NUR 206 Exam 1 Flashcards
1
Q
What is the definition of infection?
A
When a pathogen invades the body, multiples, and produces disease
2
Q
What is a pathogen?
A
An agent that causes disease
3
Q
What are the 3 categories of infection?
A
-Localized
-Disseminated
-Systemic
4
Q
What is a localized infection?
A
Limited to a small area
Ex: paper cut
5
Q
What is a disseminated infection?
A
Spread beyond the initial site
Ex: Paper cut on finger now goes up arm and caused cellulitis
6
Q
What is a systemic infection
A
Spread throughout entire body (usually via blood)
Ex: finger cut now caused pathogen to go into blood stream and causes larger signs and symptoms
(S & S occur d/t inflammation in immune response)
7
Q
A patient arrives to the ER with C/O Fever, chills, and fatigue. The nurse notes this is what category of infection?
A
Systemic - numerous symptoms occurring throughout system
8
Q
A patient arrived to the ER with C/O pain, swelling, and redness to the left foot and ankle after stepping on a piece of wood. The nurse notes this is what category of infection?
A
Disseminated
9
Q
What is the definition of epidemiology?
A
The study of the distribution and determinants of health conditions
10
Q
What is the definition of incidence?
A
The number of new cases of a health-related issue or problem that occur during a specific time period
Ex: Looking hyper-focused at HIV and 2022 (can be worldwide)
11
Q
What is the definition of prevelance?
A
The total number of people who have a specific health-related issue, problem, disease, or illness at any given time
Ex: Total number of people living with that infection; How many people have HIV?
12
Q
What is the definition of endemic?
A
Level of disease in a particular area
Ex: Africa and malaria
13
Q
What is the definition of epidemic?
A
Increase in a disease or condition within a certain community/area (smaller scope)
Ex: H1N1 in Illinois
14
Q
What is the definition of pandemic?
A
An epidemic that has significant geographical spread and affects entire countries/the world
Ex: COVID
15
Q
What are the different types of pathogens?
A
-Bacteria
-Viruses
-Fungi
-Protozoa
-Prions
16
Q
What are characteristics of bacteria?
A
-One celled organisms
-Common in nature
-Classified by shape
17
Q
What are the shapes of bacteria?
A
-Cocci –> round
-Bacilli –> rod
18
Q
Why do we all have good bacteria?
A
(Normal flora in gut) - It helps body by preventing overgrowth of microorganisms
This is why we eat yogurt and probiotics
19
Q
What are the characteristics of viruses?
A
-No cellular structure
-Reproduce by releasing their genetic material in another living organism
20
Q
What are characteristics of fungi?
A
-Similar to plants
-Mycosis – disease caused by fungus
-Stay localized
21
Q
What is thrush?
A
White, hairy fungus that lays on the tongue
*Can develop in vagina, athletes foot, ringworm, etc
22
Q
What type of environment are pathogens typically found?
A
Cold and dark areas
23
Q
What are characteristics of protozoa?
A
-Single cell microorganism
-Live in soil and bodies of water
-Includes parasites – cause diarrhea or spread malaria
24
Q
What are characteristics of prions?
A
-Abnormally shaped proteins
-Usually affect the nervous system
Ex: Undercooked meat being eaten (Mad cow disease)
25
What is an emerging infection?
An infectious disease that has recently increased in incidence or threatens to increase in the immediate future
Ex: HIV, SARS (severe acute respiratory syndrome), Lyme disease, E. coli, Ebola, COVID, Avian flu
26
What is a reemerging infection?
Infections near eradication, but they reemerge
*Would not typically see a pt with this
27
What contributes to reemerging infections?
-Lack of vaccines
-Biomedical terrorism
-Misuse of medication
28
What does antibiotic resistance mean? (microbial resistance)
Pathogenic organisms change and decrease the ability of a drug to treat disease (Ex: Penicillins given for a virus)
29
How do healthcare providers cause drug resistance?
-Giving antibiotics for viral infections
-Prescribing unnecessary antibiotics
-Using inadequate drugs
-Using broad-spectrum or combination agents vs first line medications
30
How do patients cause drug resistance?
-Skipping/missing doses
-Not taking full dose of antibiotics b/c they "feel better"
-Saving unused antibiotics for later b/c they "may need them"
-Limited resources or access to care
31
What is the definition of Healthcare Associated Infections (HAI/Nosocomial)?
