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wound care > Overview > Flashcards

Overview Flashcards

1
Q

Epidermis has _____ layers
Is it vascular or avascular?
Contains _____,_____, and ____

A

5
avascular
melanocytes, melanin, langerhan cells

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2
Q

Dermis as _____ layers
Contains _____ and _____ connective tissue
Is it vascular or vascular?

A

2
collagen and elastin
vascular

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3
Q

Hair follicles, sebaceous glands and sweat glands are found here?

A

dermis

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4
Q

Lymphatics, blood feels and nerve endings are found _____?

A

dermis

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5
Q

There dermis contains what 4 type of cells?

A

fibroblast, macrophages, WBCs, mast cells

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6
Q

Subcutaneous tissues are composed of ______ and ____. They are highly ______. _______ is used for energy.

A

adipose and fascia
vascularized
fat

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7
Q

Stratum Corneum is the ______ ______ layer containing dead ________. It makes up _______ of the epidermis.

A

outter most
keratinocytes
3/4

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8
Q

A callus makes up what layer of the epidermis and is made due to what two forces?

A

stratum corneum

friction and pressure

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9
Q

Stratum lucidum

Stratum granulosum

stratum spinosum

stratum basal

A

flattened, dead keratinocytes, appear clear in microscope

3-5 rows of flattened cells with increases concentrations of keratin

several rows of mature keratinocytes, spear spiny under the microscope

single row of keratinocytes that produce the keratin

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10
Q

what does the basement membrane doe?

A

scaffolding and selective filter between the epidermis and dermis

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11
Q

How many days does it take for cells to travel from the stratum basale to the stratum corneum?

A

14-21 days

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12
Q

How does the epidermis get its blood supply?

A

Diffusion of nutrients from the dermis across the semipermeable basement membrane

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13
Q

melanocytes produce?
merkel cells are?
langerhan cells do what?
Hair follicles are made of ______ and help with ___

A

melanin protecting from UV rays
Mechanoreceptors for light touch cells
fight infection by attacking and engulfing foreign material
soft keratin, temperature regulation

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14
Q

Hair follicles contain _____ that secrete _____ which to ______ the skin and hair.

A

sebaceous glands
sebum
lubricate

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15
Q

What are sudiferous glands?
Where are they located?
2 functions?

A

Sweat glands
Everywhere but lips and ears
cool the body and sow the grow of bacteria this reducing infection

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16
Q

Nails are made of _______. They arise from the ________. Nails can be used ______ and provide _______ to the digits.

A

hard keratin
stratum germinativum
functionally, protection

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17
Q

What is the papillary dermis?

What are its two functions?

A

ground substance that conforms to the contours of the stratum basal

Helps anchor the dermis and protects epidermal appendages

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18
Q

Blisters form where?

A

Papillary dermis junction to the basement membrane

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19
Q

The reticular layer is made up of __________ which provides ________. It is much ______ than the papillary layer.

A

DCT
structural support
deeper and thicker

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20
Q

what are the functions of the epidermis

A 
physical and chemical barrier 
regulates fluids
produce melanin and coloration
light touch sensation
asset with excretion
temp regulation
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21
Q

what are the functions of the dermis

A 
house epidermal appendages
assist with infection control
hair production
temp regulation
house sensory receptors
supplies nutrients and O2 to epidermis
supplies sebum to lubricate and protect the epidermis
vitamin D production in response to sunlight
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22
Q

What are the functions of the subcutaneous tissue?

A

insulation
support
padding
energy storage for other layers of the skin

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23
Q

What are structural changes of the skin that occur due to aging?

A 
Flattening of dermal-epidermal junction pegs
epidermal thinning
loss of elastin fibers
atrophy of dermis
diminished vascularization
increased skin permeability 
decreased inflammatory
decreased sweat and sebum production
decreased synthesis
impaired sensory perception
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24
Q

The inflammatory phase begins immediately and last ________ with the goal being to provide _______ and clear away _______.

A

3-7 days
hemostasis
bacteria, foreign material, and dead tissue

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25
Q

Which cells are phagocytic and and stimulate fibroblast activity for the proliferative stage?

