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822: Integumentary > Miscellaneous Wounds > Flashcards

Miscellaneous Wounds Flashcards

1
Q

What can be defined as a wound caused by friction to the skin’s surface?

A

abrasion

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2
Q

Describe the general presentation of a skin abrasion

A
  • May or may not be contaminated
  • Mild, stinging sensation
  • Light to moderate bleeding
  • Rarely progress to be chronic wounds
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3
Q

Describe the general intervention strategy for abrasions

A

Irrigate thoroughly with water or saline. Whirlpool may be indicated in extensive abrasions. Debridement may be required.
Clean wounds can be covered with a moisture-retentive dressing. Contaminated wounds may be treated with a broad-spectrum topical antimicrobial and a gauze dressing

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4
Q

What can be defined as a traumatic wound that has resulted from shear or friction forces that separate the epidermis from dermis?

A

Skin Tear

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5
Q

A skin tear is classified as a ____-thickness wound

A

partial

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6
Q

Who as at an increased risk for a skin tear?

A

The elderly due to age-related skin changes such as decreased dermal thickness, decreased skin elasticity, decreased sweat gland production, and flatter rete pegs

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7
Q

Describe the general presentation of a skin tear

A
  • Linear tear or flap
  • Wound edges can readily be approximated or may have tissue defect
  • Slight serous drainage
  • Bleeding minimal to significant
  • Minimal pain
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8
Q

Describe the general intervention strategy for skin tears

A

Irrigate with saline or water, then pat dry. The wound edges should be approximated if possible. Debride if necessary.
Apply a moisture-retentive dressing.

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9
Q

Skin tears that can be completely approximated may be best treated with what?

A

a skin sealant

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10
Q

What types of dressings are appropriate for a skin tear?

A
  • amorphous/film hydrogels
  • nonadherent gauze

All anchored with rolled gauze

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11
Q

What should be avoided in the management of a skin tear?

A

adhesives

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12
Q

What are the 3 types of surgical wounds?

A
  • muscle flaps and skin grafts
  • wound dehiscence
  • wounds that have been surgically debrided and left to close via 2ndary intention
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13
Q

What are the keys to wound care for surgical wounds treated via primary closure?

A
  • Keep clean and dry for 24 to 48 hours
  • Observe for infection
  • Protect from friction and tension
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14
Q

Wounds closed with staples are _ times more likely to become infected than wounds closed with sutures

A

4

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15
Q

Surgical wounds closed via primary intention are expected to epithelialize in __-__ days

A

7-10

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16
Q

What are 4 patient factors that increase the risk of dehiscence?

A
  • Malnutrition
  • Diabetes
  • Steroids
  • Smoking
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17
Q

Deficiencies of what 3 types of vitamins may decrease wound tensile strength?

A

A, C and B complex

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18
Q

Dehisced surgical wounds may result from what 2 things?

A
  • Too much tension on wound edges

- Underlying infection and abscess

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19
Q

What can be defined as sinus tracts that connect 2 epithelial surfaces (such as the GI tract and the skin)?

A

fistula

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20
Q

What is the intervention strategy for surgically debrided wounds?

A

It should be directed towards formation of granulation tissue, wound contraction, and epithelialization

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21
Q

What is the wound dressing of choice for surgically debrided wounds, of course assuming infection is not an issue?

A

moisture-retentive dressing

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22
Q

Every year how many people in the US experience a bite wound?

A

4-5 million

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23
Q

What percentage of all bite wounds do dog bites account for? Cats? Humans?

A

80-90%

5-15%

2-3%

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24
Q

Patients who have been bite and have not had a tetanus shot in the last _ years should receive a booster shot

A

5

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25
Q

Bite wound victims are at an increased risk for infection if they have an associated what 10 things?

A
  • age less than 2 or greater than 50
  • history of corticosteroid use
  • diabetes
  • cancer
  • HIV/AIDS
  • SLE
  • prosthetic joints or valves
  • asplenic
  • vascular disorder
  • wrist or hand bite
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26
Q

What are a few other things to ask the patient with an animal bite wound?

A
  • day and time of bite
  • is the animal a pet?
  • does the animal have a current rabies vaccine?
  • was the animal provoked?
  • was the animal exhibiting abnormal behavior prior to the bite?
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27
Q

What are a few other things to ask the patient with a human bite wound?

A
  • day and time of bite

- does the biter have hepatitis, HIV/AIDS, or syphilis

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28
Q

Most bite wounds are polymicrobial, with an average of _ different microbes per bite

A

4

29
Q

What percentage of dog bites will become infected?

A

2-20%

30
Q

What percentage of cat bites will become infected?

A

5-50%

31
Q

What percentage of human bites will become infected?

A

10-50%

32
Q

Why do human bite wounds tend to be more serious?

A
  • the human mouth has more varied microflora
  • closed fist bite wound etiology in which the tendons glide proximally, bringing the bacteria under the intact proximal skin
33
Q

In the United States, only __% of suspected spider bites were actually caused by spiders

A

45

34
Q

In the United States, only two types of spider bites require medical intervention, what are they?