Infections acquired because of exposure to microorganisms in a healthcare setting (pt comes to hospital and leaves with new condition)
32
What are examples of HAI's?
-Central Line (CLABS)
-Catheter (CAUTI)
-Pneumonia
-C-Diff
33
How is pneumonia acquired as an HAI?
D/t lack of use of the incentive spirometer
34
What is C-Diff?
Frequent, loose stools with a distinctive smell
35
What are standard precautions to avoid HAIs?
Hand hygiene, gloves gown and mask (PPE)
36
Who is at the highest risk for developing HAIs and why?
Immunocompromised- their immune system is already low
37
True or False:
If an antibiotic is too broad, infection can become antibiotic resistant and create a super infection that eliminates all good flora
True
38
What do you need to obtain prior to antimicrobial therapy?
-Labs
Ex: Cultures and sensitivity
39
What are cultures and sensitivity?
A list of bacteria that shows resistant and susceptible, resistant shows which meds to give and goes to the pharmacist and physician
40
What does broad or narrow spectrum mean?
The number of organisms affected by the antibiotics
41
What are standard precautions?
-Used for all pts
-Anytime exposed to blood, body fluids/secretions/excretions, non-intact skin, and mucous membranes
-Reduce the risk for transmission of microorganisms by wearing gloves, gown, and washing hands
42
What are transmission-based precautions?
-Used for those known or suspected of highly transmissible infections
-Ex: Covid, flu, TB
-Prevents transmission of specific organisms/diseases
43
What are the categories of transmission-based precautions?
-Contact precautions
-Droplet precautions
-Airborne precautions
44
What are contact precautions?
Spread by skin-to-skin
-Gloves and gown required
Ex: ESPL, Nares, MRSA, Wounds, VRE, C-Diff
45
What are droplet precautions?
Spread by large droplets
-Gloves and masks required
Ex: Mono, Influenza
46
What are airborne precautions?
Spread by tiny particles
-Use filtered masks like N-95
Ex: Covid, TB
47
Why are older adults at greater risk for infection?
-Decreased immune function
-Presence of comorbidities
-Increase in physical disabilities
48
What are present with atypical s&s of infection for the older adult?
-Cognitive and behavioral changes before lab values change
-Cannot rely on fever to indicate infection
-Inability to perform ADLs
49
What is the definition of portal of entry?
The site through which micro-organisms enter the susceptible host and cause infection
50
What are the different locations of portals of entry?
-Mucosal membrane (ex: skin with IV)
-GI tract
-Respiratory
51
What is Covid-19?
An RNA virus that infects the cells within the upper respiratory tract and spreads through respiratory droplets
52
What is the incubation period for COVID-19 and what does that mean?
Up to 14 days
-Means they can transmit even w/o S&S
53
When do people typically develop S&S for COVID-19?
Usually 5 days from the initial infection
54
True or False:
COVID-19 can cause a significant inflammatory cascade
True
55
What can the inflammatory cascade caused by COVID-19 lead to?
Can lead to acute respiratory distress syndrome (ARDS) and multiorgan dysfunction/failure (MODS)
56
How do variants of infection occur?
They occur when the virus mutates
57
What are long-hauler symptoms?
Symptoms that progress beyond normal symptoms and may have life long conditions
58
True or False:
Children are more likely to be symptomatic
False- they are more likely to be asymptomatic
59
What are the clinical manifestations of COVID?
-Cough
-Dyspnea
-Respiratory distress
-Sputum production
-Diarrhea
-Nausea/vomiting
-Fatigue, malaise
-Fever
-Headache
-Muscle/body aches
-Sore throat, runny nose, congestion
-Mental status changes
60
What are neurologic clinical manifestations?
-Headaches
-Dizziness
-Myalgia
-Stroke
61
What are renal clinical manifestations?
-Acute kidney injury
-Proteinuria
-Hematuria
62
What are hepatic clinical manifestations?
-Elevated bilirubin
-Elevated aminotransferases
63
What are gastrointestinal clinical manifestations?
-Diarrhea
-Nausea/vomiting
-Abdominal pain
-Anorexia
64
What are endocrine clinical manifestations?
-Hyperglycemia
-Diabetic ketoacidosis
65
True or False:
Vaccines change your DNA
False- they do not change your DNA
66
What are the stages of inflammatory response?
1) Vascular response
2) Cellular response
3) Formation of exudate
4) Healing
67
What is the definition of an inflammatory response?
