Other systems - Integumentary Flashcards
What are key functions of the integumentary system
Protection synthesis of vitamin D sensation thermal regulation excretion of sweat
What are the phases of normal wound healing
Inflammatory phase 1 - 10 days
proliferative phase 3 - 21 days
maturation phase 7 days - 2 years
What healing processes occur in the inflammatory phase of healing
Initial response to wound.
-Platelet activation and clotting cascade rapidly establish homeostasis.
- Necrotic tissue and debris and bacteria are moved by mast cells and neutrophils and leukocytes.
-Clean wound bed signals tissue restoration and repair to begin.
The epithelialization occurs in 24 hours, observed visible signs occur 3 days after
Characteristics in the proliferative phase of healing
- Formaiton of new tissue signals proliferative phase.
- Epithelial cells migrate over wound bed created by new capillary beds and granulation tissue
- Keratinocytes, and epithelial cells, fiber fibroblasts are active and create collagen matrix.
- Skin integrity restored.
- Wound closure occurs via epithelialization and wound contraction.
Characteristics of the maturation phase of food healing
- The scar begins to shrink and re-organize fibers and thin and contract scar
- Immature scars are red, raised, and rigid.
- Mature scars are pale flat and pliable.
- Scar tissue is remodeled/strengthened via collagen lysis and synthesis.
- For hypertrophic scarring can impact maturation phase progression, up to 2 years to reach maturity.
- Without hypertrophic scarring wounds typically mature in 4-8 weeks
What is primary intention, secondary intention and tertiary intention
Primary intention; smooth clean edges (surgical incision, laceration, puncture, superficial/partial thickness wound) approximated with sutures, staples, adhesive. Min scarring, heal quick
Secondary intention: Wound closes on its own. Necrotic irregular or non-viable wound margins can’t be reapproximated. Infection or debris contamination. Diabetes, ischemic conditions pressure damage or inflammatory disease. much larger scars occur compared to primary intention
Tertiary intention: Delayed primary intention healing. Wound at risk for developing complications: sepsis or dehiscence are temporary left open. Risk factors: wounds with significant edema, debris contamination, high risk infection, questionable vascular integrity. Once risk factors decrease primary intention is used
Factors that influence wound healing?
Age: epidermis thins and flattens with age, skin is more fragile and susceptible to injury from friction and sheer. Decreased rate of wound healing.
Co- morbidities: poor tissue perfusion in cardiovascular dx, DM, vascular conditions. Co-morb;s that suppress immune system can result in altered inflammatory process and healing.
Edema: some edema is normal. Altered hemodynamics via increased pressure form edema such as venous insiff, or lymphedema can result in poor perfusion and waste removal. increased risk of infection 2/2 poor O2 and nutrient delivery.
Harsh or inappropriate wound care: aggressive debridement and irrigation and chemicals, prolonged whirlpool, hurt granulation
Infection: immune responses are overwhelmed when bacteria compete for nutrients and release toxins that cause more damage
Life stlye: reg actiivty and good nutriaiton promote wound healing. Smoking results in hypoxia and increases infection risk
meds: anti-inflamatory, immunosupprisive, anticoagulant, anti neoplastic, steriod, birthcontrol, can negativky impact wound healing. poor/prolonged inflamatory repsonse, reduced BF, delayed collagen synthesis, decr tensile strength of repaired tissue
obesity: increased skin tension, susceptible to fissuring and therefore infection, large skin folds create moisture for bacteria growth and maceration.
What are some types of burns that can occur ?
Thermal burn. Conduction or convection result from hot liquid fire or steam
Electrical burn.
Electrical current enters and exits of wound. Complications: arrhythmias, respiratory arrest, renal failure neurological damage, fracture.
Chemical burn. Acids
Radiation burn. DNA is altered due to external beam radiation. Comlications: Severe blistering desquamation, nonhealing wound, tissue fibrosis, permanent discoloration, new malignancies
What are zones of injury for a burn ?
Zone of coagulation- Area of burn with most and irreversible damage
Zone of stasis. - Surrounds the zone of coagulation area is less severe and has reversible damage
Zone of hyperemia- Surrounds zone of stasis. Presents with information, will fully recover without permanent damage
What is a superficial burn?
-Outer epidermis, slight edema and red
– heals without peeling or evidence of scarring in 2 – 5 days
Superficial partial thickness burn
- Involves epidermis and upper portion of dermis.
- May be extremely painful, exhibit blisters.
- Healing minimal to no scarring 5- 21 days
Deep partial thickness burn
- Complete destruction of epidermis and majority of dermis.
– May appear discolored with broken blisters and edema.
– Damage to nerves endings with moderate level of pain.
– Hypertrophic or keloid scarring.
– Without infection heals in 21-35 days
Full thickness burn
Complete destruction of epidermis and dermis and partial damage to subcutaneous fat layer.
- Scar formation and minimal pain.
- Require grafts and susceptible to infection.
- Healing time varies with small areas healing in weeks with or without grafting.
- larger areas require grafts and months to heal
Sub- Dermal burn
- complete destruction of epidermis, dermis and subcutaneous tissue.
- Involve muscle and bone.
- Require multiple surgical interventions and extensive healing time
List the burn classifications from least severe to most severe
Superficial burn. Superficial partial thickness burn. Deep partial thickness burn. Full thickness burn. Sub dermal burn
How is iontophoresis related to Burns?
- Burns occur when pH increases or decreases beyond normal.
- Burns typically more severe under negative electrode due to pooling of alkaline solution.
