Other Systems: Study Set 1 Flashcards
What is the largest organ in the body
the skin
what are the layers of the skin from superficial to deep
- epidermis
- dermis
- Subcutaneous
True or False:
The epidermis is avascular
true
True or false:
The dermis is avascular
False
The epidermis is avascular
What are the key functions of the integumentary system
protection
sensation
thermoregulation
excretion of sweat
vitamin D synthesis
What are the phases of normal wound healing and how long do they last
- Inflammatory phase: 1-10 days
- Proliferative phase: 3-21 days
- Maturation phase: 7 days to 2 years
Name the phase of normal wound healing
Hemostasis is rapidly re-established through platelet activation and the clotting cascade. Necrotic tissue and bacterial debris are killed by mast cells, neutrophils, and leukocytes. Epithelization occurs within 24 hours.
Inflammatory phase
Which cells are involved in killing bacteria, necrotic tissue, and debris in the inflammatory phase of normal wound healing
neutrophils, leukocytes, and mast cells
Which phase of normal wound healing does epithelialization occur in
inflammatory phase
What happens during the inflammatory phase of normal wound healing
Hemostasis is rapidly re-established through platelet activation and the clotting cascade. Necrotic tissue and bacterial debris are killed by mast cells, neutrophils, and leukocytes. Epithelization occurs within 24 hours.
Name the phase of normal wound healing:
Capillary buds and granulation tissue begin to fill the wound bed. Keratinocytes, endothelial cells, and fibroblasts form the collagen matrix. Skin integrity is restored
Proliferative phase
Which cells are involved in forming the collagen matrix to restore skin integrity during the proliferative phase of normal wound healing
Fibroblasts, keratinocytes, and endothelial cells
Which phase is skin integrity restored during normal wound healing
proliferative phase
What happens during the proliferative phase of normal wound healing
Capillary buds and granulation tissue begin to fill the wound bed. Keratinocytes, endothelial cells, and fibroblasts form the collagen matrix. Skin integrity is restored
Name the phase of normal wound healing
Granulation tissue and epithelial differentiation appear in the wound bed and through fiber reorganization and contractions, the scar from the wound starts to shrink
maturation or remodeling phase
What percentage of pre-injury tensile strength does newly repaired tissue have
15%
Overtime it will reach 80% of pre-injury tensile strength
True or False:
Hypertrophic scarring does not affect the maturation phase of normal wound healing
False, it greatly impacts it. Especially burn scars
A burn scare without hypertrophic scarring will heal in ___-___ weeks.
A burn with hypertrophic scarring may heal up to ____ years
4-8 weeks
2 years
Which of the following exerts its primary influence on the hair follicles?
arrector pili muscles
Meissner’s glands
melanocytes
sebaceous glands
Arrector pili muscles
Which structure in the epidermis serves as a barrier against fluid, electrolyte, and chemical loss?
basal cells
Langerhans cells
keratinocytes
stratum corneum
stratum corneum
What is the proper order of skin layers from superficial to deep?
epidermis, papillary dermis, reticular dermis, subcutaneous
epidermis, reticular dermis, papillary dermis, subcutaneous
reticular dermis, papillary dermis, epidermis, subcutaneous
epidermis, subcutaneous, papillary dermis, reticular dermis
epidermis, papillary dermis, reticular dermis, subcutaneous
Which layer of the skin contains melanocytes?
epidermis
dermis
hypodermis
subcutaneous
epidermis
What type of gland helps to protect the skin by producing sebum?
apocrine sweat gland
sebaceous gland
ceruminous gland
mammary gland
sebeaceous gland
Which of the following inflammatory mediators is responsible for causing pain in an acute wound?
histamine
prostaglandins
phagocytes
renin
prostaglandins
The process by which epithelial cells die and produce a protective outer layer is called:
epithelialization
keratinization
granulation
necrotizing
keratinization
Label A, B, and C
A = Hair shaft
B = Sweat Gland
C = Basal Layer of epidermis
Label D, E, and F
D = Sebaceous gland
E= Arrector pilli muscle
F = Hair follicle
Label G and H
G = Hair root
H = Sweat gland
What are the four types of burns?
Thermal
Radiation
Chemical
Electrical
Which type of burn occurs by conduction or convection?