Sequential reaction to cell injury
68
What are typical actions of an inflammatory response?
-Neutralizes and dilutes inflammatory agent
-Removes necrotic materials
-Establishes an environment suitable for healing and repair
69
Fill in the blank:
Inflammation is _____ present with infections d/t your body's inflammatory response
ALWAYS
70
True or False:
Infection is not always present with inflammation
True- this is d/t:
-Heat
-Radiation
-Trauma
-Chemicals
-Allergens
-Autoimmune response
-Infection
71
What are the two types of responses to cell injury?
Vascular (body's response) and Cellular (immune/WBC response)
72
What does hyperemia mean?
Redness
73
What are the types of Granulocytes?
-Neutrophil
-Eosinophil
-Basophil
74
What are the types of Agranulocytes?
-Lymphocyte
-Monocyte
75
What percentage are neutrophils and what is their function?
- 55-70%
-Phagocytosis
76
What percentage are eosinophils and what is their function?
- 1-5%
-Phagocytosis
-Allergic response
-Protection
77
What percentage are basophils and what is their function?
- 0.5-1%
-Inflammation
-Allergy
-Release chemicals
-Some phagocytosis
78
What percentage are lymphocytes and what is their function?
- 20-40%
-Cellular Response
-Humoral Response
79
What percentage are monocytes and what is their function?
- 2-8%
-Phagocytosis
-Cellular immune response
80
What are the two types of leukocytes?
-Granulocytes
-Agranulocytes
81
What is the only leukocyte that does not perform phagocytosis?
Lymphocyte
82
What are the steps of the vascular response?
1) Arterioles vasoconstrict briefly
2) Release of histamines, kinins, and prostaglandins causing vasodilation, increased capillary permeability and fluid movement from capillaries into tissue spaces
3) Proteins exert oncotic pressure that further draws fluid from blood vessels
4) Fibrinogen leaves the blood and is activated to fibrin which strengthens a blood clot formed by platelets
5) Clot traps bacteria and serves as framework for healing process
6) Platelets release growth factor initiating the healing process
83
What is chemotaxis?
Directional migration of WBCs to site of injury
84
How does a cellular response work?
Neutrophils and monocytes move from circulation to site of injury and accumulate
85
What is the first WBC to arrive at site of injury?
Neutrophil
86
What do neutrophils do?
-First to arrive at injury site (6-12 hrs)
-Phagocytize (engulf) bacteria, foreign material, and damaged cells
87
Do neutrophils have a short or long life span?
Short, only 24-48 hrs
88
What make up pus?
-Dead neutrophils
-Digested bacteria
-Cell debris
89
What releases neutrophils?
Bone marrow (increases WBC count)
90
What are segmented neutrophils?
Nature white blood cells
91
Where is it most common for immature white blood cells to have an increased # of bands that "shift to the left"?
At acute bacterial infections
92
What is the second WBC to migrate to the site of infection?
Monocytes
93
When do monocytes come to the site of injury?
3-7 days after inflammation
94
What do monocytes do at the site of injury?
-Transform into macrophages which help in phagocytosis of inflammatory debris
-Cleans area for healing
95
True or false:
Monocytes have a short lifespan
False- they have a long life span, they can multiply and stay for weeks
96
What is the last leukocyte to come to the site of injury?
Lymphocytes
97
True or False:
Lymphocytes have a long life span
True - they can stay for months
98
Where are lymphocytes made?
In bone marrow
99
What kind of immunity do lymphocytes have?
-Humoral immunity
-Cell mediated immunity
100
What do B lymphocytes make?
Antibodies
101
What are T lymphocytes for?
For long-term immunity
102
What are some of the chemical mediators?
-Histamine
-Serotonin
-Kinins
-Complement system
-Prostaglandins
-Leukotrienes
-Cytokines
103
What do histamines do?
Causes vasodilation and increased capillary permeability
104
What does serotonin do?
-Causes vasodilation and increased capillary permeability
-Stimulates smooth muscle contraction
105
What do kinins do?
-Cause contraction of smooth muscle and vasodilation
-Results in stimulation of pain
106
What does the complement system do?
Stimulates histamine release and chemotaxis
(ex: C3A, C4A, C5A)
107
What do prostaglandins do?
-Cause vasodilation contributing to increased blood flow and edema
-Significant role in pain receptor sensitivity
108
What do leukotrienes do?
