Tissue Integrity & Wound Healing

Question 1

partial thickness wound

Answer 1

damage thru epidermis

dermis intact

Question 2

full thickness

Answer 2

damage thru epidermis and dermis
can extend into subcutaneous tissue, muscle, bone
scar fomation

Question 3

wound healing depends on

Answer 3

type of injury
extent of tissue loss
infection, necrotic tissue (does not regenerate), secondary tissue breakdown

Question 4

primary intention

Answer 4

primary closure
surgical closure of wound
repair: formation of new extracellular matrix
regeneration: re-epithelizalization 
little granulation tissue

Question 5

secondary intention

Answer 5

secondary/spontaneous closure
full thickness wound that heals w/out closure attempt
large amount of granulation tissue
longer healing time, larger scar
skin grafting, skin substitues

Question 6

tertiary intention

Answer 6

delayed primary closure
combination of primary/secondary intention
contaminated wound cleaned, left open to drain
scarring > primary intention

Question 7

phases of wound healing

Answer 7

hemostasis
inflammatory
proliferative
remodeling

Question 8

role of chemical mediators

Answer 8

cytokines (initiate healing process, produce growth factors/cytokines, stim expression of GF, develop ECM , coordinate intercellular communication)
growth factors (stimulate growth/division/differentiation of other cells, regulate intercellular communication)
nitric oxide (direct: bacterial killing, indirect: modulates cytokine/growth factor activity)

Question 9

Inflammatory stage

Answer 9

4-6 days
minimize tissue damage, prevent additional tissue injury, prepare wound for healing & regeneration
steps: hemostasis, platelet adhesion, platelet activation, platelet plug, fibrin clot formation, recruitment of phagocytic cells & wound debridement)

Question 10

proliferative stage

Answer 10

4-24 days
wound healing guided toward tissue repair
granulation tissue (foundation for collagen-based matrix that replaces fibrin-based provisional matrix)
fibroblasts (produce collagen, adhesive proteins for ECM)
myfibroblasts
endothelial cells (angiogenesis - neovascularization)
re-epithelialization (regeneration of keratinocytes)

Question 11

remodeling

Answer 11

21 days - 2 years
epidermis maturation
wound contraction
apoptosis and scar maturation

Question 12

factors that impede wound healing local

Answer 12

blood flow & hypoxia
infection 
radiation exposure
movement/tension 
desiccation 
excessive edema
denervation

Question 13

factors that impede wound healing systemic

Answer 13

adv age
malnutrition 
nutritional status
immune deficiency
smoking
medications 
metabolic status

Question 14

hypoxia

Answer 14

delays/stops wound healing process
greatest at center of wound
leading cause of wound infection
amplified by infection 
inhibits fibroblast activity/collage deposition in matrix

Question 15

wound healing & nutrition

Answer 15

major role in wound healing
essential CHO, fats & proteins
effects of negative nitrogen balance: impaired immune/inflammatory response, delayed healing

Question 16

vitamin A deficiency

Answer 16

impairs re-epithelialization deposition of collagen/fibronectin
impedes inflam process
impairs WBC FX/angiogenesis

Question 17

vitamin C deficiency

Answer 17

impairs inflammatory process
inhibits collagen secretion
increases localize infection

Question 18

vitamin K deficiency

Answer 18

affects hemostasis & formation of fibrin clot

Question 19

zinc deficiency

Answer 19

leads to decreased fibroblast proliferation & collagen synthesis, epidermal cell poliferation

Question 20

MG/CU/FE deficiencies

Answer 20

affect protein synthesis & cellular proliferation

Question 21

corticosteroids & wound healing

Answer 21

promote breakdown of CHO/fats/protein

anti-inflammatory action impedes inflam phase of wound healing

Question 22

antineoplastic drugs & wound healing

Answer 22

potent immunosuppressants

impairs re-epithelizlization granulation tissue formation angiogensis

Question 23

diabetes & wound healing

Answer 23

insufficient insulin/insulin resistance or both
hyperglycemia = chronic macrovascular disease, atherosclerosis (tissue ischemia & hypoxia), thickening of basement membrances: diabetic lesions
impaired FX/reduced ability to fight infection
sensory neuropathy, reduces pain sensation r/t wounds

Question 24

Fibrosis

Answer 24

excessive wound healing
replaces normal tissue
nonfunctional collagen/scar tissue
excess synthesis/delayed degradation

Question 25

Keloids

Answer 25

excessive wound healing | lesions of dermal scar or fibrotic tissue

Question 26

Hypertrophic scars

Answer 26

excess fibrotic tissue raised above level of surrounding skin grows w/in boundaries of original injury (regress spontaneously)

Question 27

contractures

Answer 27

abnormal exaggeration of wound contraction shrinking scars severely deform wound, reduces mobility compromise mobility of involved joints

Question 28

wound dehiscence

Answer 28

deficient wound healing extrafascial: partial/complete seperation of outer layers of sutured wound/underlying fascial layer remains intact fascial: evisceration, seperation of fascial layers

Question 29

s/s of impending wound disruption

Answer 29

signs of infection absence of healing ridge by 5th - 9th postoperative day seroma or hematoma formation increase in serous discharge

Question 30

chronic nonhealing wounds

Answer 30

do not proceed thru healing process progress thru healing process but cannot maintain structural & FXtional integrity arrest in inflammatory phase harbor bacteria increased levels of inflammatory mediators, chronic inflamm, necrosis, fibrosis

Question 31

pressure injuries

Answer 31

localized ischemic lesions of skin & underlying tissue over bony prominence external pressure impairs flow of blood & lymph

Question 32

risk factors pressure injuries

Answer 32

``` immobility reactive hyperemia microthrombi shearing forces poor perfusion (PAD, DM) skin status/maceration ```

Question 33

pressure injuries s/s

Answer 33

pressure decreases gradually from bony area toward periphery | discoloration to blisters or areas of denuded superficial skin to deep tissue damage w/ necrosis

Question 34

pressure injuries DX/TX

Answer 34

``` DX: regular assessment, WBC, erythrocyte sedimentation rate TX: surgical debridement autolytic debridement skin grafting topical/systemic ABX hydrocolloid/transparent film dressing alginate, foam, iodine dressings can lead to osteomyelitis ```

Question 35

pressure ulcer staging

Answer 35

Stage 1: sores are not open wounds. Painful, but no breaks or tears, reddened and does not blanch Stage 2: skin breaks open, wears away, or forms an ulcer, which is usually tender and painful. The sore expands into deeper layers of the skin. It can look like a scrape (abrasion), blister, or a shallow crater in the skin. Stage 3: forms a small crater. Fat may show in the sore, but not muscle, tendon, or bone. Stage 4: muscle and bone potentially tendons and joints