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Anatomy and Physiology - applied > The skin and wound healing > Flashcards

The skin and wound healing Flashcards

1
Q

How much does pressure area care cost the NHS everyday?

A

£1.4 million as 4-10% of hospitalised patients will develop a pressure ulcer

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2
Q

What are the common types of skin damage?

A

Pressure ulcers
Surgical wounds
Traumatic wounds
Ulcerating cancers (fungating wounds)
Burns
Non-infectious/infectious conditions
Chronic LT conditions
Allergies

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3
Q

What is the nurses role in skin care? (7 roles)

A

Asses and monitor the patients skin, skin mapping
Identify risk factors and use methods to reduce them
Carry out wound care - dressings, removal of sutures, debridement
Assist in personal hygiene - continence needs
Reposition the patient according to individual care plan
Refer patients to MDT
Administer prescription medications as directed

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4
Q

What does SSKIN stand for?

A

Surface
Skin inspection
Keep patient moving
Incontinence/moisture
Nutrition/hydration

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5
Q

What does surface of SSKIN refer to?

A

Making sure patients have the right support
Use of equipment

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6
Q

What does skin inspection of SSKIN refer to?

A

Early inspection means early detection, show patients and carers what to look for

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7
Q

What does incontinence/moisture of SSKIN refer to?

A

Patients need to be clean and dry - moisture will damage the Stratum Corneum

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8
Q

What does nutrition/hydration of SSKIN refer to?

A

Help patients have the right diet and plenty of fluids
MUST score, referral to dieticians

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9
Q

What does Keep moving of SSKIN involve?

A

Assessment, repositioning schedule, prevention

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10
Q

What is the assessment tool used to evaluate risk of pressure ulcers in adults?

A

Waterlow Risk Assessment

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11
Q

What is the assessment tool used to evaluate risk of pressure ulcers in children?

A

Braden Q - focus on occipital area

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12
Q

How can skin be assessed using observation?

A

Colour, mottling, dry, loose, oedematous, wounds, abrasion, bruise, deformity, burn, erythema, flakiness, self hygiene

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13
Q

How can skin be assessed using touch?

A

Clammy/sweaty/moist, soiled/wet, sensitive/exaggerated, sensation, dry, cap refill < 2 secs - peripheral, central

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14
Q

How can skin be assessed using positioning?

A

Ability to re-position, pain on movement

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15
Q

How can skin be assessed using clothing?

A

Loose, restrictive, soiled

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16
Q

How can skin be assessed using current medications?

A

Creams, steroids, allergies

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17
Q

How can skin be assessed using skin conditions?

A

Chronic, acute, infectious

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18
Q

What is a Pressure Ulcer (PU)?

A

A localised injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure combination with shear
A number of contributing or confounding factors are also associated with pressure ulcers - microclimate, friction, excessive moisture

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19
Q

What is a Medical Device Related Pressure Ulcer (MDRPU)?

A

A pressure ulcer that has developed due to sustained pressure from a medical device such as plaster casts, splints, oxygen therapy masks, tracheostomy tubing or urinary catheters

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20
Q

What is Moisture Associated Skin Damage (MASD)?

A

A reactive response of the skin to chronic exposure to excessive moisture from sweat, urine, faecal matter or wound exudate, which could be observed as an inflammation and erythema with or without erosion
Typically there is a loss of the epidermis and the skin appears macerated, red, broken and painful

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21
Q

What are the factors to consider in a wound assessment?

A

Mechanisms will affect treatment and healing
Bacterial loading - time, mechanism, initial first aid
Appearance - active bleeding, slough, necrosis
Map the wound/photograph (with patient consent)
Categorise the wound

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22
Q

What can a wound be categorised as in a wound assessment?

A

Vascular - arterial/venous/both
Neuropathic (diabetic)
Moisture associated dermatitis
Skin tear
Pressure ulcer
May be multi-factorial

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23
Q

What are the stages of pressure ulcers?

