Random Review INTEGUMENTARY Flashcards
1
Q
Herpes zoster AKA
A
Shingles
2
Q
Symptoms of shingles
A
- Painful, blistering skin rash
- One-sided pain, tingling, or burning followed by development of a rash
- Can also occur post-surgery
3
Q
Tapotement
A
brisk percussive movements, goal is to increase alertness or stimulate airway clearance
4
Q
Effleurage
A
slide or glide over the skin w/ continuous motion; increases relaxation and venous/lymphatic drainage
5
Q
Petrissage
A
compression of soft tissue through kneading, wringing, rolling, and picking up techniques for muscle fibrosis
6
Q
Friction massage
A
- direct circular or cross-fiber massage applied to increase mobility of scar tissue
- Breaks adhesions
7
Q
Myofascial massage
A
Stretch forces applied across fascial planes
8
Q
Types of wounds
A
- Acute
- Ulcers
9
Q
Types of acute wounds
A
- Abrasion
- Avulsion
- Incisional wound
- Laceration
- Penetrating
- Puncture
- Skin tear
10
Q
Types of ulcers
A
- Arterial insufficiency
- Venous insufficiency
- Neuropathic
- Pressure
11
Q
Arterial insufficiency ulcers
A
- Wounds from lacking circulation of oxygenated blood
- Recommend rest, limb protection, education, leg/feet inspection daily, avoid leg elevation, avoid heating pads, and wear good-fitting shoes
12
Q
Venous insufficiency ulcers
A
- Wounds from impaired venous function lacking circulation
- Recommend limb protection, education, leg/foot inspection, compression, elevate legs, attempt active exercise, good-fitting shoes
13
Q
Neuropathic ulcers
A
- Wounds secondary to ischemia and neuropathy. Can also be associated w/ DM
- Recommend limb protection, education, leg/foot inspection, compression, good-fitting shoes
14
Q
Pressure ulcers
A
- Result from prolonged pressure on tissues and subsequent ischemia
- Recommend reposition every 2 hours, management of excess moisture, off-loading, inspect skin daily, limit shear/traction/friction
15
Q
Location of arterial insufficiency ulcers
A
Lower 1/3 of leg, toes, web spaces
16
Q
Appearance of arterial insufficiency ulcers
A
- Smooth edges, well defined
- Lack granulation tissue
- Tends to be deep
17
Q
Exudate of arterial insufficiency ulcers
A
Minimal
18
Q
Pain of of arterial insufficiency ulcers
A
Severe
19
Q
Pedal pulses of arterial insufficiency ulcers
A
Diminished or absent
20
Q
Edema of arterial insufficiency ulcers
A
Normal
21
Q
Skin temperature of arterial insufficiency ulcers
A
Decreased
22
Q
Tissue changes of arterial insufficiency ulcers
A
- Thin and shiny
- Hair loss
- Yellow nails
23
Q
Impact of leg elevation w/ arterial insufficiency ulcers
A
Leg elevation increases pain
24
Q
Location of venous insufficiency ulcers
A
Proximal to the medial malleolus
25
Appearance of venous insufficiency ulcers
Irregular shape; shallow
26
Exudate of venous insufficiency ulcers
Moderate/heavy
27
Pain of venous insufficiency ulcers
Mild to moderate
28
Pedal pulses of venous insufficiency ulcers
Normal
29
Edema of venous insufficiency ulcers
Increased
30
Skin temperature of venous insufficiency ulcers
Normal
31
Tissue changes of venous insufficiency ulcers
Flaking, dry skin; brownish discoloration
32
Impact of limb elevation on pain w/ venous insufficiency ulcers
Leg elevation lessens pain
33
Location of neuropathic ulcers
Areas of the foot susceptible to pressure or shear forces during weight bearing
34
Appearance of neuropathic ulcers
- Well-defined oval or circle
- Callused rim
- Cracked periwound tissue
- Little to no wound bed necrosis w/ good granulation
35
Exudate of neuropathic ulcers
