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human conditions > wounds! > Flashcards

wounds! Flashcards

1
Q

Skin has two main layers:

A

Epidermis
Superficial and thinner epithelial layer

Dermis
Deeper and thicker connective tissue layers
Combined, 2-3mm thick

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2
Q

Hypodermis

A

Storage site for fat, containing blood vessels that surround the skin

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3
Q

Skin anatomy: epidermis top and bottom layers

A

stratum corneum –> stratum basale

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4
Q

Majority of epidermal cells
Produce fibrous protein called keratin
Make our skin tough (strength and resilience)
Allow tissue to resist damage
Involved in wound healing and in the immune system

A

keratinocytes

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5
Q

Produce pigment granules called melanin: a brown to black pigment occurring in the skin
Found in the stratum basale

A

melanocytes

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6
Q

They are macrophages: Immune cells that play a role during the inflammatory phase of acute wound healing
Produced in the bone marrow and migrate to the epidermis
Found in the stratum spinosum and stratum granulosum

A

Langerhans cells

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7
Q

Function mainly as touch receptors

Found in the stratum basale

A

Merkel cells

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8
Q

dermis includes what 2 layers?

A

Papillary Dermis and Reticular Dermis

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9
Q

Dermal dendrocytes are involved in

A

Involved in wound healing, blood clotting and inflammation

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10
Q

Innervation of dermis

A

Supplied with sensory receptors for temperature, pain, and touch

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11
Q

Phases of Wound Healing

A

Hemostasis
Inflammation (1-3 days)
Proliferation (1-2 weeks)
Remodeling or maturation (1-2 years)

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12
Q

Process to prevent and stop bleeding (blood clots) in damaged blood vessel

Vasoconstriction (brief and intense)

Activation of keratinocytes and platelets

A

Hemostasis

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13
Q

Inflammation:
Contains
Neutralizes
Dilutes the injury-causing agent or lesion
Hemoattractant molecules released by platelets also increase

A

Inflammatory Phase: 1-3 days

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14
Q

Initial process of inflammation common to all tissue types
Neutrophils (WBCs immunity) and other inflammatory cells migrate into tissue
Overall tissue strength of a wound is minimal, since tissues do not regain their normal functional strength until inflammation transitions into repair
Scar tissue will be swollen, tender, and red

A

Inflammatory Phase: 1-3 days

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15
Q

Wound contracts:
Myofibroblasts help contract the wound, pulling edges together

Wound ‘rebuilt’ with new granulation tissue comprised of collagen and extracellular matrix and into which a new network of blood vessels develop (known as angiogenesis)

A

Proliferation: 1-2 Weeks

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16
Q

Healthy granulation tissue is granular and uneven in texture
does not bleed easily and is pink/red in color

Scar tissue is deposited
Scar is RED, RAISED and RIGID
Epithelial cells finally form on wound surface
a process known as ‘epithelialisation’

A

Proliferation: 1-2 Weeks

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17
Q

Final phase and occurs once the wound has closed
May take up to 2 years
Dermal tissues enhance their tensile strength

A

Remodeling or Maturation Phase

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18
Q

Scar tissue matures as collagen disappears

Presents as softened and flattened

A

Remodeling or Maturation Phase

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19
Q

Non-functional fibroblasts are replaced by functional ones

A

Remodeling or Maturation Phase

20
Q

Cellular activity declines with time and the number of blood vessels in the affected area decreases and recede
Even after maturation, wound areas tend to remain up to 20 percent weaker than they initially were

A

Remodeling or Maturation Phase

21
Q

Occur suddenly, rather than over time

Heal at a predictable and expected rate, according to the normal wound healing process

A

acute wounds

22
Q

Can vary from superficial scratches to deep wounds damaging blood vessels, nerves, muscles, other tissue
Surgical wounds
Traumatic wounds
Abrasion, puncture, laceration, incision

A

acute wounds

23
Q

TX: Cleaning with tap water, sterile saline solution, or antiseptic solution twice a day
Most clean open wounds do not require any antibiotics unless the wound is contaminated, or the bacterial cultures are positive
Once cleaned, wound should be covered with moist gauze
followed by application of dry gauze and then the wound covered with a bandage

A

Simple Laceration Wound Treatment

24
Q

Wounds less than 12 hours old can be closed with sutures or staples
Wounds more than 24 hours old should be suspected to be contaminated and not closed completely

A

Simple Laceration Wound Treatment

25
Q

Removing dead tissue from wounds
Wounds can heal faster
Dead tissue can trap bacteria leading to infections
Bacteria can cause odor
Infection can be life threatening or lead to an amputation

A

Wound Debridement

26
Q

Types of Wound Debridement

A

Autolytic (body’s own healing process to remove tissue – moist dressing)
Enzymatic (chemical enzymes, such as an ointment, to help slough off dead tissue – ointment – can strip healthy tissue away)
Surgical (surgical removal of dead tissue)
Mechanical (wet to dry dressing regularly changed – can strip healthy tissue away)
Maggot (using larvae to remove dead tissue)