A

Stage 1 - skin is unbroken but inflamed
Stage 2 - skin is broken to epidermis or dermis
Stage 3 - ulcer extends to subcutaneous fat layer
Stage 4 - ulcer extends to muscle or bone

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24
Q

What are the characteristics of healthy skin?

A

Subcutaneous layer - contains blood vessels and cushioning fat
Dermis - where new cells are made
Bones - support the body
Sweat glands - lubricate the skin
Epidermis - outer protective covering

25
Q

What are the characteristics of fragile skin?

A

Subcutaneous layer - has fewer and flatter fat cells
Dermis - produces cells more slowly
Bones- protrude
Sweat glands - fewer so make less lubrication
Epidermis - dry and loses cell layers

26
Q

What are the characteristics of a stage 1 pressure ulcer?

A

Intact skin with a localised area of non-blanchable erythema (may appear differently in darkly pigmented skin)
Presence of blanchable erythema or changes in sensation, temperature, or firmness may precede visual changes
Colour changes do not include purple or maroon discolouration - may indicate deep tissue pressure injury

27
Q

What are the characteristics of a stage 2 pressure ulcer?

A

Partial thickness loss of skin with exposed dermis
Wound bed is viable, pink or red, moist, and may also present as an intact or ruptured serum-filled blister
Sub Cut/adipose is not visible and deeper tissues are not visible
Granulation tissue, slough and eschar are not present

28
Q

What are the characteristics of a stage 3 pressure ulcer?

A

Full thickness skin loss
Subcutaneous fat may be visible but bone, tendon or muscle are not exposed
Slough may be present but does not obscure the depth of tissue loss, may include undermining and tunnelling
Depth varies by anatomical location - the bridge of the nose, ear, occipital and malleolus do not have subcutaneous tissue (can be shallow)
Areas of significant adiposity can develop extremely deep stage 3 ulcers

29
Q

What are the characteristics of a stage 4 pressure ulcer?

A

Full thickness tissue with exposed bone, tendon or muscle
Slough or eschar may be present on some parts of the wound bed
Often includes undermining and tunnelling
Depth varies by anatomical location
Can extend into muscle/supporting structures making osteomyelitis possible
Exposed bone/tendon is visible or directly palpable

30
Q

What is slough?

A

The yellow/white material in a wound bed, usually wet with a soft texture
Consists of fibrin, white blood cells, bacteria and debris
Result of inflammation

31
Q

What is eschar?

A

A type of necrotic tissue that adheres to the wound bed
Dryer then slough and has a spongy/leather-like appearance

32
Q

What are the characteristics of an unstageable pressure ulcer?

A

Depth unknown
Full thickness tissue loss in which the base of the ulcer is covered by slough or eschar in the wound bed
Until enough slough/eschar is removed to expose the base, the stage cannot be determined

33
Q

What are the characteristics of a deep tissue injury?

A

Persistent, non-blanchable, deep red, purple or maroon areas of intact skin, non-intact skin or blood-filled blisters caused by damage to the underlying soft tissues
Common for a thin blister to form over the surface of the dark wound bed, it may become covered by thin eschar
Serious form of pressure injury - form in the underlying tissues and are often not visible until they have advanced to the point where treatment is significantly more problematic
Deteriorate quickly even under optimal care

34
Q

How can pressure ulcers be prevented?

A

Barrier creams to prevent moisture lesions
Pressure relieving devices
Skin massage/rubbing, positioning/repositioning
Nutritional interventions including hydration
Patient and carer education and training for HCPs
Assessment and grading of pressure ulcers
Management including debridement and larval therapy
Negative pressure wound therapy and hyperbaric oxygen therapy

35
Q

What are the 2 primary risk factors for developing a chronic wound?

A

Age
Diabetes

36
Q

What is wound healing?

A

The skins response to closing breaches to its barrier

37
Q

What are the mechanisms of haemostasis?

