integumentary system Flashcards
1
Q
key functions of integumentary system
A
- protection
- sensation
- thermoregulation
- excretion of sweat
- vit D synthesis
2
Q
phases of normal wound healing
A
- inflammatory phase (days 1-10): inflammation as initial response
- clotting, debris and necrotic itssue removed (mast cells, neutrophils, leukocytes), clean wound bed signals restoration to begin, re-epithelialization w/in 24 hours at borders but visually at 3 days
- proliferative phase (days 3-21): formation of new tissue
- capillary buds and granulation tissue fill wound bed for migration of epithelial cells, collagen matrix formed
- maturation phase (days 7-2 years): remodeling, when granulation tissue and epithelial differentiation begin to appear in wound bed
progression halted or delayed in chronic wounds
3
Q
newly repaired tissues have _ % of pre injury tensile strength and up to - %
A
15%, up to 80%
4
Q
layers of skin
A
epidermis
dermis
subcutaneous fatty tissue
5
Q
healing by intension
A
- primary: acute wounds with minimal to no tissue loss; sutures, staples, adhesives
- secondary: wounds close on their own without superficial closure
- tertiary: delayed primary intention healing; if at risk for complications, left open and then closed once risk factors alleviated
6
Q
bacteria in 3 ways
A
- contamination: non-replicating bacteria on wound, no additional tissue injury or inflammation
- colonization: replicating bacteria on wound but not in further tissues, no inflammatory response
- infection: replicating bacteria that invade and cause inflammatory response
7
Q
avulsion
A
- degloving
- wound resulting from tension that causes skin to become detached from underlying structures
8
Q
types of ulcers
A
- arterial insufficiency ulcers
- venous insufficiency ulcers
- neuropathic ulcers
- pressure ulcers
9
Q
arterial insufficiency ulcer
A
- d/t inadequate cirulation of oxygenated blood - ischemia
- lower 1/3 of leg, toes, web space
- smooth edges, well defined, deep, lack granulation tissue
- avoid unnecessary leg elevation, heating pads, hot water
- severe pain
10
Q
venous insufficiency ulcers
A
- impaired cenous system, inadequate circulation
- proximal to medial malleolus
- irregular shape, shallow
- mild pain
- leg elevation helps
11
Q
neuropathic ulcers
A
- s/t complications with ischemia and neuropathy, associated with DM but can be any peripheral neuropathy
- in areas of foot susceptible to pressure or shear in WB
- well-defined oval or circle with callused rim, crackled periwound tissue, little to no good wound bed
12
Q
pressure ulcers
A
- decubitus ulcers
- from sustained or prolonged pressure at levels greater than that of capillary pressure
- contributing factors: shear, moisture, heat, friction, meds, muscle atrophy, malnutrition
13
Q
monofilament testing
A
- failure to perceive 10 mg monofilament - loss of protective sensation, pt at incr risk for neuropathic ulcer
- failure to perceive 75 mg monofilament - area insensate
14
Q
wound depth classifications
A
- superficial wound: trauma to skin with epidermis intact (non-blistering sunburn), heals w/ inflammatory process
- partial-thickness wound: through epidermis and into but not through dermis (abrasions, blisters, skin tears), heals w/ re-epithelialization
- full-thickness: through dermis and deeper into subcuteanous fat - deeper than 4 mm, heal by secondary intention
- subcutaneous wound: through integ tissue and involve deeper structures like fat, muscle, bone, tendon
15
Q
wagner ulcer grading
A
- for diabetic foot ulcers
16
Q
pressure injury staging
A
- non-blanchable erythema of intact skin
- partial-thickness with exposed dermis - no adipose tissue, granulation, slough, eschar
- full-thickness skin loss - fat visible, slough/eschar may be present but not fascia, tendon, bone, muscle
- full-thickness skin and tissue loss - exposed fascia, muscle, tendon
- unstageable: obscured by slough or eschar, reveals a 3 or 4
17
Q
what do you do with stable eschar
A
leave it
18
Q
exudate classifications
A
- serous: clear, water, normal
- sanguineous: red, thin, d/t blood, can be normal
- serosanguineous: light red or pink, normal
