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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

Scar formation, Epithelial healing, Contraction
- 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
Q

what is the final product of wound healing?

A
  • scar
  • relatively avascular and acellular mass of collage
  • restore tissue continuity
26
Q

Primary Intention

A
  • 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
Q

Secondary Intension

A
  • 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
Q

How do Wounds heal with secondary intension?

A
  • Granulation and contraction
29
Q

Granulation

A
  • development of beefy red tissue that appears bumpy
  • represents new vascular growth
30
Q

Contraction

A
  • edges start marching together
31
Q

Positive signs of healing in Secondary Intention

A
  • Healthy pink tissue in the wound bed
  • Signs of new tissue growth at the wound edges
  • Decreasing wound size over time
32
Q

Tertiary Intension

A
  • 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
Q

Contamination

A
  • Presence of non-replicating bacteria on a wound surface
  • no tissue injury & does not stimulate an inflammatory immune response
34
Q

Colonization

A
  • does not invade or further injury tissue & does not stimulate an inflammatory immune response
  • can delay wound healing or may benefit wound healing
35
Q

Infection

A
  • visible inflammatory immune response
  • will delay wound healing
36
Q

Poor tissue perfusion

A
  • can limit the wound’s ability to sustain cellular activity
37
Q

what happens to epidermis with age?

A
  • thins with age, making it more fragile and susceptible to injury
38
Q

The presence of nonreplicating microbes is called?

A
  • contamination
39
Q

Which lines of defense produces the classic signs of infection?

A
  • Second line of defense
  • Redness, Swelling, Pain, Heat
40
Q

How does wound infections delay wound healing?

A
  • affect collagen metabolism
  • decreases synthesis and increases lysis of collagen
  • decrease amount of oxygen & nutrients needed
41
Q

Erythema

A

Inflamed: Well defined borders, not as intense
Infected: intense/ discoloration, red stipes / streaking

42
Q

Temperature

A

Inflamed: Elevated locally
Infected: Systemic Fever

43
Q

Exudate Character

A

Inflamed: Bleeding and serosanguinous > Serous
Infected: Serous and seropurulent > purulent

44
Q

Exudate amount

A

Inflamed: usually minimal, decrease in 3-5days
Infected: Mod-Heavy and remains high

45
Q

Pain

A

Inflamed: Variable
Infected: Persistent

46
Q

Edema and Induration

A

Inflamed: Slight swelling, firmness at wound edge
Infected: If edema and induration are localized with warmth

47
Q

Local Infection

A
  • Erythema or skin discoloration
  • Edema
  • Warmth
  • Induration
  • Increased pain
  • Purulent wound exudate with / without foul odor
48
Q

Systemic Infection

A

Increased temperature
increased WBC
confusion or agitation
red streaks from wound
tachycaardic
tachypneic

49
Q

Local Factors: Pressure

A

ischemia within 2-6 hours
necrosis after 6 hours

50
Q

Local Factors: Shear

A

causes wound undermining

51
Q

Local Factors: Friction

A

Causes skin erosion

52
Q

Local Factors: Moisture

A

Causes tissue friability

Integumentary (4 decks)

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