- Skin erosion possible with reduced skin resistance reduced and increased electric current delivery
- Causes chemical burns: Excess current, prolonged duration, electrode placement over defective skin with lower resistance,
- Causes thermal burn: Poor electrode contact or increased impedance will create thermal burn f electrode if poorly placed
What are examples of selective debridement
Sharp debridement.- Use of scalpel or similar device to remove large amount of thick, adherent necrotic tissue. Can be used for cellulitis or sepsis. Fastest way to remove necrotic tissue.
Enzymatic debridement- Topical application to remove necrotic tissue. Can be used on infected or not infected wounds with necrotic tissue. Can be used for wounds that do not respond to autolytic debridement or other techniques. Establishes clean wound bed.Discontinue when the devitalitized tissue is removed to avoid damage of healthy tissue.
Autolytic debridement- Use of bodies own mechanisms to remove nonviable tissue. Use of transparent films, hydrocolloids, hydrogels, and alginates. Moist wound environment rehydrates necrotic and eschar tissue, facilitates enzymatic digestion. Non-invasive and pain-free. Can be used with any amount of necrotic tissue and requires longer healing. Period not used on infected wounds
What are examples of non-selective debridement
Wet to dry dressings
Wound irrigation
Hydrotherapy
Sharp debridement
Sharp debridement.- Use of scalpel or similar device to remove large amount of thick, adherent necrotic tissue. Can be used for cellulitis or sepsis. Fastest way to remove necrotic tissue.
Enzymatic debridement-
Enzymatic debridement- Topical application to remove necrotic tissue. Can be used on infected or not infected wounds with necrotic tissue. Can be used for wounds that do not respond to autolytic debridement or other techniques. Establishes clean wound bed.Discontinue when the devitalitized tissue is removed to avoid damage of healthy tissue.
Autolytic debridement
Autolytic debridement- Use of bodies own mechanisms to remove nonviable tissue. Use of transparent films, hydrocolloids, hydrogels, and alginates. Moist wound environment rehydrates necrotic and eschar tissue, facilitates enzymatic digestion. Non-invasive and pain-free. Can be used with any amount of necrotic tissue and requires longer healing. Period not used on infected wounds
Wet to dry dressings
Moistened gauze is placed over necrotic tissue and is removed when dry to remove adhered necrotic tissue adhered to gauze .
Used to do bride wounds with moderate amount of exudate and necrotic tissue.
Used sparingly on wounds with necrotic and viable tissue; granulation tissue is traumatized in process.
-Removal of dry dressings from granulation tissue may cause bleeding and pain
Wound irrigation
Pulse lavage is an example. Desirable for wound infected or have loose debris. Pressure settings provide suction for removal of exudate and debris
Hydrotherapy
Use of whirlpool. Can loosen it here in a crowded tissue. Not recommended.
What is the red yellow black system
Red: pink granulation tissue goal: protect wound maintain moist environment
Yellow, moist yellow slough. Goal remove exudate and debris absorb drainage.
Black: black and eschar firmly adhered. Goals: debride necrotic tissue
When would you use an alginate dressing? What are the advantages and disadvantages
- Highly absorptive highly permeable and non-inclusive.
- Require second dressing.
- Create hydrophilic gel through interaction of calcium ion in the dressing and sodium ions in the wound exudate.
- Used on partial or full thickness draining wounds. Pressure or venous insufficiency ulcers. Used on infected wounds due to excess drainage.
Advantages: high absorption capacity, automlytic debridement, protection from microbe contamination, Non-infected or not infected wounds, not adhering to wound.
Disadvantages: frequent dressing changes based on drainage, requires secondary dressing, can’t be used on wound with exposed tendon joint capsule bone
When would you use a foam dressing dressing? What are the advantages and disadvantages
- Exudate is absorbed into foam. Commonly available in sheets or pads with various thickness. Semi permeable dressing produced in adhesive and non-adhesive forms. Non-adhesive require secondary dressing.
- Used to provide protection and absorption for partial and full thickness wounds. Can be used as secondary dressings over amorphous hydrogels
-Advantages: moist environment, available and adhesive and not adhesive forms, prophylactic protection and cushioning, encourages autolytic debridement, moderate resorption
- Disadvantages
- rolls in areas of excess friction, adhesive form can traumatize Perry wound with removal, lack of transparency; hard to inspect wound
When would you use a gauze dressing? What are the advantages and disadvantages
Impregnated gauze uses Petrolatum zinc or antimicrobials. Use with infected or not infected wounds of any size. Used for wet to wet, wet to moist, or wet to dry debridement.
-Advantages, Commonly available cost effective, can be used alone or in combination with other dressings or topical agents, multiple layers to accommodate changing wound status, can be used and infected or non infected wounds
- Disadvantages
Adheres to wound bed traumatizing viable tissue with removal, highly permeable, requires frequent changes, prolonged use decreases cost effectiveness, increased infection rate compared to occlusive dressing
When would you use a Hydrocolloid dressing? What are the advantages and disadvantages
Gel forming polymers.Does not attach to wound, anchors to intact surrounding skin. Absorbs exudate by swelling in to gel like mass and varies in permeability thickness and transparency. Useful for partial and full thickness wound effective with granular or necrotic wounds
- Advantages: Moist environment, enables autolytic debridement, offers protection from microbes, provides moderate absorption, does not require secondary dressing, waterproof surface
- Disadvantages : Can traumatize skin upon removal, may roll in areas of excess friction can’t be used in infected wounds
