Lecture 1 - Healing

Question 1

The skin receives ____ of resting cardiac output

Answer 1

1 / 3

Question 2

Where is the thinnest skin located?

Thickest?

Answer 2

Eyelid/eardrum

Hands/feet

Question 3

Describe the layers of the skin

Answer 3

Epidermis: 5 thin layers

Dermis: 2 thick layers

Question 4

T or F: the epidermis is vascular

Answer 4

F

It is avascular

Question 5

Which part of the skin produces vitamin D

Answer 5

Epidermis

Question 6

Complete renewal of epidermis takes _____ days

Answer 6

45-75

Question 7

What cell mainly handles re-epithelialization

Answer 7

Keratinocyte (90% of it)

Question 8

What is a melanocyte

Answer 8

pigment producing

Question 9

Merkel cells

Answer 9

Mechanoreceptors for light touch

Question 10

What are langerhan’s cells

Answer 10

Immune system cells in skin

derived from bone marrow

Question 11

T or F: The dermis is vascular

Answer 11

T

Question 12

Where are superficial lympathatics and epidermal appendages contained in the skin

Answer 12

Dermis

Question 13

Where do blisters occur

Answer 13

Between papillary dermis and the stratum basale

called: Rete ridges

Question 14

What layer of the skin provides sensation

Answer 14

dermis

Question 15

What is the main cell of the dermis

Answer 15

Fibroblast

produces collagen and elastin

Question 16

What is a macrophage

Answer 16

Peak 48-72 hours after injury,

housed in dermis,

clean cellular debris and fight infecion

Question 17

White blood cells

Mastcells

Answer 17

Both housed in dermis

WBC- fight infection

Mast cell - produce histamine

Question 18

Adipose tissue is highly ___________

Answer 18

Vascular

Shiney yellow/white little balls

Question 19

Fascia looks like what

Answer 19

shiny white or yellow strands when healthy

Question 20

A stage 2 pressure injury is ________-thickness

Answer 20

partial

Question 21

A stage 3 or 4 pressure injury is ________-thickness

Answer 21

full

Question 22

What are the 4 phases of wound healing

Answer 22

Hemostasis

Inflammation

Proliferation

Maturation/remodeling

Question 23

What are the cardinal signs of inflammaiton

Answer 23

Edema

Rubor

Warmth

Pain

Decreased function

Question 24

What is the first cell to arrive at a site of injury

Answer 24

PMN Polymorphonuclear neutrophils

Stimulates vascular growth and fibroblast migration, secretes inflammatory mdiatiors

Question 25

What do macrophages do

Answer 25

Direct repair process, kill bacteria and pathogens

Question 26

What cells form a plug to stop bleeding

Answer 26

platelets

Question 27

What are the signalling proteins of the inflammation phase called?

Answer 27

cytokines

Question 28

The proliferation phase starts _____ hours after an injury it consists of what 4 events

Answer 28

48 hours Angiogenesis Granulation tissue formation Wound contraction Epithelialization

Question 29

What cells are responsible for wound contraction

Answer 29

Myofibroblast

Question 30

What heals faster: circular wound or square/rectangular wounds

Answer 30

Square/rectangle

Question 31

The maturation and remodeling phase for a wound can take up to _______, most change occurs within _______

Answer 31

2 years 6-12 months

Question 32

The new collage put down in the remodeling phase is type _____, the old collage is type ______ and is broken down by collagenase

Answer 32

Type 1 Type 3

Question 33

Fully remodeled collagen is only ___% as strong as the original, if it is broken and repaired again it is __% as strong

Answer 33

80% 64% (keeps being 80% as strong each generation)

Question 34

What are MMP (Matrix Metalloprotease)

Answer 34

Inflammatory mediatiors (the boss of the wound) Takes part in all 3 healing phases Play a large role when woound becomes chronic (too many of them)

Question 35

The epidermis normally has a _______ charge A wound usually has a ______ charge

Answer 35

Electronegative Positive Note: this current difference is what starts wound healing cascade

Question 36

Intact skin has a PH of what Damage to skin can do what?