A

macrophages

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26
Q

What are the steps to the vascular response of the inflammatory phase?

A
  1. injury
  2. transudate leaks causing localized edema
  3. vasoconstriction
  4. platelets aggregate at the injury site
  5. Platelets release chemical mediators
  6. vasodilation
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27
Q

What mediates vasoconstriction to occur in the vascular response of the inflammatory phase?

A

serotonin, norepinephrine, ANS

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28
Q

What activates the platelets to aggregate at the site of the injury?

A

damaged endothelial cells and exposed collagen

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29
Q

What do platelets release? What do these things do?

A

cytokines: signaling protein
GF: control cell growth, differentiation, and metabolism
Chemotactic agents: attract cells necessary for repair

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30
Q

_____ released by mast cells increase vessel wall _______ for short term vasodilation. _______ released by injured cells cause long term vasodilation.

A

Histamine
permeability
Prostaglandin

31
Q

Increased cell wall permeability causes _______ in blood volume. This slows blood flow specifically the _______. The slower ones are pushed to the side which is known as ______. These cells then undergo ____ which is when the they adhere to the endothelium and force their way into the interstitial space. They then migrate by the means of ________.

A 
decrease
PMNs
Margination
Diapedesis
Chemotaxis
32
Q

PMNs release chemotactic agents and mediators that do what 3 functions?
What other two things do PMNs do?

A

Attract more PMNs
Stimulate fibroblast migration
Induce vascular growth

Secrete enzymes to break down damaged tissue and kill bacteria
Phagocytic bacteria and debris

33
Q

What cells come after PMNs? Once in the interstitum they become _______ and release _______ and ______. They perform _________ and direct the repair process in what 3 ways?

A 
monocytes
macrophages
N.O. and bacterial enzymes
Phagocytosis
1.signal extent of injury
2. attract more inflammatory cells
3. produce GF
34
Q

What three substances are released during the inflammatory response that should not be release during the proliferative stage?

A

ascorbic acid, lactic acid, and hydrogen peroxide.

35
Q

Which cell stimulates the beginning of the proliferative stage?

A

Macrophages

36
Q

What is fibinolysin?

A

dissolves clots and plugs

37
Q

What is Fibroplasia?
Endothelial budding?
Myofibroblast?

A

fibroblast synthesis for granulation tissue
vessels from surrounding tissue migrate to supply nutrients
perform wound contraction at margins

38
Q

What are the components of the collagen matrix in the proliferative stage?

A

collagen, hyaluronic acid, elastin and fibronectin

39
Q

Angiogenesis is directed by what three things?

A
  1. local tissue ischemia
  2. vascular endothelial GF
  3. chemical mediators
40
Q

What are Matrix Metalloproteases (MMPs) ?

A

Produced by fibroblast, keratinocytes, neutrophils, and macrophages to degrade the debris formed during the inflammatory phase leaving a defect.

41
Q

Within the granulation tissue, _______ provides a scaffold for contact guidance through the receptors of cells called _______ found on their surface.

A

Extracellular matrix

integrins

42
Q

Fibroblast are guided by ________ agents and low _____ tension

A

chemotactic agents

O2

43
Q

___________ are actin-rich fibroblast that pull on the ECM and draw the wound to close know as the process of ________.

A

Myofibroblast

contraction

44
Q

Epitheliazation/ Maturation phase last ______ to ______. Collagen fibers align to _________. The tensile strength of the scar tissue is on _____-_____% of the original skin.

A

6 months to 2 years
stress
70-80%

45
Q

what are 2 things that can go wrong in inflammation phase?

A

Inadequate stimulus for repair

Inadequate perfusion/ischemia

46
Q

How can granulation be impaired?

A

increased amounts of inflammatory cytokines
low lvls of GF cytokines
Inadequate substrates ( proteins, vitamins, minerals
Inadequate Oxygenation
Disruption of the pH and temp

47
Q

the imbalance of _______/________ activity during the remodeling phase can lead to ______ or ____?