Low/moderate
36
Pain of neuropathic ulcers
None, however dysesthesia may be reported
37
Pedal pulses of neuropathic ulcers
- Diminished or absent
- Unreliable ankle-brachial index w/ diabetes
38
Edema of neuropathic ulcers
Normal
39
Skin temperature of neuropathic ulcers
Decreased
40
Tissue changes of neuropathic ulcers
- Dry, inelastic, shiny skin
- Decreased or absent sweat and oil production
41
What mechanism with nerves is lost in patients w/ neuropathic ulcers
Loss of protective sensation
42
Wound classification by depth of injury
- Superficial wound
- Partial-thickness wound
- Full-thickness wound
- Subcutaneous wound
43
Superficial wound
Trauma to the skin w/ epidermis staying intact
44
Partial-thickness wound
Through the epidermis and into (not through) the dermis
45
Full-thickness wound
Extends through the dermis into deeper structures like subcutaneous fat
46
Subcutaneous wound
Through integumentary tissues and involve deeper structures like fat, muscle, tendon, or bones
47
Pressure injury stages
- Stage 1
- Stage 2
- Stage 3
- Stage 4
- Unstageable
- Deep Tissue Pressure Injury
48
Stage 1 pressure injury
- Non blanchable erythema of intact skin
- Changes in sensation, temperature, or firmness may precede visual changes
- Color changes do not include purple or maroon
- Discoloration (indicates deep tissue pressure injury)
49
Stage 2 pressure injury
- Partial-thickness skin loss w/ exposed dermis
- Wound bed viable, pink or red, moist
- Intact or ruptured serum-filled blister
- Adipose (fat) not visible
- Deeper tissues not visible
- Granulation tissue, slough, and eschar not present
50
Stage 3 pressure injury
- Full-thickness skin loss
- Adipose (fat) is visible in the ulcer
- Granulation tissue and rolled wound edges often present
- Slough and/or eschar may be visible
- Depth of tissue damage varies by anatomical location
- Fascia, muscle, tendon, ligament, cartilage and/or bone not exposed
51
Stage 4 pressure injury
- Full-thickness skin and tissue loss
-Exposed or directly palpable fascia, muscle, tendon, ligament, cartilage, or bone in the ulcer
- Slough and/or eschar may be visible
- Rolled wound edges, undermining, and/or tunneling often occurs
52
Unstageable pressure injury
obscured full-thickness skin and tissue loss
53
Deep Tissue Pressure Injury
Persistent non-blanchable deep red, maroon, or purple discoloration
54
Serous exudate
- Clear, light color (maybe light yellow tint) w/ thin, watery consistency
- Normal in a healthy healing wound
55
Sanguineous exudate
- Red w/ thin, watery consistency
- Red due to presence of blood, which indicates new blood vessel growth or disruption of blood vessels
56
Serosanguineous exudate
- Light red or pink color w/ thin watery consistency
- Normal in a healthy healing wound
57
Seropurulent exudate
- Cloudy or opaque, w/ yellow or tan color; thin, watery consistency
- May be an early warning of impending infection
- ALWAYS abnormal
58
Purulent exudate
- Yellow or green color w/ thick, viscous consistency
- Indicates wound infection
- ALWAYS abnormal
59
Eschar
- Hard or leathery, black/brown, dehydrated tissue
- Firmly adhered to the wound bed
60
Gangrene
Dead and decaying tissue, can include the presence of bacterial infection
61
Hyperkeratosis
- Callus
- Typically white/gray, can vary in texture from firm to soggy
62
Slough
- Moist, stringy or mucinous
- White or yellow
- Tends to be loosely attached in clumps to the wound bed
63
What is the Red-Yellow-Black system for wound healing interventions?
