Tissue Integrity Flashcards
Scraping or rubbing away of epidermis; may result in localized bleeding and later weeping of serous fluid
Abrasion
To come close together, as in edges of a wound
Approximate
Redness of the skin caused by dilation of the superficial capillaries. When pressure is applied to the skin, the area blanches, or turns a lighter color
Blanchable hyperemia
When pressure is applied to the skin, the area turns a lighter color
Blanching
Removal of dead tissue from a wound
Debridement
Separation of the edges of a wound, revealing underlying tissues
Dehiscence
Thick layer of dead, dry tissue that covers a pressure injury or thermal burn. It may be allowed to be sloughed off naturally, or it may need to be surgically removed
Eschar
Protrusion of visceral layers through a surgical wound
Evisceration
Fluid, cells, or other substances that have been discharged from cells or blood vessels slowly through small pores or breaks in small membranes
Exudate
Soft, boggy feeling when tissue is palpated; usually a sign of tissue infection
Fluctuance
Effects of rubbing or the resistance that a moving body meets from the surface on which it moves; a force that occurs in a direction to oppose movement
Friction
Soft, pink, fleshy projections of tissue that form during the healing process in a wound not healing by primary intention
Granulation tissue
Termination of bleeding by mechanical or chemical means or the coagulation process of the body
Hemostasis
Hardening of a tissue, particularly the skin, because of edema or inflammation
Induration
Torn, jagged wound
Laceration
The presence of erythema and/or other manifestation of cutaneous abnormality that persists 30 minutes or longer after removal of a device or adhesive securing the device
Medical adhesive-related skin injury (MARSI)
Occurs when the skin or underlying tissues are subjected to sustained pressure or shear from medical devices or equipment
Medical device-related pressure injury (MDRPI)
Redness of the skin caused by dilation of the superficial capillaries. The redness persists when pressure is applied to the area, indicating tissue damage
Nonblanchable hyperemia
Inflammation, sore, or ulcer in the skin over a bony prominence
Pressure Injury
Primary union of the edges of a wound, progressing to complete scar formation without granulation
Primary intention
Wound closure in which the edges are separated; granulation tissue develops to fill the gap; and finally epithelium grows in over the granulation, producing a larger scar than results with primary intention
Secondary intention
Point of which tissues receive insufficient oxygen and perfusion
Tissue ischemia
Convenient portable units that connect to tubular drains lying within a wound bed and exert a safe, constant, low-pressure vacuum to remove and collect drainage
Wound drainage evacuations
Filling of a wound with granulation tissue, wound contraction, and wound resurfacing
Epithelialization
Vacuum-assisted closure; application of subatmospheric (negative) pressure to a wound through suction to facilitate healing and collect wound fluid
Negative-pressure wound therapy (NPWT)
Small, circular wound with the edges coming together toward the center
Puncture wound
Thick, yellow, green, tan, or brown drainage from a wound
Purulent
Bright red drainage from wound; indicates active bleeding
Sanguineous
Clear, watery plasma drainage from wound
Serous
Pale, pink, watery drainage from wound; mixture of clear and red fluid
Serosanguineous
Stringy substance attached to wound bed; pale yellow to tan coverage, usually covering the entire wound bed
Slough
Device that helps in wound closure by applying localized negative pressure to draw the edges of a wound together
Vacuum-assisted closure (V.A.C.)
Disruption of the integrity and function of tissues in the body
Wound
Mechanical forces contributing to pressure ulcer formation
Shear force
High blood flow after something limited the blood flow such as ischemia
Reactive hyperemia