Stimulates chemotaxis
109
What chemical mediators do not cause vasodilation?
Leukotrienes and complement system
110
What inhibits the pathway/chemical response of prostaglandins?
-NSAIDS
-Aspirin
-Corticosteroids
111
What do prostaglandins do?
-Pro inflammatory
-Help stimulate fever
-Increases blood flow & edema formation d/t vasodilation
112
What are the types of exudate?
-Serous
-Sanguinous
-Serosanguinous
-Purulent
-Fibrinous, hemorrhagic, catarrhal
113
What color is serous exudate?
Clear
(Ex: blisters)
114
What color is sanguinous exudate?
Red/bloody
115
What color is serosanguinous exudate?
Semi clear pink
(Ex: in surgical drains, output = exudate)
116
What color is purulent exudate?
Yellow/white
(Ex: pus)
117
What are the three types of inflammation?
-Acute
-Subacute
-Chronic
118
What are the characteristics of acute inflammation?
-Healing occurs over 2-3 weeks
-No residual damage
-Mostly neutrophils respond
119
What are the characteristics of subacute inflammation?
-Similar to acute, but lasts longer
-May last months
120
What are the characteristics of chronic inflammation?
-Lasts weeks to years
-Injurious agent persists or repeatedly injures the tissue
-Mostly lymphocytes and macrophages
(Ex: rheumatoid arthritis or osteomyelitis)
121
What are the two types of clinical manifestations of inflammation?
-Local
-Systemic
122
What are the characteristics of local inflammation?
-Redness d/t vasodilation
-Heat d/t increased metabolism with inflammation
-Pain d/t swelling, pressure, and histamine prostaglandin stimulation
-Swelling d/t exudate accumulation along with fluid shift
-Loss of function d/t swelling and apin
123
What are the characteristics of systemic inflammation?
-Increased WBC count "shift to the left" --> WBC is released from bone marrow, now will see S&S
-Fatigue/malaise d/t increased temp and body is trying to work with chemical mediators
-Nausea/anorexia
-Increased HR & RR d/t increased rise in metabolism, our bodies are trying to work harder
-Fever
124
What is the process of clinical manifestations of fever?
-Triggered by release of cytokines (Ex: prostaglandins)
-Initiate metabolic change sin temp in hypothalamus
-Hypothalamus stimulates ANS to increase muscle tone and shivering, and reduces respiration and peripheral blood flow
-Epinephrine increases metabolic rate
125
What are the benefits of a fever?
-Activates the body's defense mechanisms
-Killing of microorganisms
-Increased phagocytosis by neutrophils
-Increased proliferation of T cells (lymphocytes)
-Increased interferon activity (natural virus fighting substance)
126
What are examples of antipyeretics?
Tylenol/Ibuprofen
127
What is considered a low grade fever?
Anything below 103 degrees
128
What degree of fever would require antipyeretics?
Anything 103 and above
129
True or False:
If fever goes above 105 degrees, there can be brain impairments
True
130
What conditions can mask inflammatory responses?
-Immunosuppressants
-HIV
-Cancer pts undergoing chemo
-Pts with arthritis who use corticosteroids
131
What are the assessments for Inflammation?
-Early recognition
-Assess for cause of inflammation
-Assess for risk factors that limit inflammatory responses (mask S&S)
-Monitor: temp, HR, RR (all can increase with infection)
132
What are different nursing dx for inflammation?
-Inflammation
-Altered temp
-Impaired tissue integrity
133
What can nurses do for pts with a fever?
-Apply a cooling blanket
-Cold packs
-Give tepid bath
-Provide fan
-Keep linens dry
-Provide oral and skin care
-Quiet/non-stimulating environment
134
What do antipyretic drugs do?
-Decrease fever/temp
-Lower inflammatory response
-Cause quick decreases, may work in 2-4 hr intervals
135
What are examples of antipyretics?
-Acetaminophen (Tylenol)
-NSADIS (ibuprofen (Advil/Motrin))
-Salicylates (aspirin)
136
What are examples of anti-inflammatory drugs?
-Corticosteroids
-NSAIDS
-Salicylates
137
What does RICE stand for when managing acute care/soft tissue injuries?
-Rest
-Ice (thermal therapy)
-Compression/Immobilization
-Elevation
138
How is rest beneficial for pts with soft tissue injuries?
