Immunity- Wound Healing

Question 1

Cell injury comes from:

Answer 1

Physical injury
Deficiency of normal substance
Exposure to a toxin

Question 2

1st defense

Answer 2

Innate
Skin
Mucous membranes
pH, lysozyme, temperature

Question 3

2nd defense

Answer 3

Innate
Internal
Phagocytes, NK cells, inflammation, fever, anti microbial agents, leukocytes

Question 4

3rd defense

Answer 4

Adaptive immunity
Humoral immunity- B cells
Cellular immunity- T cells

Question 5

All leukocyte types

Answer 5

2nd line of defense 
Neutrophils 
Lymphocytes (t and b) 
Monocytes 
Eosinophils 
Basophils

Question 6

Natural killer cells

Answer 6

Non-specific
Non-phagocytic
Secrete chemicals

Question 7

INF

Answer 7

Interferon
Anti microbial protein

(Complement is another example)

Question 8

Inflammatory response

Answer 8

Bacteria in blood 
Mast cell give off histamine 
Vasodilation 
Capillary permeability 
More blood flow and edema (exudate) 
Red, heat, swelling, pain

Question 9

Cellular defense

Answer 9

T cells from thymus

Become effector cells (helper and cytotoxic and regulatory) to target intercellular pathogens

Question 10

Humoral defense

Answer 10

B cells from bone marrow

T cells activate them to secrete antibodies that target extracellular proteins

Question 11

Lab signs of acute inflammation

Answer 11

High WBC
High CRP
High fibrinogen

Question 12

Lab signs of chronic inflammation

Answer 12

High CRP
High fibrinogen
High TNF alpha

Question 13

Non-steroidal anti inflammatory drugs

Answer 13

Stop Cox 1- and -2
Stop prostaglandin made 
Raise GI acid and less mucus 
Down regulate renal blood flow and blood clotting 
Gastric bleeding and ulcers

Question 14

Cox-2 inhibitors

Answer 14

Specific type of NSAIDS
Help with edema, pain, inflammation, and leukocytosis
Good for musculoskeletal problems
Risk strokes and heart attacks

Question 15

Glucocorticoids risks

Answer 15

Muscle wasting
Osteoporosis
DM
Edema from vascular permeability

Question 16

Antibody

Answer 16

Secreted by B cells when antigens present
Tag antigens and mark for destruction
M, A, G, D, E

Question 17

Pressure Ulcer

“Shear”

Answer 17

Mechanical force caused by gravity and friction like sitting

Question 18

Necrosis/Eschar

Answer 18

Brown black or tan tissue that sticks to the edges of the wound. Usually needs taken off (called debridement)

Question 19

Slough

Answer 19

Soft, moist avascular tissue that sticks/clumps to wound

White, yellow, tan, or green

Question 20

Undermining

Tunneling

Answer 20

Necrosis spreads to create a pocket underneath skin that is bigger than the wound appears on surface
Undermining joins another undermining

Question 21

Wound Vac using NPWT

Answer 21

Draws wound edges together

Negative pressure wound therapy

Question 22

Braden Scale (6-23)

Answer 22

Lower score means greater risk of bedsores

Question 23

Pressure ulcers stage 1

Answer 23

Red skin that doesn’t turn white when pressed
Skin not broken
Temp and hardness may be different

Question 24

Pressure ulcer Stage 2

Answer 24

Epidermis broken
Drainage and pus present
Dermis can be broken. Usually a shallow cut

Question 25

Pressure ulcer stage 3

Answer 25

Through dermis and into fatty tissue | Pus, odor, fever, green drainage, and necrosis may start to be visible

Question 26

Pressure ulcer stage 4

Answer 26

Wound goes into muscle or bone Dead tissue, drainage, and possible infection Surgery usually needed

Question 27

Suspected deep tissue injury characteristics

Answer 27

Purple or maroon local look Blood blister Mushy, boggy painful tissue

Question 28

Pressure ulcer: unstageable

Answer 28

Tissue completely lost but filled in with slough (yellow green brown gray or dark Eschar (necrosis)) It has to be removed to see the bottom of wound but is sometimes left in

Question 29

Normal wound healing process

Answer 29

Inflammation Proliferative Remodeling

Question 30

Kcal/protein/fluid needs for wound healing

Answer 30

25-30 or 30-35 kcal/kg 1.25-1.5 g/kg 35ml/kg or if over 55 yo, 30 ml/kg

Question 31

Arginine Glutamine

Answer 31

Collagen deposition, nitrogen balance, immune function Fuel for enterocytes, lymphocytes, and macrophages