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BSNC 3000 > Module 4 - Tissue Integrity > Flashcards

Module 4 - Tissue Integrity Flashcards

1
Q

Definition of tissue integrity

A

structually intact skin (epithelium, dermis, subq) and mucous membranes

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2
Q

Skin Functions

A

immunity (physical barrier, secrete acidic secretions)
fluid balance (keratinocytes secrete water-repellent secretion)
thermoregulation (sweating, vasodilation, vasoconstriction)
vitamin d synthesis
sensation (sensory receptors located in dermis)

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3
Q

Requirements of skin integrity

A 
good nutrition & hydration
adequate GE/perfusion
mobility
hygiene
immune function
lack of trauma
sensory perception
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4
Q

Skin assessment

A 
intact or non-intact
CWMS
skin turgor
texture
inspect lesions
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5
Q

Resolution

A

damaged cells are reversibly injured and recover

ischemia

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6
Q

Regeneration

A

damaged cells are replaced via cell division –> no scar

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7
Q

Repair

A

damaged cells are replaced by scar tissue (non-functional)

connective tissue replaces functional tissue

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8
Q

Labile cells

A

capable of mitosis –> can regenerate

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9
Q

Permanent cells

A

specialized, functional cells –> cannot regenerate (0 mitosis)

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10
Q

Stable cells

A

stop dividing when growth ceases. can regenerate (divide) when stimulated

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11
Q

Cells with no mitotic ability

A

cardiac cells
neurons
Skeletal muscle

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12
Q

Progenitor cells

A

somewhat specialized cells still capable of mitosis

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13
Q

Examples of stable cells

A 
liver cells
kidney cells
smooth muscle cells
fibroblasts --> wound healing
vascular endothelial cells
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14
Q

Examples of permanent cells

A

skeletal muscle
cardiac muscle
neurons

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15
Q

Ischemia

A

reversible cell injury caused by lack of perfusion

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16
Q

Hypoxia

A

cell injury caused by O2 deprivation

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17
Q

Infarction

A

cell death that occurs d/t lack of blood flow

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18
Q

When does repair (scar tissue) occur

A

cells cannot regenerate
extensive damage
injury is chronic (regeneration cannot keep up with cellular damage

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19
Q

Function of scar tissue

A

provides stability & protection

non-functional –> does not perform the same way as specialized cells

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20
Q

Types of wound healing

A

primary intention
secondary intention
tertiary intention

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21
Q

Primary intention

A

surgical stitches/staples

wounds are well approximated

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22
Q

Secondary intention

A

wound is allowed to heal naturally

granulation/scar tissue formation

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23
Q

Tertiary intention

A

wound infection/contamination/edema has to be treated first

surgical stitches/staples are applied after –> delayed approximation

24
Q

Phases of wound healing

A

Hemostasis
Inflammatory
Proliferative
Remodeling

25
Q

Hemostasis phases

A

vascular spasm
platelet plug
coagulation

26
Q

Stages of Inflammation

A

cellular

vascular

27
Q

Inflammatory cells

A

WBCs (neutrophils/macrophages) are recruited to clean up cellular debris/fight infection –> prepare area for healing

28
Q

Neutrophil function

A

phagocytes
remove microorganisms
break down fibrin clot

29
Q

Macrophage function

A

phagocyte
remove dead cells/debris
release growth factors –> angiogenesis, fibroblast proliferation (produce ECM)

30
Q

Proliferative stages

A

Angiogenesis
Fibrogenesis
Epithelization

31
Q

Granulation tissue

A

temporary, delicate tissue
highly vascular –> appears smooth, shiny, red
contains macrophages, new capillaries, fibroblasts, loose ECM
fills in the wound space –> provide foundation for scar formation

32
Q

Remodeling

A

collagen is broken down (initially collagen is haphazardly laid down)
collagen is rearranged in a way that increases tensile strength/range of motion

33
Q

Remodeling timeframe

A

2-3 weeks up to 2 years

34
Q

When are sutures/staples commonly removed?

