Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

6th MELEAH SAS 1 > T1 Lecture 2: Fundamentals of Wound Management > Flashcards

T1 Lecture 2: Fundamentals of Wound Management Flashcards

1
Q

Wound healing brings about tissue repair and regeneration and its a fine tune process that culminates in formation of the ____

A

scar

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the 4 stages of wound healing in order?

A

I Demand Rossies Memorize

  • Inflammatory phase
  • Debridement phase
  • Repair
  • Maturation/remodeling phase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

With wound healing can more than one stage happen at the same time? Do all wounds go through all the phases or can they skip some?

A

• Significant degree of overlap
so more than one stage may be
occurring simultaneously

• ALL normally healing wounds
must undergo all stages of wound
healing regardless of
size/cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

True or False:

Normal wound healing can bypass certain phases of the 4 step wound healing process.

A

False

• ALL normally healing wounds must undergo all stages of wound healing regardless of size/cause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe what takes place in the first 3-5 days of wound healing, what phases are predominating causing this?

A

The lag phase of wound healing because inflammation and debridement predominate and wounds have not gained appreciable strength**

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Inflammatory phase takes place first within __-__ days

A

0-5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

______ is a protective response initiated by tissue damage

A

Inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The Inflammatory phase of healing is characterized by the following: (4)

  • Increased…..?
  • Recruitment of …..?
  • Release of _____ and ____
  • Activation of these?
A

– Increased permeability of local blood vessels

– Recruitment of circulatory cells

– Release of growth factors and cytokines

– Activation of neutrophils, lymphocytes, fibroblasts & macrophages

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

1st response to any injury is?

A

Hemorrhage (TO BLEED DUHHH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the general process of inflammation

  1. Bleeding/Hemorrhage
  2. ______
  3. ____ ____
  4. Vasodilation
  5. ______ response
  6. Formation of ______
A
  1. Hemorrhage
  2. Vasoconstriction
  3. Fibrin clot
  4. Vasodilation
  5. Leukocyte response
  6. Formation of Platelets
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

During the inflammatory phase after injury takes place and the body responds with hemorrhage?

Describe what takes place next?

What quickly follows after that, why this is taking place?

A

Vasoconstriction (5-10 min.)

– Next step is to control hemorrhage = Fibrin clot

– Clot also occludes ruptured lymphatics and Prevent drainage/cause edema/localized inflammation = “Glues” wound edges together

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

After the vasoconstriction, what is next?

Vasodilation to Increased ______ _____

the vessels release ______ ____
(_____ acid cascade) & cellular components

This inflammation lasts ~ __ days

A

vascular permeability

inflammatory mediators

(arachidonic acid cascade)

~ 5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What takes place next in the sequence of inflammation after vasodilation?

State the first responders and then who comes next?

A

Leukocyte response – PMN’s = 1st responders then macrophages and then T-lymphocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Of the leukocytes who arrives first?

A

PMN’s (polymononuclear neutrophils) = 1st responders

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

After the leukocytes response next comes platelets and coagulation but these platelets are also responsible for producing?

A

several cytokines/growth factors important
for progression of wound healing

(Examples) PDGF, transforming growth factor – ⍺ & β, TNF-⍺ = chemotactic for these guys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

To transition from inflammatory phase to debridement what takes place next?

A

White blood cells (The arrival of neutrophils ~6 hr. after wounding & monocytes ~ 12 hrs) leaking from blood vessels into wounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the timing in terms of days with the debridement phase?

A

2-5 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Generally, where does debridement take place and what does it cause?

A

W/in wound bed = Development of an exudate rich in WBC’s, wound fluid & necrotic tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Neutrophils Increase in number for 2 - 3 days and there job is to?

A

Job’s are to prevent infection & phagocytize organisms and debris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the significance of degenerating neutrophils in terms of what do they release and facilitate and stimulate?

A

Degenerating neutrophils release enzymes/toxic oxygen products = Facilitate breakdown of bacteria, extracellular debris/necrotic material & they stimulate monocytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Compare and contrast monocytes and neutrophils and state who is essential for wound healing and who is not?