Thermal
Which type of burn occurs through direct contact with a hot liquid, fire, or steam
thermal
Which type of burn occurs when an electric current runs through the body
electrical
Which type of burn typically has an enter and exit wound
electrical
Which type of burn would a lightning strike be
electrical
Which type of burn occurs when chemical compounds come intact with the body
chemical
Which type of burn occurs by external mean radiation therapy
radiation
What are the three zones of injury in regards to burns
- Coagulation zone
- Stasis zone
- Hyperemia zone
Describe the coagulation zone of a burn injury
The coagulation zone is the area of the most severe injury with irreversible damage
Describe the stasis zone of a burn injury
The stasis zone surrounds the coagulation zone in which the damage is reversible
Describe the hyperemia zone of a burn injury
The hyperemia zone is a zone of inflammation in which the damage will fully recover without intervention or permanent damage
During iontophoresis, if a burn is going to occur, it is more likely to occur under the (positive/negative) electrode
negative
What are the 5 burn classifications
- Superficial
- Superficial partial thickness
- Superficial deep thickness
- Full-thickness
- Subdermal
Describe what a superficial burn looks like and the expected healing time
A superficial burn only affects the epidermis
It will be red, slight edema but will not scar
Healing will take 2-5 days
Describe what a superficial partial thickness burn looks like and the expected healing time
A superficial partial thickness damages the epidermis and the upper portion of the dermis.
This is extremely painful with blisters but no scarring
Healing will take 5-21 days
Describe what a deep partial thickness burn looks like and the expected healing time
A deep partial thickness burn damage the epidermis and the majority of the of the dermis.
This will create moderate pain with blistering and discoloration.
Scarring will occur
Healing will take 21-35 days
Describe what a full-thickness burn looks like and the expected healing time
A full-thickness burn damages the epidermis and all of the dermis into the subcutaneous layer.
This will create minimal pain with eschar
A skin graft will be needed
Healing will take weeks to months depending on the size
Describe what a sub-dermal burn looks like and the expected healing time
A sub-dermal burn damages the epidermis, dermis, subcutaneous layer and into the muscle/bone
This requires surgical intervention
Healing will take extensive time.
There are two types of wound debridement: Selective and non-selective. What are the three types of selective wound debridement
- Autolytic
- Enzymatic
- Sharp
There are two types of wound debridement: Selective and non-selective. What are the three types of non-selective wound debridement
- Wet to dry
- Wound irrigation
- Hydrotherapy
Which type of wound debridement uses scissors, scalpel, or forceps to remove large amounts of thick necrotic tissue
sharp debridement
Which type of wound debridement is used to apply a topical enzyme to prepare the necrotic tissue and is used if autolytic debridement is not working
enzymatic
Which type of wound debridement is used in order to aid the body’s natural healing process
autolytic
Which type of wound debridement is used by putting a wet gauze over necrotic tissue so that the tissue adheres to the gauze and can be pulled off
wet to dry
Which type of wound debridement uses pressurized fluid on loose or infected wounds?
Wound irrigation/pulse lavage
Which type of wound debridement uses a whirlpool to soften and loosen necrotic tissue
whirlpool
True or False:
The rule of nines accounts for the level of severity a burn is
false, it accounts for the percentage of body affected by a burn not severity
Describe healing by primary intention
Clean smooth edges reapproximated by sutures or staples that leave little to no scarring. Blisters or abrasions heal by primary intention within seventy two hours
Describe healing by secondary intention
Wounds with tissue loss that cannot be reapproximated, so granulation tissue fills in the wound bed with wound closure and scar formation. Typically a result of diabetes or pressure damage that will leave a bigger scar than primary intention
Describe healing by tertiary intention
Also referred to as delayed primary intention healing. The wound may be left open due to its high risk of developing infection/sepsis. Once the risk of infection is gone, the wound is closed by primary intention.
How does age play a factor in wound healing
as we age, the epidermis gets thinner and puts the patient at higher risk for friction/pressure injuries. Metabolism is slowed which is correlated to decreased wound healing
How does edema play a factor in wound healing
Excessive edema increases tissue pressure which then decreases availability of oxygen and nutrients that are necessary for wound healing
How does infection play a factor in wound healing
Infectious bacteria compete with the body’s own cells for available nutrients. Bacteria can release toxins that can cause further damage to the body
How does lifestyle and medication play a factor in wound healing
Regular physical activity and nutrition facilitate wound healing. Some meds have side effects that suppress the immune system which alters the wound healing process
How does obesity play a factor in wound healing
Poor periwound skin quality is susceptible to fissuring which increases the risk of infection. Increased skin tension heightens the risk of skin tears and limits options for approximation. Skin folds create moist, warm, environments that can lead to maceration and bacteria growth
(contamination/colonization/infection) is the presence of non-replicating bacteria on a wound surface that causes no additional tissue injury and does not stimulate an inflammatory immune response
contamination
(contamination/colonization/infection) is the presence of replicating bacteria on a wound surface that does not invade or further injure tissues and does not stimulate an inflammatory immune response. This process can delay wound healing, however bacteria in this stage occasionally benefit wound healing by preventing more virulent organisms from proliferating in the wound bed.