Based on the color of the tissue we have a description and goals for how to treat the wound
64
"Red" wound healing intervention description
Pink granulation tissue
65
"Red" wound healing intervention goals
- Protect wound
- Maintain moist environment
66
"Yellow" wound healing intervention description
Moist, yellow slough
67
"Yellow" wound healing intervention goals
- Remove exudate and debris
- Absorb drainage
68
"Black" wound healing intervention description
Black, thick eschar firmly adhered
69
"Black" wound healing intervention goals
Debride necrotic tissue
70
Indications for using alginate dressing
- Partial or full-thickness draining wounds
- Often used on infected wounds due to drainage
71
Indications for using foam dressings
- Provide protection and absorption over partial and full-thickness wounds
- Varying levels of exudate
72
Indications for using gauze dressings
- Commonly used on infected or non-infected wounds of any size
- Can be used for wet-to-wet , wet-to-moist, or wet-to-dry debridement
73
Indications for using hydrocolloids
- Partial and full-thickness wounds
- Can be used effectively w/ granular or necrotic wounds
74
Indications for using hydrogels
- Moisture retention (also donates moisture)
- Superficial or partial thickness wounds
- Minimal drainage
75
Indications for using transparent film
- Superficial or partial-thickness wounds
- Minimal drainage
76
Occlusion
More occlusion --> impermeable
77
Dressings from most to least occlusive
- Hydrocolloids
- Hydrogels
- Semipermeable foam
- Semipermeable film
- Impregnated gauze
- Alginates
- Traditional gauze
78
Dressings from most to least moisture retentive
- Alginates
- Semipermeable foams
- Hydrocolloids
- Hydrogels
- Semipermeable films
79
Zones of a burn injury
Zone of:
- Coagulation
- Stasis
- Hyperemia
80
Zone of Coagulation
The area of the burn that received the most severe injury w/ irreversible cell damage
81
Zone of Stasis
The area of less severe injury that possesses reversible damage and surrounds the zone of coagulation
82
Zone of Hyperemia
- The area surrounding the zone of stasis that presents w/ inflammation
- Will recover w/o any intervention or permanent damage
83
Superficial burn
- Only outer epidermis
- Red w/ slight edema
- Healing occurs w/o peeling or evidence of scarring in 2-5 days
84
Superficial partial-thickness burn
- Involves epidermis and upper portion of the dermis
- Involved area extremely painful and exhibits blisters
- Healing occurs w/ minimal to no scarring in 5-21 days
85
Deep partial-thickness burn
- Complete destruction of epidermis and majority of dermis
- Discoloration w/ broken blisters and edema
- Damaged nerve endings --> moderate pain
- Hypertrophic or keloid scarring may occur
- Healing in 21-35 days
86
Full thickness burn
- Complete destruction of epidermis and dermis
- Partial damage of subcutaneous fat
- Typically presents w/ eschar formation and minimal pain
- Minimal pain
- Skin grafts required and susceptible to infection
- Healing ranges from weeks to months
87
Subdermal burn
- Complete destruction of epidermis, dermis, and subcutaneous tissue
- May involve muscle and bone
- May need multiple surgical interventions and extensive healing time
88
Rule of nines for burns (in adults)
- Head + neck = 9%
- Anterior trunk = 18%
- Posterior trunk = 18%
- Bilateral anterior arm, forearm, and hand = 9%
- Bilateral posterior arm, forearm, and hand = 9%
- Genital = 1%
- Bilateral anterior leg and foot = 18%
- Bilateral posterior leg and foot = 18%
89
Anticipated deformity for burns to anterior neck
Flexion w/ possible lateral flexion
90
Anticipated deformity for burns to anterior chest and axilla
Shoulder adduction, extension, and IR
91
Anticipated deformity for burns to elbow
Flexion and pronation
92
Anticipated deformity for burns to hand and wrist
- Extension or hyper extension for MCP
- Flexion of IP
- Adduction and flexion of thumb
- Wrist flexion
93
Anticipated deformity for burns to hip
Flexion and adduction
94
Anticipated deformity for burns to knee
Flexion
95
Anticipated deformity for burns to ankle
Plantar flexion
96
How to test for protective sensation
Monofilament testing
97
Failure to perceive 10 gm monofilament
loss of protective sensation
98
Failure to perceive 75 gm monofilament
insensate
99
Nevus
a benign growth on the skin that is formed by a cluster of melanocytes
100
What does TMN mean when staging cancer?
