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ClinEd 1 > MIDTERMS: Integumentary System > Flashcards

MIDTERMS: Integumentary System Flashcards

1
Q

What are the layers of the skin?

A

Epidermis and Dermis (Note: Hypodermis is not part of the skin but stabilizes it over skeletal muscles and organs).

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2
Q

Name the sublayers of the epidermis.

A

Stratum Corneum, Stratum Lucidum (thick skin), Stratum Granulosum, Stratum Spinosum, Stratum Basale.

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2
Q

What is the primary role of the epidermis?

A

Avascular, water-resistant, assists with thermoregulation (via arrector pili muscle), provides protection from bacteria, chemicals, and UV radiation through melanocytes.

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3
Q

List the functions of the skin.

A
  1. Primary insulator
  2. Holds organs together
  3. Provides sensory perception
  4. Contributes to fluid balance
  5. Regulates internal temperature
  6. Absorbs UV radiation
  7. Metabolizes vitamin D
  8. Synthesizes epidermal lipids
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4
Q

What are the components of the dermis?

A

Collagen, elastic fibers, hair follicles, sweat glands, nerve endings, blood vessels.

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4
Q

Describe the role of the hypodermis.

A

Consists of loose connective tissue and fat cells, provides insulation and protection to underlying structures, plays a role in pressure ulcer prevention.

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4
Q

What are the sublayers of the dermis?

A

Papillary Dermis and Reticular Dermis.

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5
Q

What occurs during the inflammatory phase of wound healing (Day 1-10)?

A

Immune response, coagulation, cell necrosis, pathogen control, increased oxygen supply, and initiation of reepithelialization.

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5
Q

What are the five cardinal signs of inflammation?

A

Rubor (redness), calor (heat), dolor (pain), tumor (swelling), loss of function.

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6
Q

What characterizes the proliferative phase (Day 3-20)?

A

Fibroblast activity, angiogenesis, formation of granulation tissue, and differentiation into type I collagen.

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7
Q

What is the goal of the maturation phase (Day 9-2 years)?

A

Scar tissue remodeling, increased tensile strength, transition of scars in appearance, replacement of granulation tissue with less vascular tissue.

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8
Q

What factors influence the rate of wound healing during all phases?

A

Wound size, blood supply, nutrient availability, and external conditions.

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9
Q

What interventions are used for edema in wound healing?

A

: Compression (e.g., garments, bandages) is used for edema management, but it’s contraindicated in patients with arterial disease.

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9
Q

What role does oxygen play in wound healing?

A

Oxygen supports wound contraction, collagen deposition, angiogenesis, and granulation. Adequate oxygenation reduces the risk of infections, while poor oxygenation increases infection risk. Edema and necrosis can limit oxygen delivery

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10
Q

What are the effects of dry wounds on healing?

A

Dry wounds allow scab and eschar formation, which inhibit epithelial cell migration, provide food for pathogens, impede blood flow, and cool the wound surface, all of which slow healing.

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10
Q

Why is moisture important in wound healing?

A

Adequate moisture softens scabs and eschar, allowing enzymes to dissolve them naturally. Moist wounds promote healing, while dry wounds can slow healing, increase infection risk, and delay epithelial migration.

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11
Q

Why are occlusive dressings preferred over dry dressings in wound care?

A

Occlusive dressings maintain moisture, prevent trauma, keep the wound warm, protect from bacteria, and support healing even in infected wounds (e.g., hydrocolloids).

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11
Q

What is the most important external factor for wound healing?

A

Wound hydration is the most crucial external factor for effective wound healing.

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11
Q

What is wound healing by primary intention?

A

Primary intention occurs when a wound is surgically closed using sutures, staples, glue, or grafts, resulting in faster healing.

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11
Q

What should be documented for wound characteristics?

A

Location, size (depth, width, length), shape, edges, tunneling/undermining, base characteristics, necrotic tissue, exudate, granulation tissue, epithelialization, exposed structures, periwound area, and pain patterns.

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12
Q

What is the gold standard for assessing the bio-burden of a wound?

A

Quantitative biopsy is the gold standard, though it’s more expensive and painful. Swab cultures are less reliable but commonly used.

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12
Q

Describe wound healing by secondary intention.

