integumentary system Flashcards
key functions of integumentary system
- protection
- sensation
- thermoregulation
- excretion of sweat
- vit D synthesis
phases of normal wound healing
- inflammatory phase (days 1-10): inflammation as initial response
- clotting, debris and necrotic itssue removed (mast cells, neutrophils, leukocytes), clean wound bed signals restoration to begin, re-epithelialization w/in 24 hours at borders but visually at 3 days
- proliferative phase (days 3-21): formation of new tissue
- capillary buds and granulation tissue fill wound bed for migration of epithelial cells, collagen matrix formed
- maturation phase (days 7-2 years): remodeling, when granulation tissue and epithelial differentiation begin to appear in wound bed
progression halted or delayed in chronic wounds
newly repaired tissues have _ % of pre injury tensile strength and up to - %
15%, up to 80%
layers of skin
epidermis
dermis
subcutaneous fatty tissue
healing by intension
- partial: acute wounds with minimal to no tissue loss; sutures, staples, adhesives
- secondary: wounds close on their own without superficial closure
- tertiary: delayed primary intention healing; if at risk for complications, left open and then closed once risk factors alleviated
bacteria in 3 ways
- contamination: non-replicating bacteria on wound, no additional tissue injury or inflammation
- colonization: replicating bacteria on wound but not in further tissues, no inflammatory response
- infection: replicating bacteria that invade and cause inflammatory response
avulsion
- degloving
- wound resulting from tension that causes skin to become detached from underlying structures
types of ulcers
- arterial insufficiency ulcers
- venous insufficiency ulcers
- neuropathic ulcers
- pressure ulcers
arterial insufficiency ulcer
- d/t inadequate cirulation of oxygenated blood - ischemia
- lower 1/3 of leg, toes, web space
- smooth edges, well defined, deep, lack granulation tissue
- avoid unnecessary leg elevation, heating pads, hot water
- severe pain
venous insufficiency ulcers
- impaired cenous system, inadequate circulation
- proximal to medial malleolus
- irregular shape, shallow
- mild pain
- leg elevation helps
neuropathic ulcers
- s/t complications with ischemia and neuropathy, associated with DM but can be any peripheral neuropathy
- in areas of foot susceptible to pressure or shear in WB
- well-defined oval or circle with callused rim, crackled periwound tissue, little to no good wound bed
pressure ulcers
- decubitus ulcers
- from sustained or prolonged pressure at levels greater than that of capillary pressure
- contributing factors: shear, moisture, heat, friction, meds, muscle atrophy, malnutrition
monofilament testing
- failure to perceive 10 mg monofilament - loss of protective sensation, pt at incr risk for neuropathic ulcer
- failure to perceive 75 mg monofilament - area insensate
wound depth classifications
- superficial wound: trauma to skin with epidermis intact (non-blistering sunburn), heals w/ inflammatory process
- partial-thickness wound: through epidermis and into but not through dermis (abrasions, blisters, skin tears), heals w/ re-epithelialization
- full-thickness: through dermis and deeper into subcuteanous fat - deeper than 4 mm, heal by secondary intention
- subcutaneous wound: through integ tissue and involve deeper structures like fat, muscle, bone, tendon
wagner ulcer grading
- for diabetic foot ulcers
pressure injury staging
- non-blanchable erythema of intact skin
- partial-thickness with exposed dermis - no adipose tissue, granulation, slough, eschar
- full-thickness skin loss - fat visible, slough/eschar may be present but not fascia, tendon, bone, muscle
- full-thickness skin and tissue loss - exposed fascia, muscle, tendon
- unstageable: obscured by slough or eschar, reveals a 3 or 4
what do you do with stable eschar
leave it
exudate classifications
- serous: clear, water, normal
- sanguineous: red, thin, d/t blood, can be normal
- serosanguineous: light red or pink, normal
- seropurulent: cloudy, opazque with yellow or tan color, impending infection, always abnormal
- purulent: yellow of green, thickers, infection, always abnormal
necrotic tissue types
- eschar: hard or leathery, black/brown, dehydrated, firmly adhered to wound bed
- gangrene: death/decay from interruption of blood flow or bacterial infection
- hyperkeratosis: callus, white/gray in color
- slough: moist, string, mucinous, white/yellow
selective debridement
- sharp: use of scalpel, scissors, forceps (PTs can) - remove necrotic tissue
- enzymatic: topical enzymes to necrotic tissue for infected or uninfected wounds - establish clean wound bed
- autolytic - body’s mechanisms w/ films, hydrocolloids, hydrogels - non-invasive and painfree, not on infected bc takes longer
non-selective debridement
- wet-to-dry: moistened gauze over necrotic tissue dries and is removed - can cause bleeding and pain, use spareingly
- wound irrigation: pressurized fluid - for infected or loose debris
- hydrotherapy: whirlpool tank, can cause maceration
negative pressure wound therapy (NPWT)
- vacuum assisted closure (VAC)
- manage drainage
- chronic or acute wounds that cannot be closed by primary intention
- not for insufficient vascularity, untreated osteomyelitis, pain
hyperbaric oxygen
- inhalation of 100% oxygen delivered at pressure greater than 1 atm, delivered in closed chamber
- indicated for osteomyelitis, diabetic wounds, crush injuries, radiation necrosis
- contraindications: terminal illness, pneumothorax, pregnancy
growth factors
- derived from naturally occurring protein factors, facilitate healing by stimulating activity of specific cell types
- for neuropathic ulcers extending into or through subcutaenous tissue w/ adequate circulation to sustain wound healing
- not for wounds w/ primary intention, hypersensitivty, history of neoplasm
primary dressings
- come in direct contact with wound
- can include self-adhesive backing or do not require secondary dressing