Quizzes and Terms Flashcards
1
Q
Protease that degrade debris formed during the inflammatory phase of wound healing
A
MMP’s
2
Q
Describe the sequence of the preoperative phase of healing
A
- angiogenesis
- granulation tissue formation
- wound contraction
- epithelialization
3
Q
Wound contraction is accomplished by?
A
myofibroblasts
4
Q
Myofibroblasts stem from?
A
fibroblasts
5
Q
Which layers of the integument are vascularized?
A
dermis and hypodermis
6
Q
Langerhans’s cells are contained in what layer of the integument?
A
Epidermis
7
Q
The function of the Langerhans’s cells is to do what?
A
protect against infection
8
Q
Which cells are found in the epidermis?
A
- keratinocytes
- merkel cells
- melanocytes
- Langerhans’ cells
9
Q
During diapedesis these cells migrate through the capillar walls
A
PMN’s
10
Q
What stage does diapedesis occur?
A
hemostasis/inflammatory
11
Q
What are the 3 stages of wound healing and the typical time frame.
A
hemostasis/inflammatory: 0-4 days
proliferative: 4-21 days
maturation/remodeling: up to 2 years
12
Q
What is a function of the hypodermis
A
insulation
13
Q
T of F, the dermis regulates fluid loss?
A
False.
14
Q
Name the layers of the integument
A
- epidermis
- dermis
- subcuteaneous tissue
- deeper tissue
15
Q
Name the layers of the epidermis
A
- stratum corneum
- stratum lucidum
- stratum granulosum
- stratum spinosum
- stratum germanotivum or basale
16
Q
Name the layers of the dermis
A
- papillary dermis
2. reticular dermis
17
Q
Name the cells in the dermis
A
- fibroblasts
- macrophages and WBC
- mast cells
- receptors
18
Q
A wound that has loss of superficial epidermis only is called what?
A
erosion wound
19
Q
A wound that has loss of epidermis and part of the dermis is called what?
A
partial thickness wound
20
Q
A wound that has loss of epidermis, dermis and extends to the subcutaneous layer is called what?
A
full thickness wound
21
Q
what are the phases of healing?
A
- hemostasis/inflammation
- proliferation
- remodeling
22
Q
Name 3 chemical mediators in the inflammation phase of healing.
A
- cytokines
- chemotactic agents
- growth factors.
23
Q
which type of debridement is not consisdred selective? sharp autolytic enzymatic mechanical
A
mechanical
24
Q
arrange the following terms in order of increasing bioburden
colonization
contamination
infection
A
contamination > colonization > infection
25
```
a patient has fungus infection in the wound. which of the following would you NOT put in the wound bed
Gentamycin
Miconazole
Nystatin
Oxiconazonle
```
Gentamycin - it is an antiobiotic
26
the use of endogenous enzymes to digest necrosis followed by the application of moisture retentive dressing can be classified as what type of debridement?
autolytic debridement
27
Serial instrument debridement is a type sharp debridement, which tools would you use and why?
forceps and scissors to remove loosely adherent necrotic tissue. this is maintenance debridement done over several visits with minimal pain and bleeding. some prior tissue prep may be needed.
28
3 factors to consider during nutritional assessment of a patient with a wound
etiology, comorbidities, BMI
| NOT INR!
29
Albumin is not an accurate marker to determine malnutrition because
it has a long half life of 20 days
30
you are treating an obese pt with L BKA. she has a wound on her residual limb and cannot wear her prosthesis as a result. the wound is infected wiht MRSA.the appropriate team member to converse with regarding dressing selection is ?
