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NPTE > Integumentary system > Flashcards

Integumentary system Flashcards

1
Q

What is the rule of 9s?

A 
This refers to the method to determine % of body suffering burns:
Head and neck- 9%
Ant trunk - 18%
Post trunk - 18%
both anterior UE - 9%
both post UE - 9%
Genitals 1%
Both ant LE 18%
Both post LE 18%
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2
Q

How does the rule of 9s change for age 1-10 year old

A

Take 9% off the lower extremities and add to the head and neck - add 1% back each year until 9 years old.

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3
Q

What is the Wagner Ulcer classification scale?

A

0- no open lesion, healed ulcer
1 - Superficial ulcer
2. Deep ulcer including subcutanous tissue, may expose bone, tendon, mm
3. Deep ulcer with OM
4. Gangrene of digit
5. Gangrene of foot requiring disarticulation

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4
Q

What are the stages for pressure ulcers

A

I - intact skin, bony prominence, non-blanchable, pain/itch
II - Partial thickness tissue loss, shallow open ulcer, red wound bed, blister
III- Full thickness tissue loss into subcutanous layer - tunneling
IV - Full thickness exposed tendon, muscle or bone, eschar, undermining, tunneling,
Unstagable - full thickness tissue loss covered with eschar - needs debriding to stage.

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5
Q

What are the types of exudate?

A

Serous - clear, light, thin, normal

Sanguineous - red colour, thing, watery, blood, may be brown if dried - normal (moderate amount or greater indicates tissue damage)

Serosanguinous: light red or pink, thin and watery, normal in healthy healing tissue

Seropurulent - cloudy or opaque with yellow or tan colour, thin and watery, Early sign of infection

Purulent - yellow or green colour, thick, viscous indicates infection

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6
Q

What are the types of odour associated with wounds? What are they caused by

A

Pseudomonas infection - sweet odour, thin, foamy green drainage
Clostridium - strong pungent odor associated with tissue necrosis
Putrescine -pungent can cause vomiting, rotten smell

Caused by tissue degredation, necrosis or anaerobic bacteria

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7
Q

What are the 9 things that are examined when treating a wound

A
  • Examine for tunnelling
  • report colour and tissue involved record presence of granulation or epithelialization
  • Temperature
  • Girth (can use volumetric measures for girth but not for wound volume
  • Viability of periwound tissue - halo, warmth, swelling
  • Sensory integrity
  • signs of infection
  • wound scar tissue - banding, pliability, texture
  • photographic records - wound appearance.
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8
Q

What are the 4 types of burn

A

Thermal - from conduction or convection
Electrical - Complications include arrthythia, resp arrest, renal failure, neuro damage
Chemical - Reactions conitnue until chemical is diluted
Radiation - altered DNA complications include blistering, desquamation, non-healing wounds, tissue fibrosis, discoloration, new malignancies

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9
Q

What are the three classifications of burn zones

A

Zone of coagulation - irreversibly injured, cell death
Zone of stasis - cells injured, may die without specialised treatment
Zone of hyperemia - minimal cell injury, should recover

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10
Q

What are the signs of a 1st degree burn and what is the rate of healing - superficial burn

A

Redenss that lasts >20 minutes, no blistering, epidermis only, 3-7 days

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11
Q

What are the signs of a 2nd degree burn and what is the rate of healing - Superficial partial thickness burn

A

Blisters, separation between dermis and epidermis. Pain with more fluid loss. Local circulation disrupted. 7-21 days

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12
Q

What are the signs of a 2nd degree burn and what is the rate of healing - Deep partial thickness burn

A

Red or white appearance, blistering, severe pain, severe damage to dermis and epidermis. Injury to nerve endings hair follicles, sweat glands. 21-28 days

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13
Q

What are the signs of a 3rd degree burn- Full thickness burn

A

Through dermis and depidermis, may involve subcutanous tissue. Damage to muscle and tendons causing risk for developing contracture. Gray, white or black appearance, eschar.

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14
Q

What are the two types of scarring associated with a full thickness burn?

