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Pathophysiology and Pharmacology 2 > Tissue Integrity & Wound Healing > Flashcards

Tissue Integrity & Wound Healing Flashcards

1
Q

partial thickness wound

A

damage thru epidermis

dermis intact

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2
Q

full thickness

A

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

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3
Q

wound healing depends on

A

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

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4
Q

primary intention

A 
primary closure
surgical closure of wound
repair: formation of new extracellular matrix
regeneration: re-epithelizalization 
little granulation tissue
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5
Q

secondary intention

A 
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
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6
Q

tertiary intention

A

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

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7
Q

phases of wound healing

A

hemostasis
inflammatory
proliferative
remodeling

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8
Q

role of chemical mediators

A 
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)
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9
Q

Inflammatory stage

A

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)

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10
Q

proliferative stage

A

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)

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11
Q

remodeling

A

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

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12
Q

factors that impede wound healing local

A 
blood flow & hypoxia
infection 
radiation exposure
movement/tension 
desiccation 
excessive edema
denervation
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13
Q

factors that impede wound healing systemic

A 
adv age
malnutrition 
nutritional status
immune deficiency
smoking
medications 
metabolic status
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14
Q

hypoxia

A 
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
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15
Q

wound healing & nutrition

A

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

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16
Q

vitamin A deficiency

A

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

17
Q

vitamin C deficiency

A

impairs inflammatory process
inhibits collagen secretion
increases localize infection

18
Q

vitamin K deficiency

A

affects hemostasis & formation of fibrin clot

19
Q

zinc deficiency

A

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

20
Q

MG/CU/FE deficiencies

A

affect protein synthesis & cellular proliferation

21
Q

corticosteroids & wound healing

A

promote breakdown of CHO/fats/protein

anti-inflammatory action impedes inflam phase of wound healing

22
Q

antineoplastic drugs & wound healing

A

potent immunosuppressants

impairs re-epithelizlization granulation tissue formation angiogensis

23
Q

diabetes & wound healing

A

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

24
Q

Fibrosis

A

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

25
Q

Keloids

A

excessive wound healing

lesions of dermal scar or fibrotic tissue

26
Q

Hypertrophic scars

A

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

27
Q

contractures

A

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

28
Q

wound dehiscence

A

deficient wound healing

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

29
Q

s/s of impending wound disruption

A

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

30
Q

chronic nonhealing wounds

A

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

31
Q

pressure injuries

A

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

32
Q

risk factors pressure injuries

A 
immobility
reactive hyperemia
microthrombi
shearing forces
poor perfusion (PAD, DM)
skin status/maceration
33
Q

pressure injuries s/s

A

pressure decreases gradually from bony area toward periphery

discoloration to blisters or areas of denuded superficial skin to deep tissue damage w/ necrosis

34
Q

pressure injuries DX/TX

A 
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
35
Q

pressure ulcer staging

A

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

Pathophysiology and Pharmacology 2 (27 decks)

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