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Integumentary > Lesson 2/Chapter 3 > Flashcards

Lesson 2/Chapter 3 Flashcards

1
Q

Deterrents to expedient wound healing

A

Wound characteristics
Local factors
Systemic factors
Inappropriate wound management

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2
Q

Wound Characteristics

A 
Characteristics that affect rate of wound healing:
Mechanism of onset
Time since onset
Wound location
Wound dimensions
Temperature
Wound hydration
Necrotic tissue or foreign bodies
Infection
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3
Q

Mechanism of Onset

A

Surgical wounds
Traumatic wounds
Wounds with an insidious onset

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4
Q

Acute Wound

A

Wound induced by surgery or trauma in an otherwise healthy individual
Progresses through normal phases of wound healing in predictable time and manner

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5
Q

Chronic Wound

A

A wound whose progression through the phases of wound healing is prolonged or arrested due to underlying conditions

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6
Q

Time Since Onset

A

Can assist with predicting healing time in acute wounds

Assessment of limiting factors can also aid in prediction of healing in chronic wounds

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7
Q

Wound Location

A

Vascularity of area
Wounds over bony prominences
Presence of epidermal appendages
Skin thickness

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8
Q

Wound Hydration

A

Dry wound
Moist wound
Wet wound

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9
Q

Necrotic Tissue or Foreign Bodies

A

Necrotic tissue promotes infection

Foreign bodies prolong inflammation

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10
Q

Colonization

A

Presence of microbes

Normal skin microflora, up to 103 per g/tissue

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11
Q

Infection

A

Invasion and multiplication of microorganisms in body tissues
Culture with >105 microbes per g/tissue
Signs and symptoms similar to inflammation but disproportionate to wound

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12
Q

Local factors known to affect wound healing

A

Circulation
Sensation
Mechanical stress

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13
Q

Circulation

A

Inadequate macrocirculation
Inadequate microcirculation
Sympathetic response: vasoconstriction
Edema

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14
Q

Sensation

A

Warns of tissue damage

Prevents continued trauma going unnoticed

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15
Q

Mechanical Stress

A 
Pressure
Shear
Friction
Periwound edema
Tension on wound edges
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16
Q

Systemic factors that affect wound healing

A 
Age
Inadequate nutrition
Comorbidities
Medication
Behavioral risk taking
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17
Q

Age

A 
Slowed immune response
Decreased collagen synthesis and strength
Epidermal/dermal atrophy
Decreased number of sweat and oil glands
Decreased pain perception
Decreased inflammatory response
Greater number of comorbidities
Increased susceptibility of infection
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18
Q

Inadequate Nutrition

A

Increased incidence of wound complications

Delayed healing time

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19
Q

Comorbidities

A

Disease process affecting tissue perfusion/oxygenation
Immunocompromised patients
Activity limitations

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20
Q

Vascular occulsion:

A

venous insufficieny, atherosclerosis, sickle cell disease

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21
Q

Inflammation:

A

Pyoderma gangrenosum, Necrobiosis lipoidica diabeticorum, Panniculitis, Dysproteinemias, Idiopathic leukocytoclastic vasculitis, Periarteritis nodosa, Wegener’s granulomatosis, Lymphomatoid granulomatosis, Erythema elevatum diutinum

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22
Q

Pressure necrosis

A

Decubitus ulcers Neuropathic ulcers

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23
Q

Physical agents

A

Radiation, Heat, Frostbite, Chemicals, Trauma, Factitial

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24
Q

Infection

A

Bacterial, Fungal, Mycobacterial, Tertiary syphilis

25
Q

Tumors

A

Lymphomas, Metastases, Primary skin tumors

26
Q

Medication

A

Steroids at doses of >30–40 mg/day
Chemotherapy
NSAIDs

27
Q

Behavioral Risk Taking

Alcohol abuse

A

Malnutrition
Greater risk for injury
Less likely to obtain medical assistance

28
Q

Behavioral Risk Taking

Smoking

A 
Decreases tissue perfusion
Reduces tissue oxygenation
Delays normal cellular response to wounding
3x increased graft/flap necrosis
3–5x increased infection rate
29
Q