Tumor node metastasis
- T: refers to main tumor and describes its size
- N: refers to the lymph nodes and if the cancer has spread there
- M: if there is a distant metastasis of the cancer
101
Characteristics of psoriasis
- Dry erythematous plaques
- Silvery scales
102
Characteristics of urticaria
- Hives
- Red/pink edematous wheals
103
Characteristics of eczema or dermatitis
- Dry, red, itchy patches of skin
- Begin to weep in severe cases
- Commonly caused by exposure to some allergen
104
Treatment of dermatitis
ID the irritant and remove it
105
Xerosis
Dry skin
106
Dermatitis vs cellulitis
With dermatitis
- Swelling is not typical
- Fever not expected
107
Purpura
- Form when capillaries burst and leak
- Blood pools beneath the skin
- Do not blanch w/ pressurre
- Bigger than petechiae
108
Pruritus
Itching of the skin
109
Petechiae
Small (<3mm) red or purple spots on the skin due to broken capillaries
110
Guidelines for ROM interventions following a burn injury
- All extremities should be part of the program
- AROM and AAROM are preferred over PROM
- Typically safest and most effective when bandages are off to prevent shearing forcecs
111
If the patient requires grafting, when should ROM exercises begin?
4-5 days following the graft
112
Why are pillows under the knees contraindicated w/ burn recovery
- Scar bands occur most often on the posterior aspect of the knee
- Pillows under the knees may lead to knee flexion contractures
113
Where is scar banding most common in the UE?
Anterior aspect of the elbow (limits extension)
114
Primary function of the dermis?
- To nourish itself and the epidermis
- Provide sensation, assist w/ infection control, thermoregulation
115
ABCDE method of detecting melanoma
A --> asymmetrical
B --> uneven border
C --> multi-shaded brown, tan, black
D --> diameter 6+ mm
E --> elevated surface or evolving characteristics (changing size, crusting, bleeding, changing color)
116
What is the Braden Scale?
Used for predicting pressure ulcer risk
117
Subscales of the Braden scale
- Mobility
- Activity
- Sensory perception
- Skin moisture
- Nutritional status
- Friction/shear
Score ranges from 6-23 (low = more risk)
118
Split thickness skin graft
Involves the epidermis and part of the dermis
119
What does meshing a skin graft accomplish?
By placing small cuts throughout the graft, it can be stretched to cover a greater surface area
120
Allograft
A cacdaver graft
121
Efficacy differences b/t allo and autografts
Allografts may be used for temporary coverage, but they can be rejected since they are foreign tissues
122
A butterfly rash on the face indicates what?
Systemic lupus erythematosus
123
Wound dehiscence
Wound edges have dissociated
124
Scleroderma
- Chronic, diffuse connective tissue disease
- Causes fibrosis of the skin, joints, blood vessels, and internal organs
- Skin becomes firm and edematous
- Symmetrical involvement of the extremities and face
125
Progression of scleroderma
- Visceral involvement includes lungs, heart, kidneys, and GI tract
- Involvement of lungs leads to dyspnea in 60% of patients
126
Cellulitis
- Caused by a bacterial infection
- Often occurs w/ some injury to the extremity (i.e. cut, scrape, or burn)
- Results in red, swollen skin
- May present w/ a fever
- Painful to the touch
- Can have wounds that appear in the distal LE's
127
Which layers of the skin are affected by cellulitis?
Dermis and subcutaneous tissues
128
Systemic symptoms associated w/ cellulitis
Fever, chills, malaise
129
Risk factors for cellulitis
- Obesity
- Diabetes
- Alcohol use (weakens the immune system, making infection possible)
130
When do kids use the regular rule of nines for burn calculations?
At 9 years
131
Burn area calculation for kids under 1 year
- Head and neck --> 18%
- Left UE (anterior and posterior) --> 9%
- Right UE (anterior and posterior ) --> 9%
- Anterior trunk --> 18%
- Posterior trunk --> 18%
- Left LE (anterior and posterior) --> 14%
- Right LE (anterior and posterior) --> 14%
132
Transition from under 1 year to 9 years old for burn calculation
For each year, 1% is given back to the LE's
133
Stage 1 pressure injury treatment
- Most easily treated by conservative measures (repositioning and education about protection)
- May not require a dressing when skin is intact (may use one to decrease friction)
- These interventions are likely insufficient for stage 2 and above
134
When to use electrical stimulation for wound healing
Slow healing stage II pressure injury, and for stage III/IV
135
Wagner Classification Scale for Neuropathic Foot Ulcers
Grades 0-5
136
Grade 0 Wagner Classification Scale for Neuropathic Foot Ulcers
- no open lesions
- may have deformity or cellulitis
- Healed ulcer
137
Grade 1 Wagner Classification Scale for Neuropathic Foot Ulcers
- Superficial ulcer
- Without subcutaneous tissue involvement
138
Grade 2 Wagner Classification Scale for Neuropathic Foot Ulcers
- Deep ulcer to tendon capsule, or bone
139
Grade 3 Wagner Classification Scale for Neuropathic Foot Ulcers
Deep ulcer w/ abscess, osteomyetlitis, or joint sepsis
140
Grade 4 Wagner Classification Scale for Neuropathic Foot Ulcers
Localized gangrene
141
Grade 5 Wagner Classification Scale for Neuropathic Foot Ulcers
- Gangrene of the entire foot
- Requires amputation
142
What causes tunneling in a wound?