A
  • Black widow

- Brown recluse

35
Q

What is the most venomous spider in the US?

A

black widow

36
Q

Describe patient symptoms following a black widow spider bite

A

They become acutely ill within 1-3 hours of the bite. Experiencing weakness, headache, nausea/vomiting, hyperreflexia, dyspnea, diaphoresis, HTN, and tachycardia.

37
Q

Describe the presentation of a black widow spider bite

A

Small bite surrounded by erythema with urticarial rash, stinging sensation

38
Q

How is a black widow spider bite treated?

A

With antivenom, tetanus booster, muscle relaxers, and NSAIDs

39
Q

What regions of the country are brown recluse spiders endemic?

A
  • Southeast
  • Southwest
  • Midwest
40
Q

Brown recluse spiders will bite only defensively and the majority of these bites will heal without complications in - days

A

3-5

41
Q

Describe the general presentation of a brown recluse spider bite within the first 24 hours

A

Red inflammation, blue thrombosis, and white ischemia present with a possibly necrotic center

42
Q

Describe patient symptoms following a brown recluse spider bite

A

Fever, nausea, malaise, joint pain, seizures

43
Q

The mean wound healing time for a brown recluse spider bite ranges from _ to __ weeks

A

5-17

44
Q

Why should superficial heat be avoided following a brown recluse spider bite?

A

it may increase necrosis

45
Q

Why is early surgical excision contraindicated following a spider bite?

A

It may spread the spider’s venom and prolong the inflammatory response

46
Q

When is surgical intervention appropriate following a spider bite?

A

If the wound is stable but not healing after 6-8 weeks of appropriate wound care

47
Q

What percentage of patients with spider bite wounds require skin grafting?

A

3

48
Q

Describe the general presentation of a radiation burn

A
  • Mild inflammation, slight erythema, and local edema

- Dry, scaling, itchy, hyperpigmented skin

49
Q

Late tissue injury causes radiation _____

A

fibrosis

50
Q

What causes radiation fibrosis?

A

The overproduction and decreased degradation of collagen as well as hypovascularity

51
Q

What does radiation fibrosis look like?

A

Skin is dry, discolored, hairless, atrophied, fibrotic, and inelastic.
The skin appears translucent

52
Q

How many grades are there in terms of skin reactions due to radiation therapy?

A

4

53
Q

Describe grade 1 skin reaction due to radiation therapy

A
  • faint erythema
  • epilation
  • dry dequamation
  • decreased sweating response
54
Q

Describe grade 2 skin reaction due to radiation therapy

A
  • bright erythema
  • tenderness to palpation
  • moderate edema
  • moist desquamation
55
Q

Describe grade 3 skin reaction due to radiation therapy

A

Moist desquamation with pitting edema

56
Q

Describe grade 4 skin reaction due to radiation therapy

A

ulceration or necrosis

57
Q

What are the general treatment guidelines for radiation fibrosis/burns?

A
  • protect from mechanical forces
  • avoid adhesions
  • decrease bathing frequency
  • pat skin dry
  • avoid superficial heat and ice
  • avoid heavy detergents or perfumes
58
Q

What can be used to soothe radiation burns?

A
  • amorphous hydrogel
  • moisturizing ointments
  • oatmeal baths
  • topical steroids
59
Q

What is Pyoderma Gangrenosum?

A

A noninfectious, progressive necrotizing skin condition

60
Q

Onset of Pyoderma Gangrenosum:

__% have a systemic inflammatory condition
__% insidious
__% after trauma or surgery

A

50

25

25

61
Q

What are 5 differential diagnoses for Pyoderma Gangrenosum?

A
  • cancer
  • vasculitis
  • adverse drug reaction
  • spider bite
  • chronic venous insufficiency
62
Q

Describe the progression of Pyoderma Gangrenosum

A
  • Begins as small, painful papule, vesicle, or pustule on lower extremities and trunk
  • Progresses to full-thickness ulceration with irregular borders and undermining present
63
Q

Describe the general presentation of Pyoderma Gangrenosum

A
  • Indurated, boggy
  • Purulent and hemorrhagic exudates
  • Erythematous due to inflammation
  • Wound bed covered with eschar or slough
64
Q

What are a few patient complaints associated with Pyoderma Gangrenosum?

A
  • fever
  • malaise
  • myalgia
65
Q

Under what 2 circumstances should Pyoderma Gangrenosum be suspected?

A
  • If wound cultures are positive and do not respond to antibiotics
  • If the wound does not respond to standard care for presumed wound etiology
66
Q

The mainstay of pyoderma gangrenosum treatment includes medication and local wound care. What type of medication is suggested?

A
  • Immunosuppressive agents, such as cyclosporin

- Corticosteroids that can be administered either systemically or topically injected

67
Q

Is debridement suggested in patients with pyoderma gangrenosum?

A

Gentle and limited debridement of slough and necrotic tissue, however sharp or surgical debridement is contraindicated because it increases the inflammatory response leading to severe exacerbations

68
Q

Pyoderma gangrenosum healing is extremely ____ and recurrence is _____.

A

slow

recurrence

822: Integumentary (16 decks)

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