A

Secondary intention occurs when a wound is left open to heal through contraction and re-epithelialization without surgical closure.

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12
Q

What is wound healing by tertiary intention?

A

Tertiary intention (delayed primary closure) involves initially allowing a wound to heal by secondary intention before closing it surgically, often to treat infection before closure.

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13
Q

What is wound dehiscence?

A

Dehiscence occurs when a wound closed by primary intention reopens due to factors like maceration or infection, and it often then heals by secondary intention.

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14
Q

What are the typical signs of arterial ulcers?

A

Wounds on distal LEs (e.g., toes), cool skin, necrotic wound base, pain with elevation, decreased pulses, and trophic changes like abnormal nail growth and dry skin.

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14
Q

How is venous insufficiency characterized?

A

Inadequate venous drainage leading to edema, skin changes like hemosiderin staining, and ulcers near the medial malleolus. Often associated with minimal pain and a wet wound bed.

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14
Q

What is Chronic Venous Insufficiency (CVI)?

A

Long-term venous issues resulting in chronic ulcers, typically lasting 4 weeks to 3 months, with symptoms like swelling, aching, and skin changes

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15
Q

What is primary vs. secondary lymphedema?

A

Primary Lymphedema: Congenital/hereditary lymphatic abnormality (e.g., Milroy disease).
Secondary Lymphedema: Acquired due to lymphatic damage (e.g., after cancer surgery/radiation).

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16
Q

What causes pressure injuries?

A

Prolonged pressure over bony areas leading to ischemia and tissue necrosis. Risk factors include immobility, advanced age, incontinence, and underweight status.

16
Q

What are common signs of lymphedema?

A

Swelling not relieved by elevation, early pitting edema, skin changes, increased infection risk, and discomfort or tightness in the affected area.

17
Q

What causes arterial insufficiency and ulceration?

A

Inadequate blood flow due to PVD, influenced by smoking, diabetes, hypertension, and obesity. Conditions include arteriosclerosis, atherosclerosis, arteriosclerosis obliterans, thromboangiitis obliterans, and Raynaud disease

18
Q

What are the stages of pressure injuries?

A

Initial stage presents as blanchable erythema; if unrelieved, progresses to non-blanchable erythema, then to deeper tissue involvement like abrasions, blisters, or craters.

19
Q

: Where are pressure injuries most likely to occur?

A

Sacrum, coccyx, greater trochanter, ischial tuberosity, calcaneus, and lateral malleolus due to proximity to bony prominences.

20
Q

pt presents with dried, inflammatory fluids that are moist, stringy and yellow, tan, gray, green or brown, What is this cond?

A

Slough

21
Q

pt presents with necrotic tissue that is leathery or thick, and black, brown or tan

A

Eschar

22
Q

What is neuropathy, and what causes it?

A

Neuropathy refers to nerve damage, often associated with diabetes, caused primarily by prolonged high blood sugar levels.

23
Q

: List common symptoms of diabetic neuropathy.

A

Numbness, tingling, burning sensations, and pain in the legs and feet, often leading to foot insensitivity and ulcers.

23
Q

Why is blood sugar control crucial for diabetic neuropathy?

A

Effective blood sugar control helps prevent or slow the progression of neuropathy and reduces the risk of complications like nonhealing wounds.

23
Q

What are the key features of arterial insufficiency ulcers?

A

: Painful wounds on distal lower extremities (e.g., lateral malleoli, toes), pale or necrotic base, and worsened pain with elevation.

23
Q

What is a neuropathic ulcer, and where is it commonly located?

A

Neuropathic ulcers occur at pressure points, primarily on the feet, due to impaired peripheral nerve function, such as metatarsal heads and heels.

23
Q

Describe the common sites and presentation of venous insufficiency ulcers.

A

Typically proximal to the medial malleolus, with heavy drainage, granulation tissue, and associated with swelling, hemosiderin staining, and increased skin temperature.

24
Q

What is the purpose of wound cleansing?

A

Wound cleansing supports the wound bed’s return to homeostasis while minimizing chemical and mechanical trauma, even in infected wounds.

24
Q

Why should excessive wound cleansing be avoided?

A

Excessive cleansing can lead to loss of endogenous fluids and slowed cellular activity for up to three hours post-cleansing.

