Integumentary

Question 1

Integumentary I: wound healing

True or false: serum pre-albumin of 15mg/dL is indicative adequate long-term nutrition

Answer 1

False: albumin of <3.5 g/dL is indicative of long-term malnutrition

18-day half-life

Question 2

Integumentary I: wound healing

Patient requires getting enough protein for appropriate wound healing.
Which is the laboratory assessment indicative of a short-term poor nutritional status?

Answer 2

Serum Prealbumin <20 mg/dK

(past 2 to 3 days)

Question 3

Integumentary I: wound healing

Patient requires getting enough protein for appropriate wound healing.
Which is the laboratory assessment indicative of a long-term poor nutritional status?

Answer 3

Serum Albumin <3.5 g/dL

(10 to 15 days)

Affected by age, dehydration.

Question 4

Integumentary I: wound healing

in the hemostasis phase of wound healing…

Answer 4

exposed subendothelial collagen attracts platelets to create a stable plug

Question 5

Integumentary I: wound healing

in the inflammatory phase of wound healing…

Answer 5

vasodilation → neutrophils (3-24h) → macrophages

Question 6

Integumentary I: wound healing

What is the most predominant cell in the inflammatory phase?

Answer 6

macrophages

Question 7

Integumentary I: wound healing

Describe the 3 types of wound repair?

Answer 7

• Primary intention (sutures approximation)
• Secondary intention (reapproximation of skin)
• Tertiary intention (leave wound open)

Question 8

Integumentary I: wound healing

_______ is the primary source of energy for healing

Answer 8

Glucose

Question 9

Integumentary I: wound healing

Functions as a constituent in enzyme systems to metabolize fats and carbohydrates to synthesize nucleic acids and proteins.Also a constituent of immune systems and collagen
formation for increased tensile strength

Answer 9

Zinc

Question 10

Integumentary I: wound healing

Local Factors Impeding Wound Healing

Answer 10

• Bio-burden (competition for nutrients)
• Tissue Perfusion (↓ macro → ↓micro)
• Eschar / Desiccation (Death of cells)
• Foreign bodies
• Pressure, shear, friction, moisture

Question 11

Integumentary I: wound healing

Systemic Factors Impeding Wound Healing

Answer 11

• Stress (↑ sympathetic)
• Obesity
• Temperature
• Comorbidities (DM, PVD, Neuropathy)
• Cancer
• Arterial Insufficiency
• Venous insufficiency
• Nutrition
• Age

Question 12

Integumentary I: wound healing

Clinician-induced Factors Impeding Wound Healing

Answer 12

• Medications (antibiotics, may need some good bugs)
• Topical agents (chemicals?)
• Dressings (wet to dry is for debridement only)
• Poor infection control
• Modalities overutilization
  
  • whirlpool: toxic additives, pressures harmful, dependent position
  • Electrical: premature closure
  • compression therapy: tissue ischemia.

Question 13

Integumentary I: wound healing

Wound infections delay wound healing by affecting…

Answer 13

collagen metabolism – decreases synthesis and increases lysis of collagen. Effects are related to toxins, enzymes, and wastes from bacteria deposited into the environment.

Question 14

Integumentary I: wound healing

Infections decreases the amount of _______ for collagen synthesis and for oxidative killing by neutrophils

Answer 14

oxygen

Question 15

Integumentary I: wound healing

first, the second and third line of defense

Answer 15

• 1st: skin, mucous memebrane
• 2nd: cellular response
• 3rd: immune system

Question 16

Integumentary I: wound healing

Wound extends to the dermis but not through the dermis. It may heal by reepithelialization

(classification by thickness)

Answer 16

Partial Thickness

Question 17

Integumentary I: wound healing

Wound extends through both epidermis and dermis. It may involve subcutaneous tissues, muscle, and possibly bone.
(classification by thickness)

Answer 17

Full thickness

Question 18

Integumentary I: wound healing

Nonblanchable erythema of intact skin usually over a bony prominence

(classification by staging)

Answer 18

Stage I

Question 19

Integumentary I: wound healing

Partial thickness skin loss involving the epidermis and/or dermis. Does not go through the dermis. Clinically presents as a blister

(classification by staging)

Answer 19

Stage II

Question 20

Integumentary I: wound healing

Full thickness skin loss involving damage to subcutaneous tissue. It may extend to fascia but not through it. May have undermining or tunneling

(classification by staging)

Answer 20

Stage III

Question 21

Integumentary I: wound healing

Full thickness skin loss with extensive tissue destruction. Damage extended to muscle, bone, tendons and joint capsule.

(classification by staging)

Answer 21

Stage IV

Question 22

Integumentary I: wound healing

Full thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green or brown) and/or eschar (tan, brown or black) in the wound bed.

(classification by staging)

Answer 22

Unstageable

Question 23

Integumentary I: wound healing

Color of tissue necrosis

Answer 23

white, yellow, black

Question 24

Integumentary I: wound healing

a pulse of 3+ is

Answer 24

normal

Question 25

Integumentary I: wound healing

a pulse of 2+ is

Answer 25

diminished

Question 26

Integumentary I: wound healing

a pulse of 1+ is

Answer 26

barely perceptible

Question 27

Integumentary I: wound healing

a pulse of 4+ is

Answer 27

stronger than normal, bounding; possible aneurysm

Question 28

Integumentary I: wound healing

Trancutaneous Partial Pressure of Oxygen (TcPo₂) machine assesses arterial microcirculation.

a TcPo2 < 30mmHG means…

Answer 28

Impaired blood flow. Poor to No healing → No debridement

Question 29

Integumentary I: wound healing

Trancutaneous Partial Pressure of Oxygen (TcPo2) assesses arterial microcirculation.

TcPo2 > 30mmHG means

Answer 29

Adequate blood flow with potential to heal; Debridement allowed

Question 30

Integumentary I: wound healing

Trancutaneous Partial Pressure of Oxygen (TcPo2) assesses arterial microcirculation.

TcPo2 > 40 mmHG means

Answer 30

normal blood flow