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Integ Midterm > Wound Types Study Guide/ Chart > Flashcards

Wound Types Study Guide/ Chart Flashcards

1
Q

Stages of Healing:

A
  1. Inflammation
  2. Epithelialization
  3. Proliferation
  4. Remodeling/Maturation
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2
Q

Inflammation =

A

(acute): Hemostasis (retraction//sealing off blood vessels), macrophages phagocytise debris, bacteria and damaged tissue

a. Signs: redness, swelling, heat, pain, loss of function

b. Highlights: vascular responses (bleeding), cellular responses

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3
Q

Epithelialization =

A

starts within a few hrs of injury and occurs simultaneously with other stages

a. Barrier between wound surface and environment (keratinocytes), requires O2 and moist environment

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4
Q

Proliferation =

A

(approx 3 weeks): neovascularization (angiogenesis), collagen production (fibroplasia), wound contraction (myofibroblast)

a. Key cells: angioblast, fibroblast, myofibroblast (pull entire wound together thereby shrinking defect), keratinocyte

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5
Q

Remodeling/Maturation =

A

(day 9- 1 yr): remodeling scar/collagen reorganization to fit tissue and function

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6
Q

Arterial Insufficiency leads to what type of ulcer:

A

Arterial

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7
Q

Arterial Insufficiency causes:

A

Decrease in arterial blood supply
● Trauma
● Acute embolism

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8
Q

Arterial Insufficiency signs:

A

● “Dependent rubor” ● slow nail growth
● pulses faint/absent ● atrophic skin
● loss of hair

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9
Q

Arterial Insufficiency risks:

A

● Age
● Smoking
●DM
● HTN
● Hyperlipoproteinemia
● Elevated WBC count

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10
Q

Atherosclerosis (primary cause) leads to what type of ulcer:

A

Arterial

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11
Q

Atherosclerosis causes:

A

Buildup of plaque in inner lining of artery

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12
Q

Atherosclerosis signs:

A

● Intermittent claudication
● “Rest” pain

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13
Q

Atherosclerosis risks:

A

● Age
● Smoking
●DM
● HTN
● Hyperlipoproteinemia
● Elevated WBC count

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14
Q

Venous Insufficiency leads to what type of ulcer:

A

Venous

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15
Q

Venous Insufficiency causes:

A

● Mechanical insufficiency (failure of valves)
● Physiological insufficiency (imbalance of proteins)

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16
Q

Venous Insufficiency signs:

A

● Pitting edema
● Hyperpigmentation
● lipodermatosclerosis/ fibrotic
tissue
● Eczema white plaques

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17
Q

Venous Insufficiency risks:

A

● Age
● Hx of varicose veins
● Obesity
● DVT
● LE trauma
● Legs in dependent position
● Pregnancy
● Impaired lymphatic drainage
● Previous vein surgery

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18
Q

Infected wounds Signs and Sx:

A

induration
fever
erythema
edema
increased drainage
odor after irrigation
increased pain

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19
Q

Infected wounds types:

A

cellulitis, lymphangitis, sepsis, osteomyelitis

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20
Q

3 types of ulcers:

A

Arterial

Venous

Lymphatic

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21
Q

Arterial ulcers causes:

A

● Arterial insufficiency
● Atherosclero sis (primary cause)
●PAD

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22
Q

Arterial ulcers signs:

A

● Edges well demarcated
● Wound
● VERY PAINFUL
● Base of ulcer pale and dry
● Minimal drainage
● No granulation tissue present
● Periwound tissue may be black, gangrenous

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23
Q

Arterial ulcers location:

A

●Toes
● dorsum of foot
● lateral malleolus
● lower 1⁄3 of anterolateral leg

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24
Q

Arterial ulcers tests and measures:

A

● Pulses
● Doppler US
● ABI (tests perfusion)
● Rubor of Dependency
● Venous Filling Time

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25
Q

Arterial ulcers treatment:

A

● Protect from pressure
○ Bed rest, Off-loading, Positioning

● Increase blood flow/O2
○ Hyperbaric O2
○ Arterial bypass
○ Angioplasty and stents

● Wound Care
○ Ischemic ulcers kept dry

● Debridement if adequate blood flow present

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26
Q

Arterial ulcers dressings and casting:

A

● Non-adhere nt foam
● Total contact casting

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27
Q

Venous ulcers causes:

