Impairment of Integ System

Question 1

True/ False: The skin is the largest organ of the body?

Answer 1

True

Question 2

What are 6 main functions of skin?

Answer 2

1. regulate body temp
2. protection from trauma
3. prevention of fluid loss or gaim
4. prevention of bacteria and viral penetration
5. sensory reception
6. produces vit D- helps GI system absorb calcium for bone health

Question 3

What are four major layers of skin?

Answer 3

1. epidermis
2. dermis
3. basement membrane
4. subcutaneuous

Question 4

What is the role of epidermis?

Answer 4

protection, plays role in Vit D synthesis

it is avascular

Question 5

What are 4 primary cells of epidermis?

Answer 5

1. kerintinocytes- 90% (proteins)
2. melanocytes- pigment and protection
3. merkel cells- mechanoreceptors
4. langerhans- help fight infection

Question 6

What are layers of epidermis?

Answer 6

1. stratum basale
2. spinosum
3. granulosum
4. lucidum- toughest
5. corneum

Question 7

How long does it take cells to go from corneum to basale?

Answer 7

14 days

Question 8

What are characteristics of dermis?

Answer 8

highly vascularized containing superficial lymphatic system and sensory organs

Question 9

What are 2 layers of dermis?

Answer 9

1. papillary dermis- made of collagen and elastin

2. reticular dermis- contains appendages (80% of dermis)

Question 10

What are four appendages?

Answer 10

hair follicles, sabaceous (oil), sudoriferous glands (sweat), nails

Question 11

What cells compose dermis?

Answer 11

fibroblast (make collagen and elastin), macrophages, mast cells (open cells and vascular system), WBC (neutrophils)

Question 12

What should healthy dermis look like?

Answer 12

red, pink, shiny, moist

Question 13

What is characteristics of subcutaneous layer?

Answer 13

energy storage centers, anchors dermis, supports muscles bone, fascia, highly vascular

Question 14

What is goal of normal wound healing?

Answer 14

striving to achieve homeostasis

Question 15

What are potential barriers to wound healing?

Answer 15

1. co morbidity
2. meds (steroids)
3. nutrition
4. age
5. stress
6. body size
7. infxn

Question 16

What are the three phases of wound healing?

Answer 16

1. inflammation
2. proliferation
3. maturation and remodeling

Question 17

Before stage 1 what is vascular response?

Answer 17

attempt for hemostasis, vasoconstriction, platelet/clotting factors, fibrin mesh laid down

Question 18

How long is inflammatory stage?

Answer 18

10 days

Question 19

What are characteristics of this stage?

Answer 19

redness, heat, edema, pain and loss of function

histamine released which expands cells hitting pain receptors

Question 20

What are the goals in inflammatory stage?

Answer 20

provide hemostasis, bring neutrophils and macrophages (eaters) into wound, provide clean wound site for tissue restoration

Question 21

What is the main reason the inflammatory is interrupted?

Answer 21

vascular insufficiency which limits amount of O2 and other nutrients to area, also limits what current cells can do that are there

Question 22

T/F: Macrophages, growth hormones and autolytic debridement all occur in inflammatory story?

Answer 22

True

Question 23

What are characteristics of proliferative stage?

Answer 23

overlaps for Inflam stage, starts 3-5 post injury and last 3 + weeks

Question 24

What is goal of prolif stage

Answer 24

fill in wound defect with new granulation tissue and restore integrity of skin

Question 25

What are four processes in this stage?

Answer 25

1. angiogenisis 2. collegen synthesis 3. contraction 4. epitheliazation

Question 26

What are angioblasts?

Answer 26

cells in blood vessel formation

Question 27

what is a myofibroblast?

Answer 27

in between fribroblast and smooth muscle, actin rich helps with contraction of wound

Question 28

What happens during angiogenesis?

Answer 28

granulation tissue is developed, color of wound is pink to bright red, very fragile needs protection

Question 29

What happens during collagen synthesis?

Answer 29

fibroblasts produces extracellular matrix and collegen and fill wound bottom up this eventually will replace granulation with scar tissue

Question 30

What happens during contraction stage?

Answer 30

process of pulling margains of wound close together too much contraction can cause contracture needs a warm high O2 environment

Question 31

What type of contraction occurs faster?

Answer 31

linear faster than circular

Question 32

What is zinc good for?

Answer 32

a

Question 33

Iron?

Answer 33

b

Question 34

copper?

Answer 34

C

Question 35

vitamin c?

