by bacteria at the affected site. Signs and Symptoms - swelling and pain at the site of infection, change in skin color from red to brown to black, blisters that produce pus, fever, and general malaise Treatment - serious medical condition and requires immediate medical intervention. Surgical debridement of the gangrene and intravenous antibiotic treatment are typical interventions for wet gangrene. Depending on the severity, gangrene is treated by pharmacological intervention, surgery, and hyperbaric oxygen therapy.

Answer 43

* A fungal infection that primarily affects the toenails and nailbeds. * divided into subtypes, but are typically medically treated in a similar fashion. Etiology - Acquiring a fungal infection can be a fairly common occurrence. - Risk factors include manicures and pedicures with unsterile utensils, possessing nail injuries or deformities, excess skin moisture, wearing closed toe shoes, and an impaired immune response. Signs and Symptoms - yellow or brown nail discoloration; hyperkeratosis and hypertrophy of the nail causing it to partially detach from the nailbed Treatment - Manual debridement of the nail and topical antifungal medications are primary interventions. Fungal infections may return to the nailbeds and in some cases, the nails may have permanent damage.

Answer 44

* chronic autoimmune disease of the skin * most common of the five types of psoriasis. * T cells trigger Inflammation within the skin and produce an accelerated rate of skin cell growth. The skin cells accumulate in raised red patches on the surface of the skin. Etiology - Some patients have a genetic predisposition to plaque psoriasis. - Other factors may trigger psoriasis, such as injury to the skin, insufficient or excess sunlight, stress, excessive alcohol, HIV infection, smoking, and certain medications. Signs and Symptoms - The primary symptom is red raised blotches that typically present in a bilateral fashion for example over both knees or elbows. - These plaques can appear anywhere on the body and will tend to itch and flake. - Complications can include arthritis, pain, severe itching, secondary skin infections, and side effects secondary to pharmacological interventions. Treatment - primary goal to control the symptoms and prevent secondary infection. - Treatment varies widely from topical applications to systemic medications and phototherapy. - Plaque psoriasis is a life-long condition that can be effectively managed and controlled through the various stages and exacerbations.

Answer 45

* aka athlete's foot, * superficial fungal infection which causes epidermal thickening and a scaly skin appearance. * This fungus is opportunistic and will rapidly multiply in a warm and moist environment (e.g., between the toes). Etiology - Risk factors include wearing closed toe shoes that don't allow airflow, prolonged periods of moisture or wetness, excessive sweating, and possessing small nail or skin abrasions. This infection is contagious through direct contact or when making contact with a surface containing the tinea pedis infection. Signs and Symptoms - itching, redness, peeling skin between the toes, pain, odor, and in more severe cases breaks in skin continuity Treatment - Pharmacological intervention includes topical or oral antibiotics depending on the severity of symptoms. Tinea pedis may persist or recur and more long-term management may be required. Prevention includes thorough drying of the feet when bathing or swimming, wearing sandals around public pools or showers, changing socks frequently, proper hygiene, and avoiding shoe wear that creates a moist environment.

Answer 46

* varicella-zoster virus = children herpes zoster (shingles) = adults * can lie dormant for years and is highly contagious when it isn't dormant * Reactivation can occur when immune system has been weakened * S&S - blistered rash will appear on skin surface...but also on internal structures such as organ surfaces, mouth, and inner eye - itching or burning sensation (from attack on nerves) - painful blister rash - fever, body aches, chills, fatigue - blisters break open and drain * post-herpatic neuralgia due to scarring/destruction of nerve tissue is most common complication * Other complication: vision loss, balance deficits, or facial paralysis

Answer 47

Superficial

Answer 48

Full-thickness

Answer 49

Subdermal burns

Answer 50

Electrical

Answer 51

Deep partial-thickness

Answer 52

zone of coagulation There are three zones of injury at the site of a burn. The centermost area is classified as the zone of coagulation. This area corresponds with the most severe injury with irreversible cell damage. The zone of stasis is circumferentially outside of the zone of coagulation and corresponds to the area of the burn that sustained reversible damage. The outermost area of a burn is termed the zone of hyperemia and is characterized by inflammation.