-Gives body more O2 and nutrients fro repair
-Allows fibrin/collagen to form across the wound edges for healing
139
How is icing beneficial for pts with soft tissue injuries?
-Promotes vasoconstriction which reduces swelling, pain, and congestion (for the first 24 hrs)
140
When can heat be used for thermal therapy with pts who have soft tissue injuries?
Can be after 24 hrs of icing up to 48 hrs to help increase circulation up to the inflamed sight & promotes removal of debris
141
How is compression beneficial to pts with soft tissue injuries?
-Reduces edema
-Stops bleeding (if lacerated)
142
How does immobilization benefit pts with soft tissue injuries?
Supports injured tendons, muscles, and joints
143
What is a primary concern during compression and immobilization of a pt with a soft tissue injury?
Circulation - always assess distal pulses, capillary refill, color of skin, loss of feeling before and after compression (numbness/tingling), and edema/swelling, and capillary refill
144
How is elevation beneficial to a pt who has a soft tissue injury?
-If elevated above heart level, it decreases edema by increasing venous and lymphatic return
-Reduces pain caused by edema
145
True or false:
Elevation of soft tissue injuries is beneficial for pts with reduced arterial circulation
False- elevation is contradicted in these pts
146
What are the two major components of the healing process?
-Regeneration
-Repair
147
What does regeneration mean?
Replacement of lost cells and tissues with cells of the same type
148
What does repair mean?
Healing with connecting tissue replacing lost cells
149
How does repair occur?
By primary, secondary, or tertiary intentions
150
What is an example of primary intention in tissue repair?
-Incision with blood clot
-Then edges approximated with suture
-Results in fine scar
151
What is an example of a secondary intention tissue repair?
-Irregular, large wound with blood clot
-Then the granulation tissue fills in wound
-Results in a large scar
152
What is an example of a tertiary intention tissue repair?
-Contaminated wound
-Granulation tissue
-Results in delayed closure with suture
153
What are the 3 phases of primary intention and how long do they last?
-Initial (inflammatory) 3-5 days
-Granulation 5 days-4 weeks
-Maturation and scar contraction/formation 7 days - several months/years
154
What are the characteristics of the initial phase of primary intention?
-Must have edges of incision that are aligned (can even be sutured)
-Area fills with blood
-Clot forms matrix for WBC migration
-Acute inflammatory rxn occurs
-As wound debris is removed, capillary growth and migration of epithelial cells occurs
155
What are the characteristics of the granulation phase of primary intention?
-Fibroblasts migrate into site and secrete collagen to form scar
-Surface epithelium begins to regenerate
-Wound is pink and vascular, vessels are still present
-Can be friable, need to be extra careful
156
What are the characteristics of the maturation phase of primary intention?
-Collagen fibers are organized
-Remodeling occurs
-Fibroblasts disappear as scar becomes stronger and skin edges become closer
-Mature scar forms
-Pale and avascular, may be painful
157
What are characteristics of secondary intention?
-Increased exudate and extensive tissue loss causes more inflammation
-Wide, irregular margins (not symmetrical)
-More debris, cells and exudate may need to be debrieded under a sterile field
-Same as primary intention healing except there are greater defects and gaping wound edges
-Healing and granulation occurs from edges in and from the bottom up
-Larger scar, more granulation tissue
Ex: trauma, injury
158
What are characteristics of tertiary intention?
(AKA delayed primary intention)
-Occurs due to delayed suturing of the wound in which two layers of granulation tissue are sutured together
-Contaminated wound left open or primary wound becomes infection and is opened; after the infection is controlled, it is sutured
-Larger, deeper scar
159
True or False:
A wound can be acute or chronic
True
159
How do you classify the different depths of a wound
-Superficial - epidermis
-Partial thickness - extends into dermis (epidermis and dermis)
-Full thickness - epidermis, dermis, subq, and muscle
160
What is the definition of a skin tear?
Wound caused by shear, friction, and/or blunt force
161
What is the result of a skin tear?
Separation of skin layers (partial or full thickness)
162
What are the complications of healing?
-Adhesions
-Contractions
-Evisceration
-Excess granulation tissue
-Fistula formation
-Infection
-Hemorrhage
-Hypertrophic scars
-Keloid scars
163
What is the definition of adhesions?
Bands of scar tissue that form between or around organs
164
What is the definition of contractions?
Shortening of muscle or scar tissue; may cause deformity
165
What is the definition of evisceration?