A

Hypertrophic scar - raised scar that stays within the boundaries of burn wound
Keloid scar - raised scar that extends beyond boundaries of original burn wound

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15
Q

What is a 4th degree burn

A

Electrical burns - large thermal burn where current exits the body and a smaller injury at the entrance point. Extensive tissue damage.- destruction of vascular system.

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16
Q

What are the characteristics of an arterial insufficiency ulcer?

A
  • lower third leg, toes, web spaces, lat malleolus
  • Smooth edges, well defined, deep
  • Minimal exudate
  • painful
  • diminished or absent pedal pulses
  • Normal or no edema
  • Decreased skin temperature
  • thin, shiny skin, hair loss, yellow nails
  • Leg elevation increases pain

Rx: protect limb, inspect daily, avoid leg elevation, appropriate shoes with seamless socks

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17
Q

What are the characteristics of a venous insufficiency ulcer?

A
  • Proximal to medial malleolus
  • irregular shape, shallow
  • mod to heavy exudate
  • mild to mod pain
  • normal pulses
  • increased edema
  • normal skin temp
  • flaking, dry skin brownish colour
  • leg elevation decreases pain
  • limb protection, risk reduction, compression, elevation of legs, AROM ex, shoes and socks appropriate
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18
Q

What are the characteristics of a neuropathic ulcer?

A

Areas exposed to pressure or shear during WB

  • Well defined, oval or circle, little necrosis, good granulation
  • low to mod exudate
  • no pain
  • diminished or absent pulses
  • normal edema
  • decreased skin temp
  • dry, inelastic, shiny skin, decreased or absent sweat and oil
  • loss of protective sensation

Rx: repositioning 2 hourly in bed, manage excess moisture, inspect skin daily

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19
Q

What are the characteristics of a pressure ulcer?

A
  • areas of prolonged pressure - bony prom
  • Initially bruising or purple blisters
  • no exudate
  • mild pain
  • normal pulses
  • no edema
  • increased skintemp
  • shearing forces, moisture, temperature, friction, malnutrition
  • Reposition every two hours
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20
Q

What are the 6 types of wound?

A

Abrasion - shear and friction forces
Avulsion - aka degloving - skin detatched from underlying structures
Laceration - trauma - shear, tension, high force compression
Penetrating - entering the interior of organ or cavity
Puncture - penetrates skin and underlying tissue
Skin tear - trauma to fragile skin

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21
Q

What is dermatitis

A

Inflammation of skin diagnosed as:
Acute; red oozing, crusting, rash, exudate
Subacute: erythematous skin, scaling, scattered plaque
Chronic: thickened skin, skin marking from scratching, post inflamm pigmentation changes.

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22
Q

Impetigo is..

A

A bacterial skin infection caused by staph/strep infection Associated with inflammation, small pusfilled vesicles, itchy, contagious. Rx: AB

23
Q

Cellulitis is…

A

Bacterial skin infection - strep or staph, poorly defined and widespread. Hot, red edematous. can be contagious. AB elevation, cool wet dressing.

24
Q

Abscess is

A

Commonly from a staph infection. Cavity containing pus, surrounded by inflamed tissue, result of localised infection. Will naturally burst out of the skin if left alone. Rx: drain.

25
Q

Fungal infections include

A

Ring worm and athletes foot.

26
Q

Parasitic infections include

A

Scabies and lice

27
Q

Immune disorders: Psoriasis

A

Chronic autoimmune disease of the skin, red plaques covered with silvery scale.
Rx; corticosteroids, oinments, immunosuppressive drugs

28
Q

Lupus erythematosus

A

Autoimmune disease - chronic progressive inflammatory of connective tissue.
Red rah with raised scaly plaques, butterfly rash of face, joint pain.

29
Q

Scleroderma

A

Chronic autoimmune diffuse disease of connective tissue. - Fibrosis of skin, joints, blood vessels and internal organs. Skin taut, firm, edematous, firmly bound to subcutaneous tissues. No cure but can treat symtoms

30
Q

Polymyositis (PM)

A

Connective tissue disease - immune. Symmetrical distribution. Edema, inflammation, degeneration of muscles. Primarily proximal mm. Pelvic girdle, neck, pharynx. Some forms have dermatitis.