WOCN and infectious disease MD
31
Protein levels are vital for homeostasis. Patients with copious amounts of drainage/exudate are at risk for which of the following issues?
negative nitrogen balance
32
3 signs of infection
- sudden change in pain level
- decline in wound bed status
- periwound erythema that is disproportional to the size of the wond
33
a patient with irradiated skin should be instructed
do not:
wear constrictive clothing or jewelry
scratch skin if it itches
use hot tubs, saunas, or take long hot showers
use adhesive bandages
DO: apply sunscreen to areas where direct sun exposure is anticipated
34
All of the following are appropriate interventions for a patient with a skin tear EXCEPT:
a. avoid adhesives
b. approximate wound edges and then treat with skin sealant
c. never perform debridement
d. apply moisture-retentive dressings
c. Never perform debridement
35
a 46 y.o. darkly pigmented man has been referred to PT for wound management. The pt has an ulcer on his R LE that has not responded to topical antimicrobial therapy and compression bandaging. The wound appears irregular, raised, and undermined with a blue halo surround the lesion. The wound is painful and drains what the patient describes as pus. the patient has a Hx of ulcerative colitis and asthma. what could be possible etiology of this wound?
pyoderma gangrenosum
36
In pressure injuries, what time frame is necessary to cause tissue necrosis or destruction of tissue?
> 6 hours
37
Local area of purple or maroon discoloration of intact skin or blood-filled blister. Area may be painful, firm, ushy, boggy, warmer or coller than surrounding tissue. Wound may evolve and become eschar covered
Suspected deep tissue injury
38
A deep ulcer with extensive necrosis with full-thickness skin loss involving epidermis, dermis, subcuaneous tissue, fascia, and underlying structures, such as muscle, tendon, joint capsule or bone.
Stage iV
39
A superficial ulcer that presents at a shallow pink crater without slough or bruising; or a ruptured or intact blister.
Stage II
40
Typically a full thickness ulcer in which the base of the wound is obscucured by eschar or slough
Unstageable
41
non-blanchable erythema of intact skin
Stage I
42
deep ulcer that presents as deep crater; involves full-thickness skin loss including the epidermis, dermis, and subcutaneous tissue. Bone/tendon are not visible /palpable
Stage III
43
What tissues are involved in an abrasion?
epidermis and/or dermis
44
The most common locations for pressure ulcers to form while in a seated position are
sacrum/coccyx, ischial tuberosity, greater trochanter
45
your patient reports the insidious onset of burning and stinging on his right thumb last night. this morning the patient reported the affected area looked red and swollen. during your examination you note a ulceration with a bulls eye appearance followed by a red, white, and blue sign. the most likely cause of this is:
spider bite
46
surgical wound dehiscense may result from :
a. excessive tension across wound edges
b. underlying infection
c. abscess formation
d. all of the above
all the above
47
Induration can be described as?
edema that is hard or firm, also known as fibrosis
48
a patient presents with a wound on the lower leg measuring 4x3x.2 cm 100% red granular tissue. the wound produces a min amount of serous exudate. the wound is exremely painful and the patient complains that her dressings are sticking to her wound bed, making her bleed. what type of primary dressing could be implemented to minimize the trauma to her wound bed and decrease her pain?
contact layer
49
you are assessing a patient with an abdominal wound measure 13.2x4.5x3.5 cm following an exploratory laparatomy performed yesterday.you palpate the wound bed and appreciate a cavity space at 12 oclock with a depth of 5.5 cm. upon palpation, the cavity space feels like a narrow unidirectional hole.the drainage fromthe cavity space can be described as moderate serosanginous. what is the best term to document this finding?
undermining
NOT sinus tract, fistula nor tunnel
50
when examining a patinent with an open wound which charactristics should be included?
wound size, location, edges, cavity & exposed anatomical structures
51
you are applying a drssing to your patient's wounds.you apply calcium alginate onto the wound bed. next you apply a semipermeable foam dressing. you secure the dressing with paper tape. in this example, what is the secondary dressing that you applied?
semipermeable foam dressing
52
how would you interpret a 1+ dorsalis pedis pulse?
the pulse is diminished
53
blanchable erythema can be described as?
turns white whent the clinician applies digital pressureand returns to patient's original skin pigmentation when pressure is released
54
your patient presents with a wound on the lateral 5th metatarsal measuring 1,2x1.3x.5 cm. the wound produces copious amounts of odorous yellow thick drainage. erythema is observed at the periwound out of proportion to the wound bed.which dressing is appropriate to apply given the findings above?
silver calcium alginate
55
Which of the following is a contraindication to applying negative pressure wound therapy?
a. dehisced surgical wound
b. a split thickness skin graft
c. 80% granular wound
d. 80 % necrotic wound
d
56
A Free Flap is BEST suited for which of the following environments?