Intestines protrude from wound d/t edges separating
166
What is the definition of excess granulation tissue (proud flesh)?
Excess granulation tissue extends above wound surface
167
What is the definition of fistula formation?
Abnormal passage between organs or organ and skin
168
What is the definition of infection?
Increased risk when wound is necrotic or blood supply is decreased or decreased immune function
169
What is the definition of hemorrhage?
Bleeding
170
What is the definition of hypertrophic scars?
Inappropriately large, raised red and hard scars d/t an overabundance of collagen
171
What is the definition of keloid scars?
-Mass of scar tissue
-Appears tumor-like d/t protrusion beyond wound edges
-Thought to be hereditary
-Most common in dark skinned individuals
172
What makes up the integumentary system?
Composed of the skin, hair, nails, and certain glands
173
What are the two major layers of the skin?
-Epidermis (top/outer layer, very thin)
-Dermis (Inner layer, very vascular)
174
Where can epidermis be found?
-Palms of hands
-Soles of feet
175
Where can dermis be found?
-Back
-Palms of your hands
-Soles of your feet
176
What makes up connective tissues?
-Mast cells
-Sebaceous glands
-Nerves
-Vessels
177
Where is subq tissue found and what does it contain?
Under the dermis; contains adipose tissue that contains fat
178
Where is the basement membrane zone found?
Between the epidermis and dermis
179
What does the basement membrane zone do?
Provides for exchange of fluids between the two layers and provides structural support for the epidermis
180
What cell types make up the epidermis?
-Keratinocytes
-Melanocytes
-Langerhan's cells
-Merkel cells
181
What are characteristics of keratinocytes?
-Form in the basal layer
-Initially undifferentiated and shaped like columns
-As they matures (keratinize), they move to surface and flatten and die to form the outer skin layer (stratum corneum)
182
What are characteristics of melanocytes?
-In the deep basal layer
-Contain melanin
-People with darker skin have larger melanosomes
183
What is the definition of melanin?
A pigment that gives color to the skin and hair, and protects the body from UV light
184
True or False:
People with darker skin have a decreased cancer risk d/t the high amounts of melanin in their skin
True
185
What are characteristics of Langerhan's cells?
-Type of dendritic cell
-Immunocompetent cells that recognize antigens
186
What happens when Langerhan's cells are depleted in the body?
The skin can not initiate an immune response
187
What are characteristics of merkel cells?
-In the basal layer
-Involved in the sensation of light touch
188
What are characteristics of the dermis?
-Very vascular (contains nerves, lymphatic vessels, hair follicles, sebaceous glands, and specialized cells
-Made up of 3 types of connective tissue
188
What is the definition of dermis?
Connective tissue beneath the epidermis (middle component)
189
What are the three connective tissues that make up the dermis?
-Collagen (gives us skin toughness/strength)
-Elastic fibers
-Reticular fibers
190
What is subcutaneous tissue/what does it do?
Provides:
-Insulation
-Cushioning
-Temp regulation
-Energy storage
-Made up of loose connective tissue and fat cells
-Has a big role of attaching muscle to bone
191
What are considered skin appendeges?
-Hair
-Nails
-Sweat and glands (sebaceous, apocrine, and eccrine)
192
What is the papillary layer of the dermis?
-Upper/thin layer
-Contains ridges/papillae
-Form congenital pattern
*Everyone has them on your hands (fingerprints)
-Identical twins have the same fingerprint
193
What is the reticular layer of the dermis?
-Deeper, thicker layer
-Contains collagen and elastic fibers
*Powerhouse- has strength to hold up everything/mechanical strength
194
What do sebaceous glands do?
Secrete sebum which empties into the hair follicles for waterproofing and lubrication of the skin
195
Where are sebaceous glands found?
They are found everywhere on the skin except the palms and soles and dorsum of the feet
196
What role does testosterone play in sebaceous glands?
Testosterones helps regulate sebum production
197
What are the two types of sweat glands?
-Apocrine
-Eccrine
198
Where is apocrine located
-Axillary
-Genital
-Breast areas
*Are connected to a hair follicle
199
What is the function of apocrine?
They secrete a thick, milky, odorless substance
200
What happens to apocrine at pueberty?
They enlarge and become active, they produce secretions that may have an odor caused by bacteria
201
Where is eccrine found?
Found on most of the body except:
-Lips
-Ear canals
-Nail beds
-Labia minora
-Glans penis
-Prepuce
202
What makes up sweat?