A

Venous insufficiency

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28
Q

Venous ulcers signs:

A

● Achiness, decreased pain @ night
● Irregular shape, shallow
● Granulation tissue present (pink→ red)
● Flat borders
● Wet, excessive drainage
● PAINLESS or mild pain
● Slough present

29
Q

Venous ulcers location:

A

● Distal, medial third of LE
● Proximal to medial malleolus

30
Q

Venous ulcers tests and measures:

A

● Homans’ Sign
● ABI
● Tredelenberg test ● Doppler US
● Venous filling time

31
Q

Venous ulcers treatment:

A

● Compression therapy (short stretch wraps, tubular bandages, graduated compression garments)

● Wound care

● Medical intervention
(growth factors, surgery-
ligation, venous bypass)

● Keep leg elevated

32
Q

Venous ulcers dressings and castings:

A

Unna boot (semirigid dressing)

33
Q

ulcer subtypes:

A

Neuropathic/ Diabetic
Pressure

34
Q

Neuropathic/ Diabetic causes:

A

Diabetes, HIV/AIDS, Cancer, Vitamin B deficiency, MS, Charcot-Marie Tooth Disease

35
Q

Neuropathic/ Diabetic signs:

A

● Round, deep
● Often pink
● Normal pulses
● Normal or slightly higher temperature
● Periwound (callus, dry, hardened)
● induration/hardened edges
● Very little exudate
● Not painful (due to
damaged nerves)

36
Q

Neuropathic/ Diabetic location:

A

Plantar surface of foot (3rd met head, 1st met head/great toe, 5th met head)

37
Q

Neuropathic/ Diabetic tests and measures:

A

● Diabetic Foot Screening
● Pulse Examination
● Doppler US & ABI
● Capillary Refill
● Sensory integrity
(monofilament test → 5.07= loss of protective sensation)
● Wagner Scale

38
Q

Neuropathic/ Diabetic treatment:

A

● Wound care
○ Moist dressings
○ Prevent infection

● Off loading
● Rocker bottom
● Shoe modification (padded ankle foot orthosis)
● PT=ambulation

● Patient education
○ Diet and exercise
○ Disease process
○ Bone evaluation
○ Shoe wear and foot care
guidelines

39
Q

Neuropathic/ Diabetic dressings and casting:

A

Total contact casting

40
Q

Pressure ulcer causes:

A

Time+pressure= damage

Typically result from repeated episodes without adequate time for recovery in between

External: shear, moisture, friction

Internal: Age, arterial insufficiency/ arteriolar pressure, malnutrition
Impaired sensation

41
Q

Pressure ulcer risks:

A

The 5 I’s
● Immobility
● Inactivity
● Incontinence
● Improper Nutrition
● Impaired mental status or sensation

42
Q

Stage 1 pressure ulcer description:

A

Observable pressure related change in area of intact skin when compared to adjacent/comparable area of skin. Signs: skin color, skin temp, tissue consistency, sensation

43
Q

Stage 1 pressure ulcer prevention measures tests and measures:

A

● Positioning
○ Full body change of position every 2 hrs
○ Every hr in sitting
○ shift/pressure relief every 15 min

● Frequent position changes
● Pressure reduction devices
● Skin care
● Nutrition
● Good clothing choices
● Move with care
● Educate

44
Q

Stage 1 pressure ulcer treatment:

A

● Prevention is key
● Eliminate/ reduce sources of pressure
● Improve nutritional status
● Wound management

45
Q

Stage 2 pressure ulcer description:

A

Partial-thickness wound presented as abrasion, blister, or shallow crater (epidermis & dermis)

46
Q

Stage 2 pressure ulcer prevention measures tests and measures:

A

● Positioning
○ Full body change of position every 2 hrs
○ Every hr in sitting
○ shift/pressure relief every 15 min

● Frequent position changes
● Pressure reduction devices
● Skin care
● Nutrition
● Good clothing choices
● Move with care
● Educate

47
Q

Stage 2 pressure ulcer treatment:

A

● Prevention is key
● Eliminate/ reduce sources of pressure
● Improve nutritional status
● Wound management

48
Q

Stage 3 pressure ulcer description:

A

Full-thickness wound with damage or necrosis that may extend down to, but not through, fascia that presents as deep crater

49
Q

Stage 3 pressure ulcer prevention measures tests and measures:

A

● Positioning
○ Full body change of position every 2 hrs
○ Every hr in sitting
○ shift/pressure relief every 15 min

● Frequent position changes
● Pressure reduction devices
● Skin care
● Nutrition
● Good clothing choices
● Move with care
● Educate

50
Q

Stage 3 pressure ulcer treatment:

A

● Prevention is key
● Eliminate/ reduce sources of pressure
● Improve nutritional status
● Wound management

51
Q

Stage 4 pressure ulcer description:

A

Full-thickness skin loss with extensive destruction, necrosis, damage to underlying structures (muscle, bone, tendon, joint capsule, etc.)