A. A site that has a length/width ratio of 2:1
B. Is completely sterile
C. Has sufficient arterial flow
D. an environment with adequate arterial and venous flow/outflow
D. an environment with adequate arterial and venous flow/outflow
57
UVC research has shown:
a. a decrease in epithelial turnover
b. a decrease in vascular permeability
c. a bactericidal effect
d. delayed granulation tissue formation
e. none of the above
c
58
```
All of the following are ways of categorizing flaps EXCEPT
A. Vascular Supply
B. Transfer Method
C. Anatomical Location of transfer
D. Tissue composition
```
c
59
When a Full Thickness Skin Graft fails it is MOST likely due to which of the following?
A. A well vascularized recipient site
B. Use of a bolster dressing post application vs. use of NPWT
C. The skin pigmentation and tissue from the donor site do not match the recipient site
D. Application of the graft with the epidermal side down
d
60
A Split Thickness Skin Graft is best described as which of the following?
A. A graft that contains the epidermis and part of the dermis
B. Very Thin and less then .02 mm thick
C. A graft that is comprised of the Dermis
D. A graft that allows for primary closure
a
61
You have received a referral for physical therapy on a 79-year-old female with a stage IV pressure ulcer over the sacrum that presents with 50% loosley adherent slough and 50% granulation tissue. Bone is palpable in the base of the wound but not visible. There are no other sensitive anatomical structures exposed. The patient has 2/10 pain on the NPS. The patient is taking anticoagulant medication. The physician asks you to perform pulsatile lavage with suction (PLWS). What is the BEST response?
a. Tell the physician that PLWS is contraindicated in this patients case.
b. Perform PLWS on the wound with caution at 4-6 PSI.
c. Ask the physician to hold the medication so you can perform the PLWS.
d. Perform PLWS on the wound with 15 PSI.
b
62
Which of the following is NOT an indication for HBO (hyperbaric oxygen chamber)?
a. gas gangrene
b. necrotizing infections
c. DVT
d. refractory osteomyelitis
c
63
A patient with a 0.6 cm deep round punched out ulceration just proximal to the left lateral malleolus is referred to physical therapy for electrical stimulation. You note greenish, sickly-sweet exudate draining from the wound site. You have spoken with the patients referring physician regarding this change. The physician has indicated to you that he is aware of the wound bed change, the patient has been prescribed gauze soaked in acetic acid to place on the wound, the patient does not have a systemic infection, and you may initiate HVPC electrical stimulation. Which of the following electrode placements is MOST appropriate for this patient?
a. anode placed in the wound, dispersive electrode placed on the proximal quadriceps
b. cathode placed in the wound, dispersive electrode placed on the proximal quadriceps
c. anode placed in the wound, dispersive electrode placed on the proximal gastrocnemius
d. cathode placed in the wound, dispersive electrode placed on the proximal gastrocnemius
b. cathode placed in the wound, dispersive electrode placed on the proximal quadriceps
64
Which of the following is an integumentary integrity complication with obesity?
1. pressure ulcers
2. skin fold damage
3. incontinence-associated dermatitis
4. all of the above
4. all of the above
65
Palliative care is indicated to improve the quality of life when life expectancy is 6 months or less.
True
False
False
66
Which of the following is a goal you could implement for a patient with a wound in palliative care?
