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Integumentary > Lecture 1 Intro > Flashcards

Lecture 1 Intro Flashcards

1
Q

Role of PT: Primary vs. Secondary

A

Primary: PT is primary provider assessing and treating integumentary dysfunction/wounds. Most likely referral from physician. PTs do not make medical diagnoses, only rehab diagnoses

Secondary: Patient is not seeing PT specifically for skin/wound related issues

In both roles, communication with interprofessional team is required

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2
Q

Characteristics of Epidermis

A
  • Outer layer of skin
  • Repair and regenerates every 28 days
  • Consist of 5 layers
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3
Q

General Function of Epidermis

A
  • Protective barrier
  • Differentiates into hair, nails, sweat glands, and sebaceous glands
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4
Q

Characteristics of Dermis

A
  • Consist of two layers: Papillary dermis and reticular dermis
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5
Q

General function of Dermis

A
  • Supports structure
  • mechanical strength
  • resists shear force
  • supplies nutrition
  • inflammatory response
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6
Q

characteristics of subcutaneous tissue

A
  • composed of adipose and connective tissue
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7
Q

General function of Subcutaneous tissue

A

Thermal insulation
Mechanical “shock absorber”
Controls body shape

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8
Q

3 wound categories

A

superficial, partial-thickness, full-thickness

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9
Q

Superficial Wound

A

Tissue involved: epidermis
Examples: Abrasion, Superficial burn

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10
Q

Partial thickness

A

Tissue involved: Epidermis, Dermis
Examples: Blister, Stage 2 pressure injury

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11
Q

Full thickness

A

Tissue involved: Epidermis, Dermis, Subcutaneous tissue
Examples: Full-thickness burn, Stage 3 pressure injury

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12
Q

The process of wound healing requires?

A
  • complete wound closure and successful functional scar tissue organization
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13
Q

Tissue repair is a?

A
  • Continuous process
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14
Q

What are the four phases of wound healing?

A

Hemostasis, inflammation, proliferation/repair, Maturation/remodeling

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15
Q

What happens during hemostasis

A

Clotting, Vascular response
Platelet aggregation and Vasoconstriction
Main Actor: Platelets

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16
Q

What happens in Proliferation / repair

A

Epithelial healing, Contraction, angiogenesis
- Formation of granulation tissue in the wound space
- Fibroblasts move into the wound space and proliferate

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17
Q

Importance of Proliferative Phase

A
  • Type III collagen in the wound has decreased tensile strength, patient is at risk for wound dehiscence or openning of wound edges
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18
Q

Key events at Proliferative Phase

A
  • Angiogenesis: Capillary growth into ECM
  • Reepithelialization: Migration of marginal basal cells
  • Wound contraction: Contraction of fibroblasts and myofibroblasts to bring wound edges closer
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19
Q

What happens in Inflammatory Phase

A
  • Bacteria and other pathogens enter the wound, stimulating tissue repair
  • Increase vasodilation, allowing for delivery of blood and nutrients to injured area
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20
Q

What are two inflammatory cells attracted to the wound space to mount an acute inflammatory response?

A
  • Neutrophils: reach peak numbers within 24-48 hours, destroy bacteria by phagocytosis
  • Macrophages: arrive 2-3 days after injury, activate cells involved in tissue repair
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21
Q

What are normal signs of inflammation?

A
  • redness
  • swelling
  • heat
  • pain
22
Q

what are red flags of infection

A
  • excessive bleeding
  • wound breakdown
  • increased pain
  • Pus or unusual drainage
  • Spreading redness around the wound
  • Flue like symptoms
23
Q

Abnormal Inflammatory Responses

A
  • can be a significant factor in delayed wound healing
  • Re injury, infection, poor tissue perfusion
24
Q

Maturation (Remodeling) Phase

A
  • gradual return of tensile strength of skin wounds
  • 3 weeks up to 20%, can reach a maximum of 70 - 80%
25
what is the final product of wound healing?
- scar - relatively avascular and acellular mass of collage - restore tissue continuity
26
Primary Intention
- Wound edges are approximated and closed with sutures to facilitate re-epithelialization - occurs in acute wounds with minimal tissue loss, with smooth, clean edges - minimal scarring and heal quickly
27
Secondary Intension
- Wounds close on their own without superficial closure - occurs in wounds with significant tissue loss or necrosis - Requires ongoing wound care and have significantly larger scars
28
How do Wounds heal with secondary intension?
- Granulation and contraction
29
Granulation
- development of beefy red tissue that appears bumpy - represents new vascular growth
30
Contraction
- edges start marching together
31
Positive signs of healing in Secondary Intention
- Healthy pink tissue in the wound bed - Signs of new tissue growth at the wound edges - Decreasing wound size over time
32
Tertiary Intension
- delayed primary intention healing - wound at risk for developing complications may be temporarily left open - once problem has been addressed, the wound is closed by the usual primary intention methods
33
Contamination
- Presence of non-replicating bacteria on a wound surface - no tissue injury & does not stimulate an inflammatory immune response
34
Colonization
- does not invade or further injury tissue & does not stimulate an inflammatory immune response - can delay wound healing or may benefit wound healing
35
Infection
- visible inflammatory immune response - will delay wound healing
36
Poor tissue perfusion
- can limit the wound's ability to sustain cellular activity
37
what happens to epidermis with age?
- thins with age, making it more fragile and susceptible to injury
38
The presence of nonreplicating microbes is called?
- contamination
39
Which lines of defense produces the classic signs of infection?
- Second line of defense - Redness, Swelling, Pain, Heat
40
How does wound infections delay wound healing?
- affect collagen metabolism - decreases synthesis and increases lysis of collagen - decrease amount of oxygen & nutrients needed
41
Erythema
Inflamed: Well defined borders, not as intense Infected: intense/ discoloration, red stipes / streaking
42
Temperature
Inflamed: Elevated locally Infected: Systemic Fever
43
Exudate Character
Inflamed: Bleeding and serosanguinous > Serous Infected: Serous and seropurulent > purulent
44
Exudate amount
Inflamed: usually minimal, decrease in 3-5days Infected: Mod-Heavy and remains high
45
Pain
Inflamed: Variable Infected: Persistent
46
Edema and Induration
Inflamed: Slight swelling, firmness at wound edge Infected: If edema and induration are localized with warmth
47
Local Infection
- Erythema or skin discoloration - Edema - Warmth - Induration - Increased pain - Purulent wound exudate with / without foul odor
48
Systemic Infection
Increased temperature increased WBC confusion or agitation red streaks from wound tachycaardic tachypneic
49
Local Factors: Pressure
ischemia within 2-6 hours necrosis after 6 hours
50
Local Factors: Shear
causes wound undermining
51
Local Factors: Friction
Causes skin erosion
52
Local Factors: Moisture
Causes tissue friability

Integumentary (9 decks)

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