A

Day 7-14

35
Q

Complications of wound healing

A 
delayed healing (infection)
wound dehiscence
hemorrhage
hypertrophic scar/keloids
contractures
strictures
adhesions
36
Q

Factors delaying wound healing

A 
large wound size
poor perfusion/hypoxia
infection
foreign bodies
persistence of necrotic tissue
poor nutrition 
weakend immune function
certain medications (glucocorticoids)
advanced age
moisture imbalance
movement/tension in wound area
37
Q

Causes of impaired perfusion

A

swelling/immobility compresses blood vessels
chronic conditions (PVD, CHF)
vasoconstriction –> PSR, smoking, cold temp
hemorrhage/dehydration decreases effective circulating volume
blood clot –> occludes blood flow

38
Q

Causes of hypoxia

A

chronic respiratory disease (COPD, obesity, sleep apnea)
acute gas exchange impairment (pneumonia, atelectasis, respiratory depression, PE)
age related chance in respiratory function (weak muscles, decreased functional alveoli, kyphosis)
anemia
smoking (CO interferes with O2 binding to Hgb)

39
Q

Infection & wound healing

A

prolonged injury & inflammation
prolonged clearing of debris
bacteria compete for available O2/nutrients

40
Q

Signs of wound infection

A 
odour
purulent exudate 
redness, warmth, swelling
pain
fever
high WBC count
41
Q

Debridement

A

removal of necrotic tissue to facilitate wound healing

42
Q

Nutrients/vitamins important for wound healing

A

Zinc
Vitamin A
Iron

43
Q

Causes of malnutrition

A 
dietary restriction
N/V
poor appetite
constipation, paralytic ileus
dyspepsia (PSR)
drowsiness
pre-existing GI disease
older adult
44
Q

Weakened Immune function

A 
PSR
older adult
diabetes/hyperglycemia
immunodeficiency state (HIV/AIDS)
malnutrition (protein, zinc, Vitamin D)
immunosuppressants (organ transplant, autoimmune disease)
corticosteroids
chemotherapy, radiation therapy
splenectomy
45
Q

Corticosteroids & wound healing

A

inhibit inflammation (good for healing)
immunosuppression (suppress leukocyte recruitment) increase risk of infection
inhibit collagen synthesis (protein catabolism)

46
Q

Types of wounds

A 
acute surgical
trauma wounds
burns
chronic wounds
pressure ulcers
infected wounds
47
Q

Surgical wound classification

A

clean
clean-contaminated
contaminated
dirty/infected

48
Q

Wound dehiscence

A

edges of wound separate
can occur up to 14 days post-op
can be partial/complete

49
Q

Wound evisceration

A

edges of wound separate & viscera protrude through opening

50
Q

RF for wound dehiscence

A

excessive tension on surgical wound (movement, vomiting, straining, obesity, swelling)
scar tissue weakness (malnutrition, age, corticosteroids)
factors delaying wound healing (infection, hypoxia, etc)

51
Q

Stricture

A

scar tissue that causes a narrowing of the lumen

52
Q

Adhesion

A

bands of scar tissue that abnormally bind intestinal surfaces

53
Q

Nutrients for wound healing

A

protein (collagen)
carbohydrates/fats (energy, spare protein)
water (replace fluid)
vitamin c (collagen formation)
vitamin a (promotes inflammation)
vitamin k (blood clotting)
magnesium (protein synthesis, wound repair)
copper (connective tissue development)
zinc (dna synthesis, protein synthesis, cell proliferation)

54
Q

Slough

A

accumulation of dead cells

yellow tissue

55
Q

Eschar

A

necrotic tissue
dry or boggy
black
prevents wound healing

56
Q

Granulation tissue

A

red, tender, pebbly

BSNC 3000 (11 decks)

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