27
Q

OT’s Role in Wound Healing

A

Wound care
Dressing changes
Removal of stitches
Observation skills to detect possible infection

Manual therapy
Scar management
Scar massage

28
Q

Develop when any acute wound fails to heal in the expected time frame for that type of wound

Important aspect in caring for wounds is to remove the causing agent

A

Chronic Wounds

29
Q

Can be due to lack of one or more of the main requirements for healing
good supply of blood, oxygen and nutrients
clean and infection-free environment

A

Chronic Wounds

30
Q

Whether bacterial, fungal or viral, cause of the infection must be treated with the proper medication
Typically have bad odor, pus drainage, debris (dead tissue), and ongoing symptoms of inflammation (fever, pain, redness, hotness and swelling)

A

Infected wounds

31
Q

delays healing process or even prevents it
wound area will be pale and cold
may also have decreased hair growth and a weak pulse sensation in the area

A

Ischemic wounds

32
Q

excessive exposure to ionizing radiating materials
can weaken the immune system cause damage to exposed tissue
delay the healing time of all wounds

A

radiation poisioning wounds

33
Q

surgical incisions made during surgery can progress to chronic wounds
if the blood supply to the surgery area was accidentally damaged
or if wound care was inadequate
Possibly causing infection

A

surgical wounds

34
Q

Typically occur at the site of a surgical incision
instead of a clean appearance, the tissue around the incision appears red, hot, and swollen
which can indicate infection or inflammation

A

surgical wounds

35
Q

most common type of chronic wound

A

ulcers

36
Q

can occur from
Poor delivery of nutrient-rich blood to the lower extremities
Hypertension, atherosclerosis (plugging) and thrombosis (clotting)
Where reduced blood supply leads to an ischemic state

A

arterial ulcers

37
Q

Usually involve full thickness skin having a punched-out appearance with smooth edges
Occasionally pain subsides when the legs are lowered below the heart level
In some cases, ischemia (poor circulation to area) is present

A

arterial ulcers

38
Q

Account for more than half of ulcer cases, especially in the lower limbs
as associated with deep vein thrombosis, varicose veins and venous hypertension
Venous ulcers can lead to stasis
stoppage or slowdown in the

A

Venous Ulcers

39
Q

Skin is usually shiny and smooth with minimal to no hair
superficial, shallow, and irregularly shaped with pain and edema
Sometimes associated with infection or inflammation

A

Venous Ulcers

40
Q

Common complication in uncontrolled diabetes mellitus

resulting in impaired immune function, ischemia, neuropathy, which can eventually lead to ulceration

A

Diabetic Ulcers

41
Q

Origin can be neuropathic (secondary to nerve damage)
Where the lack of sweat makes the skin dry forming callus (accumulation of dead skin layers).
callused area, mostly on foot, can eventually break down and form an ulcer
Diabetic ulcers can also occur from neuropathy with ischemic origin; where the ulcer area is cool with no pulse

A

Diabetic Ulcers

42
Q

Constant pressure and friction resulting from body weight over a localized area for prolonged duration
can lead to breakage of skin and ulceration (also known as bed sores)
Especially on the back and on the ankles and feet
Present with redness that doesn’t go away when pressed upon
Includes itching, blistering, hotness, swelling and discoloration of the area

A

Pressure Ulcers (also Decubitus Ulcers)

43
Q

OT’s Role in Preventing Decubitus Ulcers

A

Frequent position changes – key
Repositioning shifts pressure stress on skin
Shift weight frequently
Lift body weight up

Use specialty reclining wheelchair or seat

Protect bony areas w proper positioning and cushioning

44
Q

Preventing Decubitus Ulcers – Skin Care

A

Clean the skin with mild soap and warm water. Gently pat dry.
Use talcum powder to protect skin vulnerable to excess moisture
Apply lotion to dry skin
Change bedding and clothing frequently
Check for buttons on the clothing and wrinkles in the bedding that irritate the skin
Thoroughly inspect skin daily to identify vulnerable areas or early signs of pressure sores
If incontinent, take steps to prevent exposing the skin to moisture and bacteria

45
Q

If no wound healing, consider factors that effect wound healing:

A 
Wound moisture level
Nutrition and hydration status
Mobility
Pressure, friction and shear
Other etiologies that effect wound healing not yet identified
46
Q

Systemic support

A

Nutrition and hydration support
Limit medications that impair wound healing: immunosuppressives, chemo
Control systemic conditions affecting wound healing: perfusion, oxygenation and metabolism

47
Q

Maintain a physiologic local wound environment

A 
Maintain a moist wound bed
Eliminate dead space
Protect surrounding skin
Remove necrotic tissue
Manage bioburden (number of bacteria living on a surface)
Manage pain
Control odor

human conditions (28 decks)

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