Patient-Related Issues

A 
Home remedies
Not following recommended treatment
Lack of understanding of information provided
Limited financial resources 
Insufficient caregiver support
30
Q

Clinician-Related Issues

A 
Failure to adequately asses wounds
Failure to properly educate patient
Inappropriate dressing
Failure to manage wound with appropriate modalities 
Failure to adequately debride
31
Q

Abnormal wound healing

A

absence of inflammation

chronic inflammation

32
Q

Absence of Inflammation

A

Use of anti-inflammatory medications

Impaired immune system function

33
Q

Chronic Inflammation

A

Presence of foreign body in wound bed
Repetitive mechanical trauma
Cytotoxic agents
Heightened inflammatory response

34
Q

Prednisone/steroids

A

inhibit inflammatory response by stabilizing lysosomal enzyme membranes preventing release of acid hydrases
Inhibits granulation, contraction, collagen production, and decreased tensile strength

35
Q

Impaired Proliferation

A

Hypo-granulation or Non-advancing Wound Edge
Hypogranular wound
Epibole

36
Q

Chronic Proliferation

A

Hypergranulation

37
Q

Chronic Remodeling

A

Hypertrophic Scarring
Keloids
Contractures
Dehiscence

38
Q

Key differences from acute wound healing

A

Senescent cells
Increased number of inflammatory mediators (MMP’s)
Reduced number of tissue inhibitors of MMPs (TIMP’s)
Reduced or arrested epithelialization
Greater bioburden
Greater numbers of inflammatory cytokines
Arrested current of injury

39
Q

Senescent cells

A

Cells that have become inactive and cease to divide

May be related to tumor growth and inhibition

40
Q

Matrix Metalloproteases (MMP’s)

A

Family of protein degrading enzymes
Functions in neutral pH
Synthesized and secreted by neutrophils, macrophages, fibroblasts, endothelial cells, epithelial cells
Allows cells to migrate through tissues
Increased production in presence of bacterial endotoxins
Important for remodeling
In excess, degrades ECM and maintains inflammatory phase
Also play a role in tumor formation

41
Q

TIMP’s

A

Tissue inhibitors of MMP’s
Necessary to mediate MMP’s
Inadequate levels in chronic wounds, allowing MMP’s to break down collagen faster than it can be produced.

42
Q

Current of Injury

A

All cells process their own currents
Average skin surface charge is –23mV secondary to the sodium pump
Dry wounds eliminate the voltage gradient
Macrophages and neutrophils are attracted to the positive pole

43
Q

What does positive current inhibit?

A

mast cells

44
Q

What does a negative pole attract?

A

neutrophils during the inflammatory phase and fibroblasts, facilitates migration of epidermal cells and suppresses bacterial growth

45
Q

How long is current positive?

A

Current becomes positive for 48 hours after injury, triggers repair process
Returns to negative 8-9 days after injury and fluctuates slightly until recovery

46
Q

Tunneling

A

Use clock terms to identify position

Common in patients with neuropathic ulcerations and surgical wounds

47
Q

Undermining

A

Use clock terms to identify position

Common in patients with pressure or neuropathic ulcerations

48
Q

Wound color red:

A

pale pink to beefy red, granulation tissue

49
Q

Goal for red wound

A

protect wound
maintain warm, moist environment
protect periwound

50
Q

Wound yellow color:

A

moist, yellow slough

may vary in adherence

51
Q

Goal for yellow color:

A

debride necrotic tissue
absorb drainage
protect periwound

52
Q

Wound black color

A

thick, black, adherent eschar

53
Q

Goal for black color:

A

debride necrotic tissue

54
Q

Type of drainage

A 
serous
sanguinous
serosanguinous
purulent
seropurulent
55
Q

Serous

A

normal, transudate

56
Q

Sanguinous

A

normal acutely or in resposne to traume

57
Q

serosanguinous

A

normal

58
Q

Purulent

A

possible infection

59
Q

Seropurulent

A

possible infection

Integumentary (18 decks)

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