A

*Monocytes: Essential for wound healing (neutrophils/lymphocytes = NOT)!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are monocytes main role?

A

Major secretory cells synthesizing growth factors that participate in tissue formation &
remodeling

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Monocytes turn into ______ in wounds with __-__ hours

A

macrophages; 24-48

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the 3 main roles of macrophages?

  1. Secrete ____ to removing ______ tissue, bacteria, and ____ ____
A
  1. Secrete collagenases removing necrotic tissue, bacteria and foreign material
  2. Secrete chemotactic & growth factors
  3. Macrophages also recruit mesenchymal cells, stimulate angiogenesis and modulate matrix production in wounds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What are chemotactic factors?

A 
Chemotactic factors (i.e., complement, collagen fragments, bacterial endotoxins, and inflammatory cell
products) direct macrophages to injured tissue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What do growth factors initiate?

A 
Growth factors (i.e., platelet-derived growth factor, transforming growth factor-α, transforming growth
factor-β, fibroblast growth factor, and interleukin-1) can initiate, maintain & coordinate formation of granulation tissue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

_____ appear later in the debridement phase than neutrophils/macrophages

A

Lymphocytes

28
Q

What do lymphocytes secrete in the debridement phase and what do they do?

A
  • Secrete soluble factors that may stimulate or inhibit migration & protein synthesis by other cells
  • Improve rate & quality of tissue repair
29
Q

Name the growth factor and state their source? Which one is from macrophages?

BFGF

A

BFGF (Basic fibroblast GF)- From Macrophages/MC’s/T-lymphs

30
Q

Name the growth factor and state their source? Which one is from macrophages?

EGF

A

EGF (epidermal GF)- From Plts/Macrophages

31
Q

Name the growth factor and state their source? Which one is from macrophages?

KGF

A

KGF (keratinocyte GF)- From Fibroblasts

AKA growth Factor 7

32
Q

Name the growth factor and state their source? Which one is from macrophages?

PDGF

A

PDGF (platelet derived GF)- From Plts./Macro./endothelial cells

33
Q

Name the growth factor and state their source? Which one is from macrophages?

TGF alpha
TGF beta

A

TGF alpha (transforming GF)- From Macrophages/Plts/lymphs/hepatocytes

TGF beta (transforming GF)- From Macrophages/Plts/lymphs/hepatocytes

34
Q

Name the growth factor and state their source? Which one is from macrophages?

VEGF

A

VEGF (Vascular Endothelial cell GF)- **From endothelial cells*

35
Q

What 2 growth factors are not from macrophages?

A
  1. KGF-from fibroblasts

2. VEGF-from endothelial cells

36
Q

During the Repair phase what days of wound healing does this take place during?

A

3-5 days to 2-4 weeks

37
Q

What happens first with macrophages during the repair phase?

A

Macrophages stimulate fibroblast & DNA proliferation

38
Q

(repair phase?)

Fibroblasts originate from?

A

Fibroblasts originate from undifferentiated mesenchymal cells in surrounding
connective tissue which leads to them Migrating into wound along strands of fibrin in wound clot

39
Q

Fibroblasts Synthesize & deposit _____, _____, and ______ that mature into fibrous tissue. What environment do they prefer?

A

collagen, elastin & proteoglycans

• Prefers slightly acidic and oxygen rich (~20mm Hg) environment

40
Q

______ infiltrate wound behind fibroblasts = and facilitate _______

– Relies on?

A

Capillaries; Angiogenesis

– Relies on interaction of extracellular matrix w/ cytokines that stimulate migration/proliferation of
endothelial cells

41
Q

Capillaries infiltrate wound behind fibroblasts = Angiogenesis which increase _____ _____ in the wound to improve ______

A

Increase oxygen tension in wound = Improved fibroplasia

42
Q

Combination of fibroblasts, new capillaries & fibrous tissue development results in
the formation of? __-__ days after wounding

A

bright red, fleshy granulation tissue ~ 3-5 days after wounding

43
Q

______ _____ fills defects and protects wounds?

A

Granulation tissue

44
Q

Granulation tissue serves 3 main functions?