24
Q

What is lymphedema, and how does it present clinically?

A

Chronic lymph fluid accumulation causing swelling that does not improve with elevation, with sensations of heaviness, tightness, and potential skin changes.

24
Q

What does a pain assessment in arterial disease focus on?

A

It focuses on symptoms like intermittent claudication and rest pain, which may require the use of scales like the Claudication Scale (CLAU-S).

24
Q

Excessive cleansing can lead to loss of endogenous fluids and slowed cellular activity for up to three hours post-cleansing.

A

Risks include contamination from waterborne pathogens, increased venous congestion, loss of endogenous fluids, mechanical disruption of granulation tissue, and increased heart and respiratory rates.

24
Q

What are the potential risks of pulsatile lavage with suction?

A

Risks include damaging newly formed tissue and causing pain during treatment.

25
Q

What are the signs of autonomic neuropathy in diabetic patients?

A

Decreased or absent sweat and oil production, dry and inelastic skin, and a propensity for heavy callus formation.

25
Q

Describe the clinical presentation of motor neuropathy in diabetic patients.

A

Includes loss of intrinsic muscles, leading to deformities like hammertoe and claw-toe, and foot drop.

25
Q

How does non-forceful irrigation work in wound cleansing?

A

It minimizes pressure on the wound bed by pouring a solution over the wound or using devices like a bulb syringe.

25
Q

What is the significance of trophic changes in wound evaluation?

A

Trophic changes like dry, shiny skin, decreased leg hair, and thickened toenails indicate impaired circulation in the lower extremities.

26
Q

What is pulsatile lavage with suction, and what are its advantages?

A

It is a wound irrigation technique that combines pulsed irrigation with suction. Advantages include less water usage, reduced treatment time, and suitability for bedside or home settings.

26
Q

What is the difference between non-selective and selective debridement?

A

Non-selective debridement removes all tissue (necrotic and living), while selective debridement removes only necrotic tissue in a controlled manner.

26
Q

What is the gold standard for debridement?

A

Sharp debridement using sterile instruments like scalpels and scissors is considered the gold standard.

26
Q

Describe the advantages and disadvantages of chemical or enzymatic debridement.

A

Advantages: minimal patient discomfort and simple application. Disadvantages: potential dermatitis on periwound skin and the need for crosshatching eschar.

27
Q

How does medical-grade honey aid wound healing?

A

It enhances debridement, reduces odor, prevents biofilm formation, and softens necrotic tissue while facilitating autolytic debridement.

28
Q

Describe the function of hydrogels in wound care.

A

Hydrogels increase moisture in dry wound beds, soften necrotic tissue, and support autolytic debridement.

29
Q

What is the function of primary and secondary dressings in wound care?

A

Primary dressings are applied directly to the wound, while secondary dressings are applied over the primary dressing for added protection.

29
Q

How do transparent films contribute to wound healing?

A

They trap endogenous fluids, maintain a moist environment, and facilitate autolytic debridement and wound bed homeostasis.

29
Q

Case: A patient requires wound debridement.
Question: What are the risks of whirlpool therapy?

A

Case: A patient requires wound debridement.
Question: What are the risks of whirlpool therapy?

29
Q

What are the key elements in scar management after wound healing?

A

Key elements include compression garments, stretching exercises, orthotics, positioning, specific massage techniques, and topical adjuncts like silicone gel sheets.

29
Q
A
29
Q

Case: A patient requires dressing for a chronic wound.
Question: What are primary and secondary dressings?

A

Primary dressings are applied directly to wounds; secondary dressings cover primary dressings for protection.

29
Q

Case: A patient has an infected wound.
Question: What should you consider before cleansing?

A

Choose methods that support homeostasis and avoid excessive cleansing to prevent fluid loss and cellular activity slowing.

29
Q

Case: A patient has a deep wound with debris.
Question: What are the advantages of pulsatile lavage with suction?

A

Efficiently collects exudate and debris, can be done bedside, and minimizes cross-contamination.

29
Q
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Q
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Q
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29
Q

Case: A patient experiences venous stasis.
Question: Why is compression therapy important?

A

It manages venous stasis, reduces swelling, and improves blood flow, aiding healing.

ClinEd 1 (14 decks)

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