Answer 36

4-6.5 Increase PH/loss of acidity

Question 37

What can increase skin acidity

Answer 37

Urine/stool Systemic disease

Question 38

Eczema, dermatitis can _______ skin acidity

Answer 38

Decrease acidity (higher ph)

Question 39

What is wound primary closure (surgery)

Answer 39

Wound is cleaned and edges are approximated and closed

Question 40

What is secondary wound closure

Answer 40

Wound is left open to heal on is own through the 3 phases

Question 41

What is delayed primary closure

Answer 41

Where the surgeon leaves the wound open temporarily to monitor for infection before eventually closing it

Question 42

What is dehiscence

Answer 42

Where primary wound closure from a surgery opens back up

Question 43

Hypogranulation vs hypergranulation

Answer 43

Hypo- wound fails to granulate hyper- granluation occurs outside wound

Question 44

A chronic wound is defined by medicare as _____

Answer 44

taking more than 30 days to close

Question 45

Technical definition of chronic wound (not medicare)

Answer 45

Wound is stuck in a phase of healing with no progress

Question 46

What are senescent cells

Answer 46

Dr flynns brother useless cells usually found in chronic wounds

Question 47

Chronic wounds typically have ______ levels of MMP

Answer 47

higher +dont respond to growth gactor +lower level tissue inhibitors of matrix metalloprotease (TIMPs)

Question 48

Why do you want to do change the dressing of a wound as less-frequent as you can?

Answer 48

To avoid changing temp

Question 49

Optimal temp for wound healing? When is it too cold?

Answer 49

37-38C Below 12C

Question 50

Should you let a wound "air out"

Answer 50

No, wounds cannot become too dry wounds must stay hydrated

Question 51

What is normal water intake for a person? Normal intake if u have a wound?

Answer 51

30-35ml per kg of BW 2.7-3.7L per day

Question 52

How can you tell if someones dehydrated

Answer 52

1% decrease in bodyweight decreased urine output/dark color decreased skin turgor

Question 53

Why is vitamin A important?

Answer 53

Improves **tensile strength** of tissue increases **collagen** synthesis Helps w/ longterm corticosteroid use note: can damage liver if too much

Question 54

Why is vitamin C important?

Answer 54

absorb iron/ antioxidant/ synthesis collagen/ capillary integrity

Question 55

Why is vitamin E important

Answer 55

**Antioxidant**/ decrease inflammation phase/ enhance immune function/ decreases platelet adhesion

Question 56

Why is Vitamin K important

Answer 56

Essential for blood clotting

Question 57

How does Zinc help wound healing

Answer 57

Aids in **collagen** and **protein synthesis** and cell proliferation/ normal **immune** function

Question 58

Why is iron important

Answer 58

O2 transport, immune function

Question 59

Why is copper important

Answer 59

Required for hemoglobin synethsis and iron absorption

Question 60

why is magnesium important

Answer 60

Deficiency can cause HTN and vasoconstriction often caused by diabetes/alcoholism/diarrhea/dehydration

Question 61

Why is calcium important

Answer 61

Required for fibrin synthesis

Question 62

What happens at these Loss of lean bodymass percentages? 10% 20% 30% 40%

Answer 62

10%- impaired immunity 20% - impaired healing and thin skin 30% - no healing, new wounds can form 40%- death

Question 63

What do creatinine levels indicate

Answer 63

Kidney function

Question 64

What do albumin levels indicate

Answer 64

protein deficiency

Question 65

What do prealbumin levels indicate same for serum transferrin levels

Answer 65

see how change in protein in impactng patient serum transferrin- looks at protein status/recent changes

Question 66

What do C-reactive protein levels indicate

Answer 66

Indicates inflammation

Question 67

What do BUN levels indicate

Answer 67

decreased healing

Question 67

What do blood glucose levels indicate

Answer 67

increase risk for ulcer, infection, impaired healing