A

lysis/synthesis

dehiscence or hypertrophy

48
Q

Partial thickness wounds heal by the process of ____? which on take ____-_____ hours

A

re-epithelialization/ regeneration

49
Q

What are the 4 phases of a full thickness wound?

A

Inflammation
Granulation/Proliferation
Epithelialization
Maturation/remodeling

50
Q

Wound edges are _____ and will gradually adhere. If they are not this, then it is know enduration which is ________ around the wound

A

soft,

hardness

51
Q

Intrinsic Factors affecting healing

A 
age
chronic disease
immunosuppression
sensory impairment
presence of foreign body
tissue perfusion
malnutrition
52
Q

Extrinsic Factors affecting healing

A 
smoking
medication
nutrition
chemotherapy/radiation
stress
trauma
infection of microbial overload
53
Q

Edema cuts of ______% of blood supply

A

40

54
Q

Iatrogenic factors affecting healing

A

local ischemia, treatment choices, trauma

55
Q

What do you assess about the skin?

A 
color
moisture
turgor
degenerative changes
scar tissue
hair pattern (no hair=no blood supply_
weight of person
56
Q

How do u calculate the ABI?

who is this test invalid for?

What are 3 other methods that can be used?

A

ankle systolic pressure / brachial systolic pressure

diabetics

pulses
rubor of dependency test
semmes-weinstein monofilament

57
Q

epiboly? how do fix it?

A

epithelization occurs downwards and under instead of across

debridement or silver nitrate to promote inflammatory phase again

58
Q

Pressure Ulcers are______ while diabetic ulcers are ______.

A

staged, graded

59
Q

Granulation tissue has what characteristics?

A 
beefy red
bump
bleeds easily
sometimes painful
fragile
60
Q

When there is inflammation still occurring during the process of granulation, this can lead to _______ also known as _______.

A

hypergranulation

proud flesh

61
Q

What are the two types of necrotic tissue?

A

slough and eschar

62
Q

re-etpithelialized tissue could be ______ or _____ in color

A

pink or purple

63
Q

What are the 4 types of drainage? describe them

A

serous: clear fluid
sanguinous: has blood
serosanguinous: blood and clear fluid mixed
purulent: puss

64
Q

what is maceration? how do u correct problem?

A

moist wound edges
white
fragile
peeling

more absorptive dressing
increase frequency of dressings
utilize skin barriers/skin prep

65
Q

what are signs of infection?

A

induration, fever, erythema, edema, odor, purulence, increased pain, friable tissue, change in color

66
Q

what is induration and fiable?

A

induration= hardness

fiable= can’t hold structure

67
Q

paper cuts, surgical incision, and small cutaneous wounds close by

A

primary intention

68
Q

what must be built in secondary intention wound closure that doesn’t occur in primary intention?

A

granulation tissue matrix must be built and wound contraction achieved

69
Q

short term goals are ____-_____ weeks and consist of?

A 
2-4 weeks
Promote moist clean environment
Reduce/localize erythema-measure
Reduce/control edema
Shift drainage from purulent to serous
reduce the drainage from copious to mod/min
pain control with dressing or positioning choices
improve periwound integrity to promote contraction
soften necrosis to prepare debridement
reduce risk factors for infection
control drainage with dressings 
education
70
Q

long term goals are _____- ______ weeks and consist of?

A 
4-6 weeks
reduce necrosis by a %
promote granulation %
reduce size of undermining,tract, or tunnel by cm's
reduce wound size by cm's
tissue perfusion and O2 are enhanced
complications are reduced
71
Q

Long term goals in healing for diabetics are?

A 
loading on a body part is decreased
protection of a body part is increased
tolerance to activités are increased
weight bearing status is improved
awareness and use of comm. resources improve
72
Q

Long term goals in healing for vascular insufficiency are?

A

pain is decreased
protection of a body part is increased
sense of well-being is increased
swelling, inflammation or restriction is reduced
tolerance to positions and activities are increased

73
Q

Long term goals in healing for pressure ulcers?

A

loading on a body part is decreased
protection of a body part is improved
sense of well-being is improved
tolerance to positions and activities is increased

wound care (3 decks)

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