Overview Flashcards
Epidermis has _____ layers
Is it vascular or avascular?
Contains _____,_____, and ____
5
avascular
melanocytes, melanin, langerhan cells
Dermis as _____ layers
Contains _____ and _____ connective tissue
Is it vascular or vascular?
2
collagen and elastin
vascular
Hair follicles, sebaceous glands and sweat glands are found here?
dermis
Lymphatics, blood feels and nerve endings are found _____?
dermis
There dermis contains what 4 type of cells?
fibroblast, macrophages, WBCs, mast cells
Subcutaneous tissues are composed of ______ and ____. They are highly ______. _______ is used for energy.
adipose and fascia
vascularized
fat
Stratum Corneum is the ______ ______ layer containing dead ________. It makes up _______ of the epidermis.
outter most
keratinocytes
3/4
A callus makes up what layer of the epidermis and is made due to what two forces?
stratum corneum
friction and pressure
Stratum lucidum
Stratum granulosum
stratum spinosum
stratum basal
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
what does the basement membrane doe?
scaffolding and selective filter between the epidermis and dermis
How many days does it take for cells to travel from the stratum basale to the stratum corneum?
14-21 days
How does the epidermis get its blood supply?
Diffusion of nutrients from the dermis across the semipermeable basement membrane
melanocytes produce?
merkel cells are?
langerhan cells do what?
Hair follicles are made of ______ and help with ___
melanin protecting from UV rays
Mechanoreceptors for light touch cells
fight infection by attacking and engulfing foreign material
soft keratin, temperature regulation
Hair follicles contain _____ that secrete _____ which to ______ the skin and hair.
sebaceous glands
sebum
lubricate
What are sudiferous glands?
Where are they located?
2 functions?
Sweat glands
Everywhere but lips and ears
cool the body and sow the grow of bacteria this reducing infection
Nails are made of _______. They arise from the ________. Nails can be used ______ and provide _______ to the digits.
hard keratin
stratum germinativum
functionally, protection
What is the papillary dermis?
What are its two functions?
ground substance that conforms to the contours of the stratum basal
Helps anchor the dermis and protects epidermal appendages
Blisters form where?
Papillary dermis junction to the basement membrane
The reticular layer is made up of __________ which provides ________. It is much ______ than the papillary layer.
DCT
structural support
deeper and thicker
what are the functions of the epidermis
physical and chemical barrier regulates fluids produce melanin and coloration light touch sensation asset with excretion temp regulation
what are the functions of the dermis
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
What are the functions of the subcutaneous tissue?
insulation
support
padding
energy storage for other layers of the skin
What are structural changes of the skin that occur due to aging?
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
The inflammatory phase begins immediately and last ________ with the goal being to provide _______ and clear away _______.
3-7 days
hemostasis
bacteria, foreign material, and dead tissue
Which cells are phagocytic and and stimulate fibroblast activity for the proliferative stage?
macrophages
What are the steps to the vascular response of the inflammatory phase?
- injury
- transudate leaks causing localized edema
- vasoconstriction
- platelets aggregate at the injury site
- Platelets release chemical mediators
- vasodilation
What mediates vasoconstriction to occur in the vascular response of the inflammatory phase?
serotonin, norepinephrine, ANS
What activates the platelets to aggregate at the site of the injury?
damaged endothelial cells and exposed collagen
What do platelets release? What do these things do?
cytokines: signaling protein
GF: control cell growth, differentiation, and metabolism
Chemotactic agents: attract cells necessary for repair
_____ released by mast cells increase vessel wall _______ for short term vasodilation. _______ released by injured cells cause long term vasodilation.
Histamine
permeability
Prostaglandin
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 ________.
decrease PMNs Margination Diapedesis Chemotaxis
PMNs release chemotactic agents and mediators that do what 3 functions?
What other two things do PMNs do?
Attract more PMNs
Stimulate fibroblast migration
Induce vascular growth
Secrete enzymes to break down damaged tissue and kill bacteria
Phagocytic bacteria and debris
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?
monocytes macrophages N.O. and bacterial enzymes Phagocytosis 1.signal extent of injury 2. attract more inflammatory cells 3. produce GF
What three substances are released during the inflammatory response that should not be release during the proliferative stage?
ascorbic acid, lactic acid, and hydrogen peroxide.
Which cell stimulates the beginning of the proliferative stage?
