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PHTH 536 - Body Systems > Integumentary System > Flashcards

Integumentary System Flashcards

1
Q

What is the primary function of the epidermis?

A

Maintain skin integrity as a physical barrier against:
- bacteria
- shear
- friction
- irritants
- protect aginst loss of fluid at cellular level

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2
Q

What is the primary function of the dermis?

A

Provide tensile strength and support

retain:
- moisture
- blood
- O2 to the skin

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3
Q

Skin receives how much of the blood volume?

A

1/3 of the bodies

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4
Q

Normal wound healing

Phase 1

A

Inflammatory phase
1-10 days

If interrupted = chronic inflammation can happen

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5
Q

Normal wound healing

Phase 2

A

Proliferative phase
3-21 days

Interruptions or delay = chronic wound

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6
Q

Normal wound healing

Phase 3

A

Maturation phase
7-2 years

Scar tissue will remodel but strength is 80% of normal tissue

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7
Q

What influences wound healing?

A
  • age
  • comorbidities
  • edema
  • inappropriate wound care
  • infection
  • lifestyle
  • stress
  • medications
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8
Q

What is healthy skin reliant on?

A

The proper function of the peripheral vascular sysem and lymphatic system

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9
Q

What is necessary for wound healing?

A

Oxygen because otherwise infection risk is increased

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10
Q

Perfusion to wound can be compromised by?

A
  • arterial insufficiency
  • presence of edema
  • necrotic tissue
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11
Q

What is the environment needed for wound healing?

A

Important to set up a moist wound environment

  • proper wound hydration is the most important EXTERNAL factors
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12
Q

What are the basic principles to set up an optimal environment?

A
  • barrier to cover the wound that is “breathable”
  • preserve fluid in the wound bed
  • maintain the peri-wound integrity by controlling heavy exudate
  • changing bandage when leakage happens outside of borders
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13
Q

What should we include when documenting wounds?

A
  • location
  • size
  • shape
  • edges
  • tunneling, undermining, sinus tracts
  • peri-wound area
  • pain
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14
Q

Drainage type

Serous type

Color, thickness, healing phase

A

Color
- clear, light color

thickness
- think, watery

healing phase
- inflammatory and proliferative phase

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15
Q

Draining types

Sanguineous

Color, thickness, healing phase

A

Color
- red color

thickness
- thin and watery

Healing phase
- inflammatory and proliferative phase

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16
Q

Draining types

Serosanguineous

Color, thickness, healing phase

A

Color
- clear or tinge light of red or pink

Thickness
- thin and watery

Healing phase
- inflammatory and proliferative phase

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17
Q

Drainage type

Seropurulent

Color, thickness, healing phase

A

Color
- cloudy, opaque, yellow or tan

thickness
- thin and watery

Healing phase
- early warning signs of infection (abnormal findings)

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18
Q

Drainage types

Purulent

Color, thickness, healing phase

A

Color
- yellow and green

thickness
- thin and viscous

Healing phase:
- wound infection (abnormal findings)

19
Q

Necrotic tissue types

What is slough?

A

Moist, stringy or mucinous white/yellow tissue that is attached to the wound bed
- easily removed

20
Q

Necrotic tissue types

What is eschar?

A

Hard, leathery, black/brown, dehyrated tissue and is usually adhered to healthy ones under

21
Q

Necrotic tissue types

What is gangrene?

A

Death and decay of the tissue because interrupted blood flow

22
Q

Necrotic tissue types

What is hyperkeratosis?

A

“callus” is white/gray
- texture firm to soggy depending on moisture surrounding it

23
Q

Wound closure

What is the primary intention?

A

Surgeon closes the wound edges by approximating while using sutures, staples, graphs and glue
- if infection or maceration causes it to open = “dehiscence”

24
Q

Wound closure

What is secondary intention?

A

When a wound is left to heal on its own
- new tissue is laying down in the wound bed which closes the area until it is healed from the deepest layers to most superficial

25
Q

Wound closure

What is tertiary intention?

A

“delayed primary” meaning the secondary intention fails then has to be surgically closed
- when delay is purposeful = infection
- once healed = closure happens

26
Q

What is the clinical sign that a wound is not following a normal pattern?

A
  • change in color and ordor
  • persistent edema
  • necrotic tissue formation
  • tunneling or undermining
  • infection
  • wound edge builds up a ridge that curls under itself
  • hypertrophic scarring or keloid
27
Q

What are the clinical features of a venous ulcer?