Answer 53

hot liquids Contact with hot liquids is the primary cause of burns in adolescent and adults. Men and boys between the ages of 16 and 40 have the highest incidence of injury.

Answer 54

Chemical Chemical burns can significantly alter systemic tissue pH and metabolism. These changes can create potentially serious pulmonary and metabolic complications. The severity of the complications is heavily influenced by the concentration of the chemical, duration of contact, and mechanism of action.

Answer 55

superficial partial-thickness burn A superficial partial-thickness burn involves the epidermis and the upper portion of the dermis. The involved area may be extremely painful and exhibit blisters. Healing occurs with minimal to no scarring in 5-21 days.

Answer 56

Sharps Enzymatic Autolytic

Answer 57

Wet-to-dry Wound Irrigation Hydrotherapy Surgery

Answer 58

Autolytic debridement

Answer 59

Hydrotherapy

Answer 60

sharp Sharp debridement is a surgical procedure that uses scissors, scalpels and other sharp instruments to cut away or remove infected tissue. Sharp debridement improves the wound’s appearance and promotes enhanced healing by removing devitalized tissue.

Answer 61

type of dressing that is completely impermeable

Answer 62

Transparent film Transparent film dressings such as Tegaderm are dressings of choice for stage 1 and 2 pressure injuries with blister formation over bony prominences. This type of dressing should not be used on draining or infected wounds.

Answer 63

Calcium Alginates Calcium alginates are typically used on partial or full-thickness draining wounds such as pressure or venous insufficiency ulcers. Alginates are often used on infected wounds due to the likelihood of excessive drainage.

Answer 64

Superficial = Epidermis Superficial partial-thickness = papillary dermis Deep partial-thickness = Reticular dermis Full-thickness = Entire dermis

Answer 65

Braden Scale

Answer 66

Post herpetic neuralgia

Answer 67

arterial insufficiency The rubor of dependency test is used to assess for the presence of arterial insufficiency. The therapist elevates the patient’s leg with the patient in supine and notes the change in color of the lower extremity. A patient with arterial insufficiency will experience a rapid loss of the normal pinkish color of the skin, and it will take a prolonged period of time (i.e., greater than 30 seconds) for the color to return when the leg is returned to the starting position.

Answer 68

40 mm Hg Short stretch bandaging with high working pressure and low resting pressure help to facilitate the effects of the calf muscle pump during activity. Pressure of 40 mm Hg has been suggested as an acceptable guideline for patients with venous wounds.

Answer 69

compression dressings Compression dressings can further impede the circulation of a patient with an arterial insufficiency ulcer. There is no restriction to therapeutic exercises and gait training as long as pressure is not applied to the wound. Applying a hot pack to a more proximal segment will cause vasodilation and can help circulation at more distal segments

Answer 70

eczema Eczema is a term for a group of medical conditions that cause the skin to become inflamed or irritated. The condition is characterized by red or brown-gray, itchy, lichenified skin plaques that may be exacerbated by topical agents such as soaps and lotions. The most common type of eczema is known as atopic dermatitis or atopic eczema.