Macrophages
What is fibinolysin?
dissolves clots and plugs
What is Fibroplasia?
Endothelial budding?
Myofibroblast?
fibroblast synthesis for granulation tissue
vessels from surrounding tissue migrate to supply nutrients
perform wound contraction at margins
What are the components of the collagen matrix in the proliferative stage?
collagen, hyaluronic acid, elastin and fibronectin
Angiogenesis is directed by what three things?
- local tissue ischemia
- vascular endothelial GF
- chemical mediators
What are Matrix Metalloproteases (MMPs) ?
Produced by fibroblast, keratinocytes, neutrophils, and macrophages to degrade the debris formed during the inflammatory phase leaving a defect.
Within the granulation tissue, _______ provides a scaffold for contact guidance through the receptors of cells called _______ found on their surface.
Extracellular matrix
integrins
Fibroblast are guided by ________ agents and low _____ tension
chemotactic agents
O2
___________ are actin-rich fibroblast that pull on the ECM and draw the wound to close know as the process of ________.
Myofibroblast
contraction
Epitheliazation/ Maturation phase last ______ to ______. Collagen fibers align to _________. The tensile strength of the scar tissue is on _____-_____% of the original skin.
6 months to 2 years
stress
70-80%
what are 2 things that can go wrong in inflammation phase?
Inadequate stimulus for repair
Inadequate perfusion/ischemia
How can granulation be impaired?
increased amounts of inflammatory cytokines
low lvls of GF cytokines
Inadequate substrates ( proteins, vitamins, minerals
Inadequate Oxygenation
Disruption of the pH and temp
the imbalance of _______/________ activity during the remodeling phase can lead to ______ or ____?
lysis/synthesis
dehiscence or hypertrophy
Partial thickness wounds heal by the process of ____? which on take ____-_____ hours
re-epithelialization/ regeneration
What are the 4 phases of a full thickness wound?
Inflammation
Granulation/Proliferation
Epithelialization
Maturation/remodeling
Wound edges are _____ and will gradually adhere. If they are not this, then it is know enduration which is ________ around the wound
soft,
hardness
Intrinsic Factors affecting healing
age chronic disease immunosuppression sensory impairment presence of foreign body tissue perfusion malnutrition
Extrinsic Factors affecting healing
smoking medication nutrition chemotherapy/radiation stress trauma infection of microbial overload
Edema cuts of ______% of blood supply
40
Iatrogenic factors affecting healing
local ischemia, treatment choices, trauma
What do you assess about the skin?
color moisture turgor degenerative changes scar tissue hair pattern (no hair=no blood supply_ weight of person
How do u calculate the ABI?
who is this test invalid for?
What are 3 other methods that can be used?
ankle systolic pressure / brachial systolic pressure
diabetics
pulses
rubor of dependency test
semmes-weinstein monofilament
epiboly? how do fix it?
epithelization occurs downwards and under instead of across
debridement or silver nitrate to promote inflammatory phase again
Pressure Ulcers are______ while diabetic ulcers are ______.
staged, graded
Granulation tissue has what characteristics?
beefy red bump bleeds easily sometimes painful fragile
When there is inflammation still occurring during the process of granulation, this can lead to _______ also known as _______.
hypergranulation
proud flesh
What are the two types of necrotic tissue?
slough and eschar
re-etpithelialized tissue could be ______ or _____ in color
pink or purple
What are the 4 types of drainage? describe them
serous: clear fluid
sanguinous: has blood
serosanguinous: blood and clear fluid mixed
purulent: puss
what is maceration? how do u correct problem?
moist wound edges
white
fragile
peeling
more absorptive dressing
increase frequency of dressings
utilize skin barriers/skin prep
what are signs of infection?
induration, fever, erythema, edema, odor, purulence, increased pain, friable tissue, change in color
what is induration and fiable?
induration= hardness
fiable= can’t hold structure
paper cuts, surgical incision, and small cutaneous wounds close by
primary intention
what must be built in secondary intention wound closure that doesn’t occur in primary intention?
granulation tissue matrix must be built and wound contraction achieved
short term goals are ____-_____ weeks and consist of?
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
long term goals are _____- ______ weeks and consist of?
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
Long term goals in healing for diabetics are?
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
Long term goals in healing for vascular insufficiency are?
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
Long term goals in healing for pressure ulcers?
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