A

– Excellent barrier to infection

– Serves as source of special fibroblasts
• Myofibroblasts = Use in wound contraction

– Surface for epithelial migration

45
Q

What is the rate of at which granulation tissue is formed?

A

Formed at each wound edge at rate of:

0.4 to 1mm/day

46
Q

During the repair phase, what step is next after healthy granulation tissue is formed?

A

Epithelialization = Mobilization, proliferation & differentiation of epithelial cells

47
Q

Epithelialization of sutured wounds begins within __-__ hours and with an open wound it begins within __-__ days

A

sutured 24-48 hours

open wound 4-5 days

48
Q

Open wound epithelialization begins within 4-5 days and requires?

A

requires granulation tissue to create a scaffold to crawl across

49
Q

Migration of epithelial cells is random but guided by ____ ____. Migrating cells enlarge, flatten & mobilize, losing their attachments to the basement membrane &
other epithelial cells

A

collagen fibers

50
Q

– Cells in the layers behind these altered cells migrate over them until they contact the wound surface
– Cells continue to slide forward until the wound surface is covered
– The migrating cells move under scabs & produce ______ = Dissolves the base of the scab so it can be shed

A

collagenase

51
Q

Contact on all sides w/ other epithelial cells does what?

A

inhibits further cell migration = Contact inhibition

52
Q

*Epithelialization occurs faster in a ____ environment than in a ____ one & will not occur over
______ tissue

A

moist; dry; nonviable

53
Q

Epithelialization/migration is _____ dependent and related to ____ ____ –>

A

Energy-dependent & related to oxygen tension (Anoxia prevents epithelial migration & mitosis)

54
Q

Wet-to-dry bandages debride newly formed epithelium, ______ re-epithelialization

A

delaying

55
Q

During the repair phase after epithelization, what comes next?

A

Wound contraction = Size of wound is reduced d/t fibroblasts, reorganizing collagen in
granulation tissue & myofibroblast contraction at the wound edge

56
Q

Wound contraction occurs simultaneously with _____ and ____ but is independent of ______

A

Occurs simultaneously w/ granulation & epithelialization but is independent of
epithelialization

57
Q

(Repair Phase: Contraction)

Involves a complex interaction of cells, extracellular matrix & cytokines
– Significant _____ invasion into the wound is necessary for initiation of _____

A

fibroblastic; contraction

58
Q

During repair/contraction

Centripetal, full-thickness skin edges are pulled inward by contraction
– wounds noticeably smaller by __-__ days post injury and progresses at a rate of ___-___ mm/day

A

5-9 days/ .6-.8mm day

59
Q

When is the contraction phase of repair terminated?

A

When wound edges meet

60
Q

What are some things that inhibit contraction?

A

If skin around wound = Fixed, inelastic, under tension

or when myofibroblasts are inadequate (i.e. insufficient granulation tissue)

61
Q

During the maturation and remodeling phase:

How are strengths of the wound optimized?

A

d/t changes in the scar during the maturation phase

62
Q

Wound maturation begins once? State the timing as well

A

adequate levels of collagen are reached

– 17 to 20 days after injury and may continue for years

63
Q

During the maturation and remodeling phase:

Collagen fibers remodel w/ alteration of their orientation
& increased cross-linking to improve wound strength, what type of collagen increases and decreases during this?

A

Type I collagen increased & type III gradually decreases

64
Q

When is the most rapid change in wound strength and what is it due to?

A

Most rapid gain in wound strength = Bet. 7 & 14 days after injury d/t rapid collagen
accumulation

– Wounds gain only about 20% of their final strength in the first 3 weeks after injury

65
Q

True or False:

After a traumatic wound, normal tissue strength is fully gained back.

A

FALSE

• Slower increase in wound strength then occurs BUT normal tissue strength is never regained
– Only ~ 80% of original strength may be regained

6th MELEAH SAS 1 (8 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions