Skin Structure and Function 5 - Tutorial

Question 1

Spongiosis?

Answer 1

Intracellular edema

Question 2

Parakeratosis?

Answer 2

Mode of keratinisation (keratin hardening) characterised by the retention of nuclei in the stratum corneum

Question 3

Abscess?

Answer 3

A swollen area within body tissue containing an accumulation of pus

Question 4

Rete pegs?

Answer 4

Downwards thickening of the epidermis between dermal papillae

Question 5

6 requirements for healthy skin?

Answer 5

Intact physical barrier
Functioning immune system
Functioning vasculature/ adequate supply and drainage (arterial, venous, lymphatics and capillaries)
Normal sensory nerve function
Functioning sweat glands
Adequate nutrition

Question 6

What is slough?

What is it made of?

Answer 6

Necrotic tissue separating from living structure

Mixture of dead cells, polymorphs + bacteria

Question 7

Should slough be removed from a wound?

Answer 7

Yes - has a negative effect on wound healing

Question 8

How is slough removed from a wound?

Answer 8

Chemically or physically by debridement

Question 9

What are the 3 stages of wound healing?

Answer 9

Inflammation
Proliferation
Tissue remodelling

Question 10

What happens during inflammation in wound healing?

Answer 10

Platelets form initial clot and release inflammatory mediators
Leukocytes debride the wound bed by phagocytosing bacteria and scavenging cellular debris
Inflammation gradually decreases as keratinocyte proliferation and new tissue formation becomes predominant

Question 11

What happens during proliferation in wound healing?

Answer 11

Cells divide to re-epitheliase the wound surface
Granulation tissue formation is stimulated
Fibroblasts lay down matrix and contract the wound (fibroplasia)
Epithelial cells develop into new blood vessels (angiogenesis)

Question 12

What happens during tissue remodelling in wound healing?

Answer 12

New tissue is converted into mature scar tissue over a period of months
Fibroblasts lay down collagen to improve the tensile strength of the scar and restore the normal dermal matrix

Question 13

Primary intention of surgical wounds?

Answer 13

An acute wound is closed by approximating wound edges

Question 14

Secondary intention of surgical wounds?

Answer 14

Acute wound is left to heal on its own - takes longer but can produce satisfactory results

Question 15

What is a burn?

Answer 15

Thermal injury to the skin

Question 16

What layers of the skin does a first degree burn affect?

Appearance?

Answer 16

Epidermis only

Erythematous, wet, extremely painful

Question 17

What layers of the skin does a second degree/ partial thickness burn affect?
Appearance?

Answer 17

Epidermis and dermis

Red, blistered, wet/ weeping, painful

Question 18

What layers of the skin does a third degree burn affect?

appearance?

Answer 18

Extends beyond dermis

White or black, charred, dry, numb

Question 19

6 causes of delayed healing of a wound?

Answer 19

Infection
Poor arterial blood supply
Poor nutrition
Impaired venous return
Repeated trauma/ pressure
Systemic disease e.g. diabetes/ anaemia

Question 20

What is another name for a decubitus ulcer?

Answer 20

Pressure sore/ bed sore/ pressure ulcer/ pressure wound

Question 21

Causes of a bed sore? (4)

Answer 21

Prolonged pressure over bony area
Lack of blood flow (2 - 3 hours)
Friction from bedding/ clothing
Sweat, blood, urine, faeces

Question 22

Stages of development of a bed sore?

Answer 22

• Skin unbroken but shows a pink or reddened area (may be tender or itch)
• skin is red, swollen and painful. Blisters may be present. Upper layers of skin begin to die
• sore has broken through skin and wound extends down to deeper layers of tissue. Crater-like ulcers are present Wound is prone to infection
• sore extends beyond the skin and into fat, muscle and bone tissue. Blackened dead tissue called “eschar” ma be seen in deep opened wounds

Question 23

Prevention of Bed Sores? (6)

Answer 23

Identify at risk groups
Use special mattresses
Turn patient regularly
Keep skin clean and hydrated
Regularly assess skin
Good nutrition