Answer 71

* Ulcer is caused by inadequate perfusion of oxygenated blood to affected tissue. ----leads to cell death and necrosis. * typically from atherosclerosis or arterial embolism * Peripheral artery disease (PAD): narrowing of arterial vessels that impedes delivery of oxygen to tissues * Limb-related pain is most commonly positional, occurring with the limb is in a non-dependent position or with activity that results with intermittent claudication * Characteristics: lower 1/3 of leg, lateral malleolus, dorsum of foot, toes, smooth and defined wound edges, minimal exudate, skin is cool to touch, thin, shiny, and hairless. Diminished distal pulses

Answer 72

* typically from peripheral neuropathy, atherosclerotic changes, and pressure, * most frequently in the diabetic population * Motor Neuropathy: cause weakness of the intrinsic foot m allowing the forefoot to splay during the WB and altering the fit of footwear. Decreased coordination, loss of protection sensation. * Common sites: heel, tips of prominent toes, tips of hammer toes, plantar surface of the metatarsal heads, dorsal aspect of hammer toes, and bunions. * Wound characteristics: - Well-defined oval or round shape - Granular tissue with little evidence of necrosis - Exudate is minimal - Pain is minimal - Skin is shiny, dry, and inelastic - Pulses is diminished or absent - ABI measures may be unreliable especially for pts with DM who are likely to develop vessel rigidity. * Treatment - Pharmaceutical interventions: PDGF, antimicrobial antibiotics - Surgical management: debridement for wounds with heavy necrosis, grafting for non-healing wounds. - Activity restrictions - Specialized footwear - PT: skin protection, moisturizers, skin inspection, and wound healing interventions

Answer 73

* From venous hypertension either idiopathically or secondary to valve incompetence or peripheral impedance * Formation of ulcer from increased tissue pressure that decreases skin resilience and endothelial damage that allows enzyme and free radical leakage into tissue * Location/Characteristics - medial surface of lower leg in between mid-calf and medial malleolus - large in area and shallower in depth - irregular borders - Granulation tissues - Moist layer of yellow-white slough - serous or serosanguineous exudate (moderate to heavy) - Stasis dermatitis - Skin dry, flaky appearance - Hemosiderin staining (ruddy, brownish skin discoloration) - Distal LE pulses are intact - Mild pain complaints - increased tissue tension caused by edema - pain is typically relieved by elevation or compression garment * Treatment - bypass, stent, grafting, valve repair - graded compression (garments, bandaging, Unna boot) - typically heal by secondary intention

Answer 74

abduction, flexion, lateral rotation The anticipated deformity from a burn to the anterior chest or axilla is shoulder adduction, extension and medial rotation. Splinting that places the shoulder in a position that is opposite the anticipated contracture would be the most appropriate

Answer 75

hip extension and abduction The anticipated deformity resulting from a burn to the anterior hip would be hip flexion and adduction. Anterior hip spica casts and abductions splints are common interventions to prevent and manage contraction.

Answer 76

shoulder An airplane splint is used to immobilize a shoulder during healing from an injury, surgery or burn. The splint maintains the arm in an abducted position at or below shoulder level with the elbow typically flexed.

Answer 77

- Age - Co-morbidities - Edema - Harsh or Inappropriate wound care - Infection - Lifestyle - Medication - Obesity

Answer 78

16 It is recommended that individuals who score an 18 or less on the Braden scale be placed on a pressure injury prevention program. The scale assesses sensory perception, moisture, activity, mobility, nutrition, and friction and shear. Each section of assessment is scored from one to four with the exception of friction and shear, which is scored one to three. The maximum score on the Braden scale is 23.

Answer 79

venous insufficiency A percussion test assesses the valves of the saphenous vein by percussing a distal segment of the vein while palpating a proximal segment. If the proximal hand senses blood movement, the valves are not functioning properly. Venous insufficiency is a major risk factor for developing skin breakdown

Answer 80

Head and neck = 9% Trunk = 36% (Anterior 18%/ Posterior 18%) Arm = 9% (each) (Anterior 4.5%/Posterior 4.5%) Genital Region = 1% LE = 18% (each LE) (Anterior 9%/Posterior 9%)

Answer 81

* Anticipated deformity: flexion with possible lateral flexion * Splinting: soft collar, molded collar, Philadelphia collar

Answer 82

* Anticipated Deformity: Shoulder adduction, extension, and medial rotation * Splint: Axillary or airplane splint, shoulder abduction brace