Answer 35

d

Question 36

What happens in epitheliazation stage stage?

Answer 36

keratinocytes migrate in a single layer across wound, think of ends of wounds sliding across wound surface cells cannot migrate over dead tissue

Question 37

What is goal of epi stage?

Answer 37

close wound, not healed but closer

Question 38

How long should an acute surgical wound complete proliferation stage of wound healing?

Answer 38

4 weeks, closed not healed

Question 39

What happens if the wound becomes chronic during epi stage?

Answer 39

lack or moisture causes rolled edges there can also be too much or too little fluid

Question 40

What are characteristics of maturation stage?

Answer 40

final wound healing phase, begins when granulation tissue is formed during prolif stage and continues 1-2 post injury

Question 41

What is the strength of the scar tissue post injury?

Answer 41

80% as strong as original

Question 42

What type of collagen is used during remoldeling?

Answer 42

starts with type 3 and then is replaced by type 1

Question 43

What happens if there is too much collagen synthesis?

Answer 43

hypergranulation can occur in forms of hypertrophic (puffy) or keloid scars (scar outside border of original wound)

Question 44

What do most scar changes occur?

Answer 44

within first 6-12 months

Question 45

How can a PT check if scar is healing properly?

Answer 45

it should move in every direction

Question 46

What is collegen ratio in normal skin?

Answer 46

4:1 type 1/3 hypertrophic- 2:1 1/3

Question 47

What is dehiscense?

Answer 47

insufficient scar formation- due to impaired collegan synthesis

Question 48

What color should scar mature into?

Answer 48

high vascular to low vascular

Question 49

what can't a scar do if appendages were damage?

Answer 49

sweat, have hair, secrete oil and no senseation

Question 50

What can help with scar management?

Answer 50

silver nitrate sticks ( cuts back hypergranulation), compression, massage, e stim

Question 51

What can be done to patient to increase wound healing?

Answer 51

increase their circulation, ventilation, watch nutrition and treat co morbidities

Question 52

What factors related to the wound affect healing?

Answer 52

mechanism of onset, time since onset, location, dimensions, temp, hydration, necrotic tissue, infxn, edema

Question 53

Why is oxygen so important to wound healing?

Answer 53

fibroblasts are oxygen sensitive, and healing is energy dependent

Question 54

Which stage of healing is most reliant on O2?

Answer 54

proliferative stage has increased metabolism and protein synthesis

Question 55

What level of PO2 is needed for collagen synthesis

Answer 55

atleast over 40 mmHG, anything under the wound is at great risk for infxn

Question 56

What nutrient is most important for wound healing?

Answer 56

protein, pts should be having 1.5 kg/ day carbs also vital for energy

Question 57

What should pts albumin levels be?

Answer 57

3.5 mg/kg

Question 58

What is vitamin C useful for with wound healing?

Answer 58

collagen synthesis, minimize scarring

Question 59

B12?

Answer 59

helps with O2 uptake

Question 60

Folic acid?

Answer 60

RBC production

Question 61

vit A?

Answer 61

inflammation response

Question 62

Vit E?

Answer 62

helps break down fat for energy

Question 63

Zinc?

Answer 63

WBC count

Question 64

Iron?

Answer 64

helps with RBC count which increases O2 transport

Question 65

Arginine?

Answer 65

triggers growth hormone

Question 66

What is a superficial wound?

Answer 66

superficial skin lesion only penetrating dermis like a scrape or sunburn usually self healing

Question 67

What is a partial thickness wound?

Answer 67

penetrates through epidermis and top portion dermis like a blister, heals primarily by epithelization

Question 68

What is a full thickness wound?

Answer 68

penetrates through epidermis, dermis and extends into subcutaneous tissue heals by secondary intention-contracture, epitheliazation, granulation and scar tissue development

Question 69

What is a primary wound closure?

Answer 69

aka primary intention usually a surgical wound closed by sutures or staples closes within 7 days with little to no scarring

Question 70

What happens if primary closure is opened?

Answer 70

usually has to close by secondary intention

Question 71

What is secondary closure?

Answer 71

heals from bottom up and includes granulation etc. involves scar formation

Question 72

For secondary closure at what time period should a wound have substantial healing?

Answer 72

after 2 weeks wound should atleast be smaller

Question 73

What is delayed primary closure?

Answer 73

wound heals by secondary closure and then is closed by primary closure

Question 74

What are reasons for delayed closure?

Answer 74

large amount of tissue loss, large amount of swelling, contamination, high infxn risk