-Salts
-Ammonia
-Urea
-Other wastes
203
What is the function of eccrine?
-Cool the body by evaporation
-Excrete waste products
-Moisturize skin cells
204
What are the functions of skin?
-Protect
-Insulate
-Sensory regulation
-Heat regulation
-Synthesis of Vitamin D
205
How does the skin protect?
Protects underlying tissue by being a barrier to the external environment 9things out of our control)
206
How does the skin insulate?
Fat in the subq tissue layer insulates the body and provides protection from trauma
207
How does the skin help with sensory regulation?
Nerve endings and special receptors in the skin collect sensory regulation for the brain
*Related to pain, heat and cold, touch, pressure, and vibration
208
How does the skin control heat regulation?
By responding to changes in internal and external temps through vasoconstriction and vasodilation
(insensible respiration)
209
Why is synthesis of Vitamin D crucial for the skin?
It is critical to calcium and phosphorus balance
(occurs in epidermis, and UV light acts on Vitamin D precursor cells)
210
What are the effects of chronic UV exposure and sun damage on older adults?
-Contributes to photo-aging and wrinkling of skin
-Cumulative and increases the risk of skin cancers
211
What are the wound characteristics for assessment?
-Location
-Size
-Depth
-Undermining and tunneling
-Wound margins
-Wound base
211
What do you need to record as qualitative data for wounds?
-Consistency
-Color
-Odor of any drainage
212
What does wound management and type of dressing depend on?
-Type, extent, and characteristics of wound
-Phase of healing
213
What are the purposes of wound management?
-Protecting a clean wound from trauma so that it can heal properly
-Cleaning a wound to remove any dirt or debris from the wound bed
-Treating infection to prepare the wound for healing
214
What are factors that may delay healing of a wound?
-Nutritional deficiencies
-Inadequate blood supply
-Corticosteroids
-Infection
-Anemia
-Smoking
-Mechanical friction
-Advanced age
-Obesity
-Diabetes
-Poor general health
215
What nutritional deficiencies would you look for when seeking factors that may delay healing?
-Vitamin C
-Protein
-Zinc
216
What typically happens if you have inadequate blood supply?
They probably have decreased nutrition supply
217
What about infections may contribute to delayed healing of a wound?
-Increased inflammatory response
-Tissue destruction
218
What about mechanical friction may contribute to delayed healing of a wound?
Destroys granulation tissue
219
What about advanced age may contribute to delayed healing of a wound?
-Impaired circulation
-Takes longer for epithelialization
220
What about obesity may contribute to delayed healing of a wound?
Decreases blood supply in fatty tissues
221
What about diabetes may contribute to delayed healing of a wound?
-Delays capillary growth
-Impairs phagocytosis
-Reduces oxygen and nutrients
222
When does anemia occur that may delay healing of a wound?
If there is less oxygen at tissues
223
How does smoking impact healing of a wound?
-Vasoconstriction d/t no O2
-Impedes blood flow
224
What are closure devices for clean wounds?
-Adhesive strips
-Sutures
-Staples
-Tissue adhesives
225
What do dressings for clean wounds do?
Promote epithelialization
226
What are factors to consider when applying dressing to clean wounds?
-Keep wound surface clean
-Keep wound surface slightly moist
227
True or False:
You cannot let wounds that are granulating and re-epithelializing dry out or "air dry"
True
228
What are factors to consider when applying topical antimicrobials/antibacterials?
-Use cautiously to avoid damaging epithelial tissue
-Do not use on a clean granulating wound
229
What do primary intention wounds need when being treated?
-Need a dry, sterile dressing
-Removed 2-3 days after drainage stops
230
What may be needed for treating contaminated wounds?
-Must be clean for healing to occur
-Debridement may be necessary if debris or dead tissue is present
-Absorptive dressings (duoderm) --> inner part of dressing forms a hydrated gel over the wound
231
What does suction do?
-Removes fluid, exudate, and bacteria
-Enhances blood flow to base
232
What do you need to monitor when performing Negative Pressure Wound Therapy (NPWT)?
-Serum protein levels
-Fluid and electrolyte balance
-Coagulation studies
233
What is a Hyperbaric O2 Therapy (HBOT)?
Topical or systemic delivery of O2 at increased atmospheric pressure to the tissue
234
What does the HBOT do?