1. manage exudate
2. manage odor
3. manage bleeding
4. manage pain
5. all of the above
5. all of the above
67
Gel forming dressings, alginates, thin hydrocolloids with minimized dressing changes should be considered for utilization in the pediatric population (This question excludes the neonatal population).
True
False
True
68
Regarding neonatal skin development, the stratum corneum is first established at ____ weeks of gestation.
1. 24 weeks
2. 26-29 weeks
3. 30 weeks
4. 40 weeks
1. 24 weeks
69
Which of the following statements is true regarding the altered skin function of an obese patient?
1. There is decreased perspiration.
2. There is increased transepidermal water loss.
3. There is decreased androgens and growth factors.
4. There is a decreased prevalence of papules, pustules and nodules.
2.There is increased transepidermal water loss.
70
There is an increased incidence of surgical wound dehiscence and surgical site infections in the obese population due to:
1. Hypoperfusion of adipose tissue
2. Perioperative hypoglycemia
3. Prolonged operative time
4. 1 & 3 only
5. none of the above
6. all of the above
4. 1 & 3 only
71
Corticosteroids, antibiotics and aluminum acetate soaks are recommended for the treatment of moisture associated skin damage in obese patients.
True
False
False
72
In the neonatal population, disinfectants, antiseptics, adhesive tapes and calcium alginates should be avoided.
True
False
True
73
The neonatal skin is structurally similiar to adults and the epidermal/dermal layers are ____ % as strong as adults at 36 weeks.
1. 20
2. 40
3. 60
4. 80
3. 60
74
According to the lecture on lymphedema, lymph collectors are innervated by the sympathetic nervous system of the autonomic nervous system.
T/F?
T
75
```
According to the lecture on lymphedema, Stage 2 Lymphedema (Spontaneous Irreversible Lymphedema) is characterized by:
1.
accumulation of protein-rich fluid
2.
pitting edema
3.
connective tissue proliferation (fibrosis)
4.
all of the above
```
4
76
```
All of the following are consequences or risks of lymphedema EXCEPT
1.
local tissue hyperemia
2.
infection
3.
tissue fibrosis
4.
paresthesias
```
1
77
```
According to the lecture on lymphedema, lymph vessels are ABSENT in all of the following EXCEPT:
1.
bone
2.
spinal cord
3.
muscle
4.
teeth
```
3
78
```
According to the lecture on lymphedema, the lymphatic system is DIFFERENT than the cardiovascular system in that:
1.
it is a closed circulatory system.
2.
it's lymph transport is interrupted by lymph nodes.
3.
it has a central pump.
4.
it protects the body from infection.
```
2.
| it's lymph transport is interrupted by lymph nodes.
79
```
According to the lecture on lymphedema, the following exercises should be implemented for lymphedema treatment EXCEPT:
1.
shoulder rolls
2.
diaphragmatic breathing
3.
neck active range of motion
4.
push up
```
4
80
Which of the following interventions for lymphedema, according to Hamm, requires education beyond her textbook and/or a certification course?
1.
Bandaging
2.
Education of the patient in skin care
3.
Manual lymphatic drainage therapy
4.
Wound care
3
81
According to the lecture on lymphedema, the Stemmer's sign is:
1.
Bulging of superficial veins following release of a thigh tourniquet following elevation of a lower extremity
2.
The inability to pinch a skin fold on the dorsal aspect of an edematous digit
3.
Brownish discoloration of the skin of an extremity
4.
Lack of perspiration on a foot
2
82
According to the lecture on lymphedema, Initial lymph capillaries are located:
1.
approximately 1 mm beneath the epidermis.
2.
approximately 1 mm beneath the dermis.
3.
approximately 1 mm beneath the hypodermis.
4.
approximately 1 mm beneath the subdermis.
1
83
```
Which of the following is NOT a common characteristic of lymphedema?
1.
Chronic condition
2.
Protein-rich edema
3.
Fibrotic changes
4.
Loss of sensation in the affected limb
```
4