Pulses - Pain - Color - Temp - Edema - Skin changes - Ulceration - Gangrene

A

Color
- normal

Pain
- none to aching (dependent to position)

Color
- normal or cyanotic (may see dark pigmentation)

Temp
- normal

Edema
- often marked

skin changes:
- pigmentation
- statis dermatitis
- skin gets thick as scarring develops

ulceration
- may develop medially
- wet with large amount of exudate

gangrene
- absent

28
Q

What are the clinical features of aterial ulcers?

Pulses - Pain - Color - Temp - Edema - Skin changes - Ulceration - Gangrene

A

Pulses
- poor or absent

pain
- often severe
- intermittent claudication
- progressing to pain at rest

color
- pale on elevation
- dusky rubor on dependency

temp
- cool

edema
- usually absent

skin changes
- trophic changes
- loss of hair on foot and toes
- nails thicken

ulceration
- on toes or feet
- can be deep

gangrene
- black gangrenous skin adjacent to ulcer can develop

29
Q

What are the clinical features of diabetic ulcers?

Pulses - Pain - Ulceration - Gangrene

A

Pulses
- may be present or diminished

pain
- typically not painful
- sensory loss usually present

ulceration
- may develop due to trauma to insensitive skin

gangrene
- may develop if left untreated

30
Q

What are the clinical features of pressure ulcers?

Pain - Color - Temp - Skin changes - Ulceration - Gangrene

A

pain
- can be painful if sensation is intact

color
- red
- brown/black
- yellow

temp
- may be warm if localized infection is present

skin changes
- inflammatory response with necrotic tissue

ulceration
- typically occurs over bony prominences

gangrene
- may develop if left untreated

31
Q

What are the characterisitics accounted for the Braden Scale?

A
  • sensory perception
  • moisture
  • activity
  • mobility
  • nutrition
  • friction and shear
32
Q

Staging pressure ulcers

Stage 1

A

intact skin with non-blanchable redness over a localized area over a bony prominence

dark pigmented skin may not be seen

its color may differ according to the area

can be painful, firm, soft, warmer or color than adjacent skin

warning signs for at-risk patients

33
Q

Staging pressure ulcers

Stage 2

A

partial thickness loss of dermis that shows as a shallow open ulcer with a red-pink wound bed with sloough

can be present as in intact or open/ruptured serum-filled blister

34
Q

Staging pressure ulcers

Stage 3

A

full thickness tissue loss

subcutaneous fat may be visible but the fascia and structures beneat the fascia are not exposed

slough may be present but does not obscure the depth of tissue loss

can include undermining and tunneling

35
Q

Staging pressure ulcers

Stage 4

A

Full thickness tissue loss with exposed bone, tendon or muscle

slough or eschar may be present on some parts of the wound bed

often includes undermining and tunneling

36
Q

Staging pressure ulcers

Suspected deep tissue injury

A

purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear

area may be preceded by tissue that is painful, firm, mushy, bogggy, warmer or coolr as compared to adjacent tissue

37
Q

Staging pressure ulcers

Unstageable

A

Full thickness tissue loss in which the base of the ulcer is covered by slough and/or eschar in the wound bed

38
Q

What are the risk factors of diabetic foot ulcers?

A

foot tissues
- poor footwear
- foot deformities
- trauma to the foot

noncompliance with disease management

lack of protective sensation

skin changes
- dry, red, shiny skin, previous ulcers

history of:
- amputation
- alcohol/tobacco use
- immobile
- increased age
- weak immune system
- vascular disease

39
Q

Wagner Diabetic Ulcer Grade Classification

Stage 0

A

no open lesion
may have pre-ulcerative lesions (healed ulcers or presence of bony deformity)

40
Q

Wagner Diabetic Ulcer Grade Classification

Stage 1

A

Superficial ulcer
- does not involve any subcutaneous tissue

41
Q

Wagner Diabetic Ulcer Grade Classification

Stage 2

A

deep ulcer
- penetrating through subcutaneous tissue
- has potential to expose bone, tendon, ligament, joint capsule

42
Q

Wagner Diabetic Ulcer Grade Classification

Stage 3

A

Deep ulcer
- with osteitis, abscess or osteomytelitis

43
Q

Wagner Diabetic Ulcer Grade Classification

Stage 4

A

Gangrene
- likely requiring amputation

44
Q

Wagner Diabetic Ulcer Grade Classification

Stage 5

A

Gangrene
- suspected deep tissue injury
- requiring amputation

PHTH 536 - Body Systems (28 decks)

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