wounds!

Question 1

Skin has two main layers:

Answer 1

Epidermis
Superficial and thinner epithelial layer

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

Question 2

Hypodermis

Answer 2

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

Question 3

Skin anatomy: epidermis top and bottom layers

Answer 3

stratum corneum –> stratum basale

Question 4

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

Answer 4

keratinocytes

Question 5

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

Answer 5

melanocytes

Question 6

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

Answer 6

Langerhans cells

Question 7

Function mainly as touch receptors

Found in the stratum basale

Answer 7

Merkel cells

Question 8

dermis includes what 2 layers?

Answer 8

Papillary Dermis and Reticular Dermis

Question 9

Dermal dendrocytes are involved in

Answer 9

Involved in wound healing, blood clotting and inflammation

Question 10

Innervation of dermis

Answer 10

Supplied with sensory receptors for temperature, pain, and touch

Question 11

Phases of Wound Healing

Answer 11

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

Question 12

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

Vasoconstriction (brief and intense)

Activation of keratinocytes and platelets

Answer 12

Hemostasis

Question 13

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

Answer 13

Inflammatory Phase: 1-3 days

Question 14

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

Answer 14

Inflammatory Phase: 1-3 days

Question 15

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)

Answer 15

Proliferation: 1-2 Weeks

Question 16

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’

Answer 16

Proliferation: 1-2 Weeks

Question 17

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

Answer 17

Remodeling or Maturation Phase

Question 18

Scar tissue matures as collagen disappears

Presents as softened and flattened

Answer 18

Remodeling or Maturation Phase

Question 19

Non-functional fibroblasts are replaced by functional ones

Answer 19

Remodeling or Maturation Phase

Question 20

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

Answer 20

Remodeling or Maturation Phase

Question 21

Occur suddenly, rather than over time

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

Answer 21

acute wounds

Question 22

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

Answer 22

acute wounds

Question 23

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

Answer 23

Simple Laceration Wound Treatment

Question 24

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

Answer 24

Simple Laceration Wound Treatment

Question 25

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

Answer 25

Wound Debridement

Question 26

Types of Wound Debridement

Answer 26

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)

Question 27

OT’s Role in Wound Healing

Answer 27

Wound care Dressing changes Removal of stitches Observation skills to detect possible infection Manual therapy Scar management Scar massage

Question 28

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

Answer 28

Chronic Wounds

Question 29

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

Answer 29

Chronic Wounds

Question 30

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)

Answer 30

Infected wounds

Question 31

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

Answer 31

Ischemic wounds

Question 32

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

Answer 32

radiation poisioning wounds

Question 33

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

Answer 33

surgical wounds

Question 34

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

Answer 34

surgical wounds

Question 35

most common type of chronic wound

Answer 35

ulcers

Question 36

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

Answer 36

arterial ulcers

Question 37

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

Answer 37

arterial ulcers

Question 38

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

Answer 38

Venous Ulcers

Question 39

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

Answer 39

Venous Ulcers

Question 40

Common complication in uncontrolled diabetes mellitus | resulting in impaired immune function, ischemia, neuropathy, which can eventually lead to ulceration

Answer 40

Diabetic Ulcers

Question 41

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

Answer 41

Diabetic Ulcers

Question 42

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

Answer 42

Pressure Ulcers (also Decubitus Ulcers)

Question 43

OT’s Role in Preventing Decubitus Ulcers

Answer 43

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

Question 44

Preventing Decubitus Ulcers – Skin Care

Answer 44

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

Question 45

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

Answer 45

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

Question 46

Systemic support

Answer 46

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

Question 47

Maintain a physiologic local wound environment

Answer 47

``` 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 ```