- seropurulent: cloudy, opazque with yellow or tan color, impending infection, always abnormal
- purulent: yellow of green, thickers, infection, always abnormal
19
Q
necrotic tissue types
A
- eschar: hard or leathery, black/brown, dehydrated, firmly adhered to wound bed
- gangrene: death/decay from interruption of blood flow or bacterial infection
- hyperkeratosis: callus, white/gray in color
- slough: moist, string, mucinous, white/yellow
20
Q
selective debridement
A
- sharp: use of scalpel, scissors, forceps (PTs can) - remove necrotic tissue
- enzymatic: topical enzymes to necrotic tissue for infected or uninfected wounds - establish clean wound bed
- autolytic - body’s mechanisms w/ films, hydrocolloids, hydrogels - non-invasive and painfree, not on infected bc takes longer
21
Q
non-selective debridement
A
- wet-to-dry: moistened gauze over necrotic tissue dries and is removed - can cause bleeding and pain, use spareingly
- wound irrigation: pressurized fluid - for infected or loose debris
- hydrotherapy: whirlpool tank, can cause maceration
22
Q
negative pressure wound therapy (NPWT)
A
- vacuum assisted closure (VAC)
- manage drainage
- chronic or acute wounds that cannot be closed by primary intention
- not for insufficient vascularity, untreated osteomyelitis, pain
23
Q
hyperbaric oxygen
A
- inhalation of 100% oxygen delivered at pressure greater than 1 atm, delivered in closed chamber
- indicated for osteomyelitis, diabetic wounds, crush injuries, radiation necrosis
- contraindications: terminal illness, pneumothorax, pregnancy
24
Q
growth factors
A
- derived from naturally occurring protein factors, facilitate healing by stimulating activity of specific cell types
- for neuropathic ulcers extending into or through subcutaenous tissue w/ adequate circulation to sustain wound healing
- not for wounds w/ primary intention, hypersensitivty, history of neoplasm
25
primary dressings
- come in direct contact with wound
- can include self-adhesive backing or do not require secondary dressing
26
secondary dressing
- place directly over primary dressing for additional protection, absorption, occlusion, securing primary dressing in place
27
alginates
- derived from seaweed extraction
- for partial or full-thickness draining wounds - pressure or venous ulcers
- used on infected wounds d/t inc drainage
- high absorptive capacity, enables autolytic debridement
- disadvantages: may require frequent changes based on exudate levels, requires secondary dressing, no exposed tissues under
28
foam dressings
- hydrophilic polyurethance base that contacts wound surface and hydrophobic outer layer, allow exudate to be absorbed through hydrophilic layer
- for protection and absorption over partial and full-thickness wounds with varying levels of exudate
- can be secondary dressing
- moderate absorption
29
gauze
- can be impregnated with meds
- common on infected or non-infected wounds
- can be used for wet to dry
- highly permeable
30
hydrocolloids
- gel-forming polymers back by strong film or foam adhesive that surrounds wound
- absorb exudate by swelling into gel-like mass and vary in permeability, thickness, transparency
- for partial or full thickness wounds
- can be used for granular or necrotic wounds
- moist for wound healing, waterproof
- moderate absorption
31
hydrogels
- consist of varying amounts of water and gel foring materials like glycerin
- moisture retentive for superficial and partial-thickness wounds with minimal drainage
- moist env for wound healing
- dressings can dehydrate, not for wounds with signif drainage
32
transparent film
- thin membranes, permeable to vapor and oxygen but not water or bacteria
- superficial or partial thickness wounds with minimal drainage
- not for infected wounds
33
_ and _ are broad-spectrum antimicrobial agents that have become valuable adjucts for wound healing
- silver and iodine
34
dressings from most occlusive to non-occlusive
- hydrocolloids
- hydrogels
- semipermeable foam
- semipermeable film
- impregnated gauze
- aligantes
- traditional gauze
- occlusive: ability of a dressing to transmit moisture, vapor, gases btw a wound and atmosphere (fully - latex glows)
35
dressings from most to least moisture retentitve
- alginates