A

Vasoconstriction - reduce blood flow from damaged vessels (prevents further damage)
Platelets detect collagen from damaged vessels and signal the formation of a fibrin clot

38
Q

What does thrombin do?

A

Triggers platelet activation, encouraging coagulation and clot formation, platelets recruit immune cells to the site

39
Q

What are the secondary functions of eschar (the plug)?

A

Shielding against bacteria
Providing a scaffold for incoming immune cells
Harbouring a reservoir of cytokines and growth factors shaping the behaviour of wound cells for early repair

40
Q

What are the 3 stages of wound healing?

A

Inflammation
Proliferation
Maturation

41
Q

What is the time frame for inflammation?

A

1-5 days

42
Q

What happens during inflammation?

A

Vasodilation and release of histamine
Wound becomes red, swollen and hot with tenderness for 1-3 days
Neutrophils, macrophages and lymphocytes remove debris and bacteria and secrete cytokines and growth factors

43
Q

What do histamines do during inflammation?

A

Increases capillary permeability to white blood cells so they exude into the surrounding tissues

44
Q

How does diabetes affect inflammation?

A

Macrophages are reduced - hypoxia wounds and malnourished wounds mean healing is delayed

45
Q

What is the time frame for proliferation?

A

3-24 days

46
Q

What happens during proliferation?

A

Macrophages initiate fibroblasts to divide and produce collagen
Angiogenesis
Mitosis and epithelial migration
Hair follicles can re-grow from damaged appendages but in full thickness wounds they only grow around the outside of the wound

47
Q

What is angiogenesis?

A

Formation of new blood vessels, join existing blood vessels forming loops - fragile and held within a collagen matrix

48
Q

What is mitosis and epithelial migration?

A

Re-epithelisation occurs and spans the granulating wound bed, keratinocytes change polarity and span the wound front to rear migrating laterally across the wound

49
Q

What are the factors required for proliferation?

A

Oxygen
Optimal nutritional levels
Proteins
Carbs
Iron
Vitamin A&C

50
Q

How is the time frame for maturation?

A

21 days+

51
Q

What happens during maturation?

A

Collagen remodels to emulate pre-injury skin
Contracture occurs when myo-fibroblasts adhere to one another via desmosomes
Elastin that makes a scar more flexible can take months to appear in skin tissue

52
Q

What are the properties of scar tissue?

A

Avascular, blood vessels are rationalised - thinning and fading of scar tissue
The integrity of a scar will never reach that of undamaged skin - only up to 80% of its original strength

53
Q

What is the primary intention of wound healing?

A

Union of wound edges under aseptic conditions (surgical, traumatic, laceration) with clips, sutures, skin adhesives

54
Q

What is the secondary intention of wound healing?

A

Left open, heal through contraction and epithelisation
Less cosmetic and likely to become infected

55
Q

What is the tertiary intention of wound healing methods?

A

Delayed primary closure, allow swelling and bleeding to reduce before primary closure

56
Q

How does skin help with thermoregulation?

A

It loses heat and insulates against heat loss
Hypothalamus responds to the temp of blood
Arterioles in the dermis constrict decreasing blood flow
Arterioles dilate cooling the body & sweat glands are stimulated
Inflammatory cells and pyrogens will increase the hypothalamus ‘thermostat’ and the body will retain heat until the increased temp is reached and then through excessive sweating the body cools

57
Q

How does the skin form vitamin D?

A

Lipid based 7-dehydrocholesterol in the skin is converted to vit D by the sunlight

58
Q

What are the other functions of the skin?

A

Excretion - sweat, urea
Absorption

59
Q

What are the common disorders of the skin?

A

HPV
Herpes
Impetigo
Cellulitis
Ringworm
Dermatitis (eczema)
Psoriasis
Acne Vulgaris
Melanoma

Anatomy and Physiology - applied (14 decks)

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