31
Q

Types of benign tumors include

A

Seborrheic keratosis, actinic keratosis, Benign nevus (common mole)

32
Q

Types of malignant tumors include:

A

Basal cell carcinoma, Squamous cell carcinoma, malignant melanoma.

33
Q

Skin graft types include

A

Allograft - other human skin
Xenograft - other species (temporary)
Biosynthetic - collagen and synthetics
Cultured skin - lab grown from patients own skin
Autograft - use of patients own skin
Split thickness graft - epidermis and upper layers of dermis from donor site
Full thickness graft - epidermis and dermis from donor site
z-plasty - surgical resection of scar contracture used to lengthen burn scar

34
Q

Hydrocolloids

A

Gel forming polymers - backed by strong film or foam adhesive.

Ind: Partial and full thickness granular or necrotic tissue
mild exudate

Adv: enables autolytic debride, no secondary dressing, protects from microbes
Disadv: may traumatise surrounding skin

  • not for infected wounds
35
Q

Hyrdogel

A

Gel forming materials and water - protect wounds

Ind: superficial and partial thickness wounds
Minimal exudate

Requires secondary dressing. Not for heavily draining wounds

36
Q

Transparent film

A

Transparent polyurethan - permeable to oxygen, impermeable to water/bacteria

Ind: Superficial and partial thickness
Min drainage

Not for infected wounds.
not for excessive exudate

37
Q

Foam

A

Hydrophilic base that contacts the wound and hydrophobic outer layer.

Partial and full thickness wounds. Secondary over hydrogel. Varying levels of exydate

Can be adhesive or non adhessive. Moderate absorption.

38
Q

Gauze

A

Patch for protection. Infected or non-infected.

Sticks to the wound bed - lots of dressing changes, high infection rate.

39
Q

Alginates

A

Seaweed extract, calcium ions that combine with wound exudate to create gel

Full/partial thickness wounds, draining/infected wounds
Cannot be used on wounds with exposed bone or tendon. Requires secondary dressing.

highly absorptive

40
Q

Silver sulfadiazine

A

Can be applied with or without dressings. Painless.
Burn care

Does not penetrate eschar

41
Q

Sulfamylon

A

infection control in full thickness ulcers/burns

Pain at site of application

42
Q

Silver nitrate

A

non-allergenic, painless
used for burn care

Removal is painful, discolours, poor penetration

43
Q

Panafil

A

Debrides dead tissue/things pus from superficial layers -improves recovery time/odor

Used for wounds and burns.

44
Q

Povidone-iodine

A

Antifungal - easily removed with water

Burn care

45
Q

Gentamicin

A

may be covered or left open.

Burn care

46
Q

Dakin

A

Antiseptic

Infected wounds/bacteria

47
Q

Santyl

A

Enzymatic debriding ointment - removes dead skin from wounds and burns

48
Q

Most occlusive to non occlusive dressings in order

A
  • Hydrocolloids
  • hydrogels
  • semipermeable foam
  • semipermeable film
  • impregnated gauze
  • Alginates
  • traditional gauze
49
Q

Most Moisture retentive to least moisture retentive

A
  • Alginates
  • semipermeable foams
  • hydrocolloids
  • hydrogels
  • semipermeable films
50
Q 
What dressings to use based on the amount of exudate:
Dry wound:
Minimal exudate:
Moderate exudate:
Heavy exudate:
A

Dry wound: hydrocolloid

Minimal exudate: hydrocolloid, hydrogel, silicone, transparent film

Moderate exudate: Foam, calcium alginate, negative pressure hydrocolloid

Heavy exudate: calcium alginate, foams, absorbant dressing, negative pressure therapy

51
Q

Types of selective/non-mechanical debridement include

A

Sharp, Autolytic, Enzymatic

52
Q

types of non-selective/mechanical debridement include

A

Wet to dry, hydrotherapy, irrigation

53
Q

Face and Hand burns are classified as what severity?

A

Considered major burns

54
Q

What is a Kaposi sarcoma

A

Cancer in skin, lymph, organs - red/purple/brown/black lesions

NPTE (19 decks)

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