Narrow separations of the fascial planes
143
How many "ply's" can be used to help a prothesis fit better in an amputee?
Up to 10-ply socks
144
Complications resulting from burn injuries
- Increased capillary permeability
- HYPOvolemia
- HYPOtension
- Increased metabolism
- Pulmonary edema
- Respiratory distress
- Risk of infection
- Organ dysfunction
- Emotional trauma
145
When using electrical stimulation for wound healing, are the electrodes allowed in the wound?
Yes it is allowed, either in or adjacent
146
Frequency of electrical stimulation for wound healing
Daily is effective, 45-60 minutes
147
Type of current for electrical stimulation for wound healing
High-volt monophasic
148
Intensity of electrical stimulation for wound healing
Sub-motor
149
Phases of healing
- Inflammatory Phase
- Proliferative Phase
- Maturation Phase
150
Characteristics of Inflammatory Phase
- Prepares the wound for healing
- Characterized by redness, edema, warmth, and pain
- Typically lasts 1–6 days
151
Characteristics of Proliferative Phase
- Rebuilds damaged structures and strengthens the wound
- Inflammatory response subsides
- Epithelialization, collagen production, wound contraction, and neovascularization occur simultaneously
- Typically occurs between 3 and 20 days after injury
152
Characteristics of Maturation Phase
- Scar is remodeled with changes in size and form
- Scar tissue matures and strengthens
- Typically lasts 9 days to 2 years
153
Which kind of collagen would you expect in the proliferation stage?
Type III
154
Which kind of collagen would you expect in the maturation stage?
Type I (stronger and more mature)
155
Adaptic dressing
Designed to minimize wound adherence so pain is minimized during dressing changes
156
Use of collagenase
Debride eschar
157
Eczema
Skin inflammation caused by an endogenous agent
158
Keloid scar
- Excessive collagen production with
- Scarring extends beyond the margins of the original wound
159
Hypertrophic scar
- Excessive collagen production
- Scarring says within the margins of the original wound
160
How often should dressing changes happen w/ negative pressure wound therapy?
- Every 48+ hours for a healthy, clean wound
- Every 12 hours for infected wounds
161
In what circumstances is negative pressure wound therapy used?
- Acute surgical wounds
- Slow healing wounds
162
What kind of dressing is appropriate with negative pressure wound therapy?
Foam dressing
163
What outcomes can be expected with negative pressure wound therapy?
- Decreased edema
- Increased oxygen levels
- Promotes wound closure
- Increases granulation tissue
164
National Pressure Injury Advisory Panel (NPIAP) classification system description of wound healing
- Stages can be described progressively, but not regressively
- I.e. stage 3 does not become stage 2 as it improves, but is described as "healing stage 3" with percentage of healing that has occurred
- Also has measurements and descriptions
165
Standard time interval for repositioning
- 2 hours
- Less time for patients who have an existing wound
166
Gas gangrene
a special type of gangrene caused by infection of injured tissue by one of many species of Clostridium
167
Gangrenous necrosis
due to death of tissue and results from severe hypoxic injury, not infection
168
Wet gangrene
- develops when neutrophils invade the site,
- Causes liquefactive necrosis
- It is not due to infection
169
Fat necrosis
- cellular dissolution caused by powerful enzymes, called lipases
- occurs in the breast, pancreas, and other abdominal structures
- It is not due to infection