-Stimulates angiogenesis
-Kills anaerobic bacteria
-Increases killing power of WBCs/some Anbx
-Accelerates granulation and healing
235
How long do HBOT treatments last?
-90 to 120 minutes
-10 to 60 treatments
*Depending on the condition being treated
236
When is becaplermin (regranex) used?
Only used when the wound is free of infection and dead tissue
*Gel form for treatment of foot injuries for those with diabetes
237
What is drug therapy?
Platelet derived growth factor
238
What does drug therapy do?
Released from the platelets and stimulates cell proliferation and migration
239
What does high fluid intake do in aspects of nutritional therapy?
Replaces fluid loss from perspiration and exudate formation
239
What does diet high in protein, carbs, and moderate fat do in aspects of nutritional therapy?
-Protein needed for the negative nitrogen balance d/t increased metabolic rate
-Synthesis of immune factors, WBCs, Fibroblasts, and collagen
-Carbohydrates meet the increased metabolic energy required for healing
-Fats help in synthesis of fatty acids and triglycerides
240
What does Vitamin A do in aspects of nutritional therapy?
-Aids in epithelialization
-Collagen synthesis
-Wound strength
241
What does Vitamin B Complex do in aspects of nutritional therapy?
Are coenzymes for metabolic reactions
242
What does Vitamin C do in aspects of nutritional therapy?
Needed for capillary synthesis and collagen production by fibroblasts
243
What are the infection prevention and control factors for wound healing?
-Hand hygiene and aseptic procedures
-Keep environment free from contaminated items
-Possible prophylactic antibodies
-Culture and sensitivity if suspect infection
-Nurses can for Levine's Technique
-HCP performs needle and punch biopsy
244
What is Levine's Technique and how it it performed?
-Rotate culture swab near the center of the wound using enough pressure to extract fluid from deep tissue layers of wound
-Take a culture of the clean tissue - exudate and necrotic tissue will not provide an accurate sample
-Send samples to lab within 1 hr
245
What are psychological complication of wound healing?
-Pt may be distressed at thought/site of incision d/t fear of scars or disfigurement
-Drainage or odor can cause alarm for pts
246
What do nurses need to do to help minimize pt's psychological implications for wound healing?
-Educate on healing process and normal changes that occur as wound heals
-Be aware of your facial expressions while changing dressing
-Do not focus on wound to the extent that you are not treating the pt as a whole
247
Why do nurse's need to be aware of their facial expressions while changing wound dressings?
It may alert pt to problems with wound or raise doubts about ability to care for wound
248
What are pt teachings for wound healing?
-Wound care/dressing changes
-Adequate rest, hydration, and nutrition is essential
-Minimize physical and emotional stress
-Teach and report S&S of complication
-Medications
249
What teaching comes with teaching pt about S&S of complications with wound healing?
-Contractures
-Adhesions
-Secondary infection
-Changes in wound color
-Amount of drainage
250
What is a pressure injury?
Localized damage to skin and/or tissue
251
How do pressure injuries occur?
-D/t intense and/or prolonged pressure or pressure in combination with shearing of skin
-Usually over a boney prominence or related to medical or other devices
252
What are the biggest area for pressure injuries to occur?
-Sacrum
-Heels
253
What are influencing factors of pressure injuries?
-Amount of pressure (intensity)
-Length of time pressure is exerted (duration)
-Ability of tissue to tolerate externally applied pressure
254
What are contributing factors to pressure injuries?
-Shearing force
-Excessive moisture
255
What is a shearing force?
Pressure exerted on skin when it adheres to bed and skin layers slide in direction of body movement
256
How does excess moisture contribute to pressure injuries?
Increases risk for skin breakdown
257
What are the main risk factors for pressure injuries?
-Bed/wheelchair bound
-Diabetes
-Friction
-Immobility
-Impaired circulation
-Incontinence
-Mental deterioration
-Pain
-Spinal cord injury
258
What is a Stage 1 pressure injury?
-Non-blanchable erythema of intact skin
-Blanchable erythema or changes in sensation, temp, or firmness
*May precede visual changes
259
What is a Stage 2 pressure injury?
-Partial-thickness loss of skin with exposed dermis
-Shallow, moist, open wound with red-pink wound bed
-May present as an in tact or ruptured serum-filled or serosanguinous-filled blister
-Skin has broken
*Typically occurs from shearing of skin over the pelvis and the heel
260
True or False:
Wound size and depth does not vary based on location
False- they do vary based on location
260
