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Integumentary > Lecture 4 Integumentary Diagnoses, Part 2 > Flashcards

Lecture 4 Integumentary Diagnoses, Part 2 Flashcards

1
Q

Skin Tears Pathophysiology

A
  • traumatic wounds
  • resulted from friction or shear separating the epidermis from the underlying dermis
  • Partial-thickness wound
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2
Q

Horizontal vs Vertical Skin Tears

A
  • often edges are jagged and cannot be approximated
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3
Q

Which population are at higher risk for skin tear?

A
  • older adults due to age-related skin changes
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4
Q

Skin Tear can result from?

A
  • sliding down in bed
  • bump into objects
  • removal of dressings
  • nails or jewelry
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5
Q

Most common sites for skin tears?

A
  • arms, hands, and pretibial region
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6
Q

How long should you leave the dressing in place for skin tears?

A
  • for several days to avoid disturbing the skin flap
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7
Q

The skin flap should not be disturbed for how many days to allow for adherence to the cellular structures below?

A
  • at least 5 days
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8
Q

An abrasion is caused by?

A

friction to the skin’s surface and may result in superficial or partial-thickness wound

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9
Q

Characteristics of Abrasions

A
  • likely to be contaminated and have increased risk for infection
  • generally accompanied by a mild stinging sensation, which increases during irrigation or bathing
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10
Q

Superficial Abrasions vs. Deeper Abrasions

A
  • Superficial abrasions may bleed slightly, wheres deeper ones will have a moderate amount of bleeding due to the involvement of dermal vessels
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11
Q

Abrasion Clinical Management

A
  • irrigation with water or normal saline
  • Extensive abrasions may benefit from whirlpool therapy
  • Contaminated wounds may be treated with antimicrobial
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12
Q

Lacerations is caused by?

A
  • cutting or tearing into the skin’s surface
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13
Q

Lacerations wound edges may be

A
  • smooth or irregular
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14
Q

Laceration treatment depends on?

A
  • size and depth of the injury
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15
Q

Interventions for Laceration

A
  • Tissue adhesives / adhesive strips
  • Primary closure
  • Wound dressings
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16
Q

Most surgical wounds are closed by what methods?

A
  • Primary intention methods
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17
Q

Surgical Wound ( Primary Intention): Typical Presentation

A
  • small amount of bleeding or drainage for the first 24-36 hours
  • Mild edema and ecchymosis is normal due to expected inflammation
  • Sutures are more likely to cause an inflammatory response
  • signs of infection? Excessive redness or induration?
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18
Q

what is the first thing to check for surgical wound?

A
  • observe signs of infection
  • palpate for temperature & tissue texture
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19
Q

Surgical Wound: Inflammatory Phase

A
  • Normal signs of inflammation: warmth, redness, edema, pain
  • Approximation of wound edges: epithelialization; no tension on sutures
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20
Q

Surgical Wound: Proliferative Phase

A
  • Healing Ridge occurs
  • Drainage should be serosanguinous > serous > nil
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21
Q

Surgical Wound: Remodeling Phase

A
  • incision color changes from red/pink silvery > gray > white
  • Healing ridge gradually softens
  • wound strength reaches 80% of previous state
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22
Q

Abnormal scar responses in Remodeling Phase

A
  • Keloid: Beyond borders of initial wound
  • Hypertrophic: stays within wound borders
23
Q

Surgical Wound (Primary Intention) Clinical Management

A
  • kept clean and dry for the first 24-48 hours
  • Gauze dressing or adhesive strips to avoid friction and tension
  • Most stitches are removed in about 7-10 days
24
Q

Infection can lead to?

A
  • dehiscence and/or need for surgical debridement
25
Q

what does dehiscence mean?

A
  • Separation of wound margins
26
Q

When does wound dehiscence generally occur?

A
  • 4 to 14 days after surgery
27
Q

Wound Dehiscence is associated with?

A
  • high mortality rate, especially abdominal wounds
28
Q

Risk Factors for surgical wound dehiscence

A
  • Increased age
  • malnutrition
  • diabetes
  • anemia
  • COPD
  • Smoking
  • Abnormal tension across the incision
  • infection
29
Q

When is Surgical reconstruction wounds required?