52
Q

Stage 4 pressure ulcer prevention measures tests and measures:

A

● Positioning
○ Full body change of position every 2 hrs
○ Every hr in sitting
○ shift/pressure relief every 15 min

● Frequent position changes
● Pressure reduction devices
● Skin care
● Nutrition
● Good clothing choices
● Move with care
● Educate

53
Q

Stage 4 pressure ulcer treatment:

A

● Prevention is key
● Eliminate/ reduce sources of pressure
● Improve nutritional status
● Wound management

54
Q

Unstageable pressure ulcer:

A

Full thickness tissue loss in which the base of the ulcer is completely covered by slough and/or eschar

Eschar or slough needs to be removed to expose base to determine true stage of wound

55
Q

Deep Tissue Injury pressure ulcer:

A

Damage of underlying soft tissue from pressure and/or shear Appears maroon colored

56
Q

Burns =

A

Superficial (1st degree)
Superficial Partial Thickness (2nd degree)
Deep Partial Thickness (2nd degree)
Full Thickness (3rd degree)
Electrical (4th degree)

57
Q

Burn Rehab =

A

● Chest PT
● Positioning & Splinting
● ROM
● Resting hand position (wrist ext)
● Ambulate with ace bandages with pt who has skin grafts
● Exposed tendons no PROM only AROM/AAROM

58
Q

Burn Tests and Treatment =

A

Test:
● Rule of Nines

Treatment:
● Fluid resuscitation
● Critical Care tx/evaluation
● CPT/percussion & PROM
● Positioning (team effort)
● GENTLE ROM → PROM/AAROM
● May see skin blanch

● Outpatient PT
○ Paraffin as tx adjunct
○ Monitor skin 20-30s
○ Prolonged stretch: 1-3min

59
Q

Burns Dressings and castings:

A

● Silvadine -wax like substance, topical, antimicrobial , can be covered with gauze

● Sulfamylon -exposed cartilage

● Xeroform -impregnated gauze

● Silver Nitrate -minimize hypergranul ation tissue to prevent hypertrophic scar

60
Q

Superficial (1st degree) burn =

A

● No bleeding due to avascular tissue
● No blister formation
● location = Epidermis Only

61
Q

Superficial Partial Thickness (2nd degree) burn =

A

● Extremely painful due to irritation of nerve endings and pain sensors
● blister formation
● location = Epidermis and into upper layer of dermis

62
Q

Deep Partial Thickness (2nd degree) burn =

A

● Dermal appendages destroyed
● Burn will appear red, tan or white and
dull looking
● Eschar may develop
● Infection can occur to cause it to
develop into a full thickness burn
● location = Severe damage to dermal layer

63
Q

Full Thickness (3rd degree) burn =

A

● Burn will not blanch
● location = Epidermal, dermal, and subdermal layer completely destroyed

64
Q

Electrical (4th degree) burn =

A

● Entrance and exit wounds
● Fractures may occur
● Internal injuries may occur
● MI involvement
● location = Destruction into bone

65
Q

Burn Wound 3 zones:

A

Zone of of Coagulation
Zone of of Stasis
Zone of of Hyperemia

66
Q

Zone of of Coagulation =

A

Area that receives the most direct and intense heat

Cells are irreversibly damaged and skin death occurs

Tissue necrosis and eschar are present

67
Q

Zone of of Stasis =

A

Contains injured cells that will die within 24-48 hours without specialized treatment

Blood supply is compromised by cellular and vascular changes

It is here that infections and or dying of tissues could result in conversion of tissues into necrotic tissue

68
Q

Zone of of Hyperemia =

A

outermost area of burn

vasodilatation and increased blood flow
site of minimal cell damage

should recover within seven days with no lasting effects

Integ Midterm (9 decks)

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