- semipermeable foams
- hydrocolloids
- hydrogels
- semipermeable films
36
in an appropriately moist wound, _ appear earlier and in greater numbers to decrease infection risk
- macrophages
- SO collagen synthesis and epithelialization rates enhanced - facilitate more rapid wound closure
37
US for wound healing
- US at low intensity w/ pulsed duty cycle
- enhances fibroblasts, endothlial, and WBC activity
38
high voltage pulsed current (HVPC) for wounds
- estim that enhances healing numerous types of wounds including ulcers, burns
- sensory or subsensory settings
39
contusion
injury d/t blow that does not disrupt skin integrity - pain, edema, discoloration
40
desiccated
dry out or dehydration of a wound resulting from poor dressing selection that does not control evaporation of wound bed moisture
41
desquamation
- shedding of layers of epidermis
- in small scales though can be larger scales or sheets with deeper layers of skin
42
ecchymosis vs erythema
- ecchymosis: discoloration, bruise
- erythema: redness from capillary dilation and congestion or inflammatoin
43
epidermis
- avascular
- epithelial layer
- squamous cells, round basal cells, melanocytes
44
dermis
- vascular
- hair follices, sebaceous glands, sweat glands, lymphatic and blood vessels, nerve endings
45
hematoma
localized swelling or mass of clotted blood confined to tissue, organ, space - usually caused by break in BV
46
turgor
speed with which skin resumes normal appearance after being lightly pinched
47
burns zones
- zone of coagulation: area that received most severe injury with irreversible cell damage
- zone of stasis: area of less severe injury that possesses reversible damage and surrounds zone of coagulation
- zone of hyperemia: area around zone of stasis that presents with inflammation but will fully recover without innervention or permanent damage
48
superficial burn
- only outer epidermis
- may be red with slight edema
- healing w/o peeling or scarring in 2-5 days
49
superficial partial thickness-burn
- epidermis and upper dermis
- painful and blister
- minimal scarring
- heals 5-21 days
50
deep partial thickness burn
- complete destruction of epidermis and majority of dermis
- broken blisters, discolored, edema, damage to nerve endings
- moderate pain
- hypertrophic or keloid scarring
- heals 21-35 days if no infection
51
full thickness burn
- epidermis and dermis destruction with partial damage to subcutaneous fat layer
- eschar
- minimal pain
- healing varies
- can require graft
52
subdermal burn
- involves complete destruction of dermis and epidermis w/ subcutaneous tissue - can involve bone and muscle
- mult surgeries and extensive healing time
53
rule of 9s
- children under 1 have 9% taken from LE and added to head/neck - 1% distrib to LEs until 9 when "normal"
54
anticipated derformities based on burn location
- ant neck: flexion, lateral flexion
- anterior chest and axilla: shoulder add, ext, medial rotation
- elbow: flex, pron
- hand and wrist: extension of MCP, flexion IP, add/flexion of thumb, flexion of wrist
- hip: flexion, add
- knee: flexion
- ankle: PF
55
compression garments for burns
- for burns requiring > 14 days to heal
- use of sustained compression from 15-35 mmHg
56
topical agents for burn care
- silver sulfadiazine
- silver nitrate
- providone-iodine
- mafenide acetate
- gentamicin
- nitrofurazone
| all broad spectrum
57
allograft
| homograft
temporary skin graft from another person (cadaver) to cover large burn
58
autograft
permanent skin graft from patient's body
59
heterograft
| xenograft
- graft from another species
60
z plasty
surgical procedure to eliminate scar contracture
incision in z-shape to change configuration and lengthen scar
61
cellulitis
- localized redness, warm skin, TTP, chills, fever
- d/t bacterial infection
- rule out other issues, PT for wound care
62
dry gangrene
- loss of vascular supply resulting in local tissue death
- slow developing
- can lead to autoamputation
- mummified skin
63
wet gangrene
- associated bacterial infection - can be complication of untreated wound
- after burn, frostbite
- cessation of bloodflow -> bacterial invasion at site
- red -> brown -> black skin
64
tinea pedis
athlete's foot