A
  • if the area is missing tissue
30
Q

Reconstructive Ladder

A
  • Split-thickness skin graft (least amount of loss)
  • Full thickness skin graft
  • Tissue flaps (MOST amount of loss)
31
Q

Split-Thickness Skin Graft (STSG)

A
  • Consist of epidermis and dermis
  • are used for large wounds
  • donor sites are usually the thigh, buttocks, and trunk
  • donor areas usually heal within 14-21 days
32
Q

Split-thickness skin grafts are typically adherent after how many days?

A

5-7 days upon completion of wound healing

33
Q

Once the graft has integrated into the wound bed

A

it undergoes a maturation process that takes over one year to complete

34
Q

Skin graft maturation process includes?

A
  • changes in pigmentation
  • flattening and softening
  • may maintain a cobblestone appearance
35
Q

Full-Thickness Skin Graft

A
  • Reserved for small areas only, such as on the face and hands
  • Donor sites are closed by primary intention
36
Q

Full-Thickness Skin Graft Management

A
  • graft secured with sutures and donor site is repaired with a layered closure
  • patient should avoid trauma to the site and strenous activity for at least 2 weeks after surgery
37
Q

What is tissue flap?

A
  • a unit of tissue that can be moved to cover a wound while surviving on its own vascular supply
    -named for their composition
38
Q

what type of wounds are tissue flaps used for?

A
  • damaged tendon, muscle, bone
39
Q

Tissue flaps are transplanted to provide?

A
  • form & function
40
Q

Tissue Flap management focuses on which three areas?

A
  • close monitoring of the patient and fresh flap
  • anticoagulation
  • fluid resuscitation
41
Q

What are the four major factors contribute to free flap failure?

A
  • venous thrombosis
  • arterial thrombosis
  • tissue condition
  • mechanical compression
42
Q

Wounds/ Skin changes may be related to?

A
  • Disease process
  • Functional changes
  • Treatment interventions
43
Q

Radiation-induced skin reactions

A
  • skin cells are highly sensitive to the damaging effects of radiation
  • results from both direct tissue destruction and indirect damage from free radical production
44
Q

Effect of radiation

A

-delays normal healing
- damage may become visible within 2-3 weeks of the start of treatment or as long as 4 weeks after finishing radiation therapy

45
Q

Radiation-induced skin reactions: Early Stage

A
  • Mild inflammation, slight erythema, and local edema
  • Dryness
  • skin might feel tight, itchy, tender to touch
46
Q

Radiation-induced skin reactions: Later Stage

A
  • Increased pain
  • Ulcer formation
  • Radiation necrosis
  • Presence of open wounds increases risk for infection
47
Q

What is Radiation Fibrosis?

A
  • Chronic changes in which the skin appears discolored, dry, hairless, atrophied, fibrotic, and inelastic due to increased collagen deposition and vascular damage
  • Superficial blood vessels readily visible
  • Ulceration can occur 9 years after radiation therapy
48
Q

Precautions for Patients with irradiated skin

A
  • Daily skin checks
  • Diabete patterns
49
Q

Infection: Cellulitis

A
  • Acute bacterial skin infection causing inflammation of the deep dermis and surrounding subcutaneous tissue
50
Q

Risk Factors for cellulitis

A
  • skin injuries
  • surgical incisions
  • intravenous site punctures
  • fissures between toes
  • insect bites
  • animal bites
51
Q

what type of patients are at high risk for developing cellulitis?

A
  • diabetes mellitus
  • venous insufficiency
  • peripheral arterial disease
  • lymphedema
52
Q

Cellulitis Clinical Presentation

A
  • presence of spreading erythematous inflammation
  • worsening erythema, edema, warmth, and tenderness
  • redness can present as streaky
  • generalized malaise, fatigue, and fevers
53
Q

Most common presentation of Cellulitis

A
  • most common on the lower extremities
  • most often unilateral
54
Q

Cellulitis Management

A
  • Oral antibiotics first line of defense, minimum of 5 days
  • Hospitalization may be requires and will include IV medication

Integumentary (4 decks)

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