Answer 83

* Anticipated Deformity: Flexion and pronation * Splint: Gutter splint, conforming splint, three-point splint, air splint

Answer 84

* Anticipated deformity: - Extension or hyperextension of the MCP joints; - Flexion of the IP joints; - Adduction and flexion of the thumb; - Flexion of the wrist * Splint: - Wrist splint - Thumb or spica splint - Palmar or dorsal extension splint

Answer 85

* Anticipated deformity: Flexion and adduction * Splint: Anterior hip spica, abduction splint

Answer 86

* Anticipated deformity: Flexion * Splint: Conforming splint, three-point splint, air splint

Answer 87

* Anticipated deformity: Plantar flexion * Splint: - Posterior foot drop splint - Posterior ankle conforming splint - Anterior ankle conforming splint

Answer 88

superficial The “rule of nines” is commonly utilized to assess the percentage of the body surface affected by partial thickness and full thickness burns

Answer 89

9 A child under one year has 9% taken from the lower extremities and added to the head and neck region. Each year of life, 1% is distributed back to the lower extremities until the age of nine when the head is considered to be the same proportion as an adult.

Answer 90

Head and neck According to the rule of nines, 36% of the body is made up of the trunk, 18% for each lower extremity, 9% for each upper extremity, 9% for the head and neck, and 1% for the genitals. When using this method for a child, the head and neck make up 18% of the body and the lower extremities each make up 14%.

Answer 91

36.0% The rule of nines is a method used to approximate the percentage of the body affected by a burn. The posterior trunk constitutes 18% of the total body surface area, the posterior portion of the left lower extremity constitutes 9%, and the entire left upper extremity constitutes 9% (4.5% for each side). 18%+9%+9% = 36%

Answer 92

27.0% According to the rule of nines, each arm is approximately 9% of the total body surface area and each leg is 18%. Therefore the bilateral, anterior surfaces of all four extremities would represent 27.0% of the total body surface area.

Answer 93

22.5% According to the rule of nines, the total surface area of the anterior portions of the bilateral lower extremities is 18% and the total surface area of the anterior portion of the right arm is 4.5%. The total surface area affected by the burn is equivalent to 22.5%.

Answer 94

* Severe edema is the most common occurrence. Severe burns cause protein loss from burned tissues and increased cell membrane permeability. Both factors contribute to alterations in tissue microcirculation resulting in significant edema formation in the interstitial spaces. - Hypertrophic or keloid scarring: associated with an imbalance of collagen lysis and synthesis during the healing process. During the remodeling phase (so not while in acute care) - Eschar refers to necrotic tissue which is typically brown or black in color and thickly textured. Eschar may be observed while a patient with significant burns is in an acute care environment. Though less likely than edema to be directly attributed to changes in cell permeability and microcirculation.

Answer 95

* Deep partial-thickness or full-thickness (burns typically taking greater than 14 days to heal) * 15-35mmHg to create an environment that facilitates the balance of collagen synthesis and lysis * worn for 22-23 hr/day for 2weeks and 2 months after wound closure or grafting. May continue up to 2 years. * Replace the garment every 3-6 months *

Answer 96

Superficial to deep "Come Lets Get Sun Burned" Corneum Lucideum Granulosum Spinosum Basal

Answer 97

1+: pitting edema ~2mm in depth and disappears in under 10 seconds. 2 +: 4mm in depth and disappears in 10 – 15 seconds. 3+:pitting edema ~ 6mm in depth that lasts from 16 seconds to potentially longer than one minute. 4+: 8mm in depth and can last anywhere from 2-5 minutes.

Answer 98

Bactrin mild antimicrobial activity, is nontoxic, moisturizing, and can be reapplied one to five times daily, so it is useful for facial and perineal burns.

Answer 99

Antimicrobial dressing. Commonly used with neuropathic foot ulcer.