colonization
(contamination/colonization/infection) The presence of replicating bacteria that invades viable tissue beyond the wound surface causing a visible inflammatory immune response. Infection will significantly delay wound healing and, if untreated, can progress to sepsis, osteomyelitis, and gangrene
infection
What are the nine bony prominences that are associated with pressure injuries if a patient is in supine for too long?
occiput
spine of scapula
inferior angle of scap
verterbral spinous processes
medial epicondyle of humerus
posterior iliac crest
scrum
coccyx
heel
What are the seven bony prominences that are associated with pressure injuries if a patient is in prone for too long
forehead
anterior portion of acromion process
anterior head of humerus
sternum
ASIS
patella
dorsum
What are the eight prominences that are associated with pressure injuries if a patient is in sidelying for too long
ears
lateral portion of acromion process
lateral head of humerus
lateral epicondyle of humerus
greater trochanter
head of fibula
lateral malleolus
medial malleolus
What are the three bony prominences that are associated with pressure injuries if a patient is sitting in a chair for too long
spine of scap
vertebral spinous process
ischial tuberosity
What is an abrasion wound
A wound caused by a combination of friction and shear forces
What is an avulsion wound
a serious wound resulting from tension that causes skin to become detached from underlying structures
If a patient has an arterial insufficiency ulcer, they should
(rest/exercise)
avoid leg (elevation/depression)
avoid (cold/heat)
rest
avoid leg elevation
avoid heat
arterial/venous insufficiency wounds are a result secondary to inadequate circulation
venous
arterial/venous insufficiency wounds are a result secondary to inadequate circulation of oxygenated blood
arteial
arterial/venous insufficiency wounds are a result secondary to inadequate circulation of oxygenated blood
arterial
If a patient has an venous insufficiency ulcer, they should
(avoid/use) compression
avoid leg (elevation/depression)
(exercise/rest)
use compression to control edema
should elevate legs above heart when resting/sleeping
exercise
Describe the following characteristics of a lower extremity arterial insufficiency ulcer
Location
Appearance
Exudate
Pain
Pedal Pulses
Edema
Skin Temp
Tissue Changes
Leg elevation increasing or decreasing px
Location - Lower 1/3 of leg, distal toes, dorsal foot, lateral malleoli
Appearance - smooth edges, deep, well defined
Exudate - minimal
Pain - severe
Pedal Pulses - diminished or present
Edema - normal
Skin Temp - decreased
Tissue Changes - thin and shiny, hair loss, yellow nails
Leg elevation increasing or decreasing px - elevation increasing px
Describe the following characteristics of a lower extremity venous insufficiency ulcer
Location
Appearance
Exudate
Pain
Pedal Pulses
Edema
Skin Temp
Tissue Changes
Leg elevation increasing or decreasing px
Location - proximal to medial malleolus
Appearance - irregular shape, shallow
Exudate - moderate/heavy
Pain - moderate
Pedal Pulses - normal
Edema - increased
Skin Temp - normal
Tissue Changes - flaking dry skin, brownish discoloration
Leg elevation increasing or decreasing px - elevation decreases px
Describe the following characteristics of a lower extremity neuropathic ulcer
Location
Appearance
Exudate
Pain
Pedal Pulses
Edema
Skin Temp
Tissue Changes
Leg elevation increasing or decreasing px
Location - areas of the foot susceptible to pressure
Appearance - oval or circle, callused rim, no necrosis with good granulation
Exudate -low/moderate
Pain - none
Pedal Pulses - decreased or absent, unreliable ABI
Edema - normal
Skin Temp - decreased
Tissue Changes - dry, inelastic, shiny, decreased sweat production
Leg elevation increasing or decreasing px - elevation creates a loss of protective sensation
Define the following
superficial wound
partial thickness wound
full thickness wound
subcutaneous wound
superficial - trauma to the epidermis but not through the epidermis
partial - trauma to the epidermis and down to the dermis, but not through the dermis
full thickness - trauma through the dermis and into subcutaneous tissue
subcutaneous tissue - trauma down to the muscle/bone
