Miscellaneous Wounds/Integumentary issues Flashcards
(41 cards)
1
Q
Abrasions: presentation
A
- caused by friction
- floor burns-usually clean
- road rash: often contaminated
- may bleed moderately, pending depth
- may become complicated if immunosuppressed, medical complications
2
Q
Abrasions: interventions
A
- cleanse
- debride if needed
- dressings: keep moist (petroleum gauze or hydrocolloid)
- possible need for antibiotic ointment
- consider tetanus booster if needed (ask when they last had one)
3
Q
Skin tears:
A
- traumatic wounds resulting from shear or friction forces that separate the epidermis from the dermis
- 80% of skin tears occur on hands and arms
- presentation: superficial tears involving the epidermis and/or dermis
- frequently of flap of skin is peeled back and may be preserved or it may not survive the healing procuess
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4
Q
Skin changes to the older adults that make them more at risk for skin tears
A
- becomes thinner
- less elastic
- decreased underlying fatty tissue for protection and insultation
- thinning dermis
- flattening of the papillae
- decrease in secretions from oil and sweat glands (help with/turgor)
5
Q
Skin tear management
A
- controls bleeding
- cleanse wound gently and pat dry
- realign edges if possible
- low adherenet dressing: soft silicone, petroleum gauze
- draws arrows on dressing to indicate direction of dressing removal
- mark date on dressing, limb/skin protector
6
Q
Skin tear reduction program
A
- educaton
- awareness of nutrition and hydration
- appropriate selection of assistive devices/inspect for safety; no shapr edges
- awareness of medication induced skin fragility (glucocorticoids)
- wear protective clothing
- moisturize
- keep fingernails short (pt’s fingernails too)
7
Q
Surgical wounds
What type of healing and what types
A
- 1º intenion healing
- sutures, staples or tissue adhesives
- normal healing require little care
- observe for signs of infection and protect from friction and shear
8
Q
typical post op healing: 24-48 hours
A
- keep clean and dry
- protect with a sterile dressing
- may have small bleeding/seeping
- changing to serosanguinous
9
Q
Postop healing: PO days 1-4
A
- drainage should be scant
- should see epithelialization of the entire incision
- watch hematoma development
10
Q
Post op healing: OPD 5-9
A
- should see collage deposition
- healing ridge
11
Q
Post-op healing: POD 10-14
A
- re-epithelialization occurs and stitiches/staples can be removed
- know orders from physician
12
Q
Post-op healing: POD 15 through 1-2 years
A
it depends
13
Q
Surgical wound healing
maximize healing
A
- warm
- well hydrated
- pain free (pain and stress slow healing)
- well oxygenated
14
Q
Surgical wound healing
intrinsic factors
A
- increased age = increased risk of poor wound healing
- decreased elastin and collagen in skin, thinning dermo epidermal junction, cellular senescenece, decreased mirgation of keratinocytes
- decreased ability to replace collagen after abdominal surgery
- delays in wound resurfacing increase risk for infection especially. if not well approximated
- decline in immune system which increases risk for infection
- increased chronic disease
15
Q
retention sutures
A
- where there is a lot of tension that could cause the wound to pull open
16
Q
Documentation of surgical wounds
A
- time since surgery
- location
- size/number of staples or sutures
- closure materials (often count)
- color incision
- surrounding skin inflammation
- type and amount of exudate
- dressing if appropriate
- actions taken for follwo up or referral
- education of patient
17
Q
Dehised surgical wound
A
- results from too much tension across wound edges
- may use abdominal binder or montgomery strpas post abdominal surgery
- due to underlying infections or abscess formation
- treat like other chronic wounds
- irrigation, debridement and provide moist wound environment
18
Q
Education recommendations
A
- specific cautions requiring based on wound (no heavy lifting, showering/bathing area/protection)
- significance of wound exudate tissue color, tissue condition
- wound dressing care routine
19
Q
education recommendations: wound dressing care routine
A
- wash hands then remove old dressing and discard gloves
- clean wound with normal saline (or water unless they have a well)
- apply primary dressing, secondary dressing and secure properly
- universal precautions and dressing disposal
- frequency
20
Q
Referral criteria for wound
A
- markedly increase blood drainage
- exudate changes from bloody/serosanguinous to purulent
- increased exudate after post-op day 4
- absence of healing ridge formation by day 9
- signs and symptoms of wound infecion
- wound dehiscence or tunnel/fistula formation
21
Q
Pilonidal cyst
A
- sacs filled with hair and skin bebrid that form at the top of the crease of the buttocks above the scarum
- need surgical debridement
- abcess fluid and filled
22
Q
Panniculus (apron)
A
- panniculectomy: surgical removal of redundant abdominal skina nd subcutaneous tissue following extreme weight loss
- skin issues: fungal infection, bacterial infection and or skin break down
23
Q
Bite wounds: animal bites
A
- dogs: 80-90% typically with jagged edges and minimal tissue loss
- cats (5-15%) typically are puncture wounds
24
Q
Bite wounds: human bites
A
- from actual bite or from close fist injury to mouth
- most at tisk for infection than any other type of bite
- tetanus booster if no shot in last 5 years
- high risk for infection
- average of 4 different microbes per bite
- all get broad spectrum antibiotics
25
bite wounds: spider bite
- difficulty to diagnose most dont feel the bite
- only 2 types of bites endemic to the US that need medical care: black widow and brown recluse
26
Pyoderma gangrenosum
- noninfectious progressive necrotizing skin condition
- uncommon, ulcertaive cutaneous condition of uncertain etiology
- it is assoicated with systemic disease in at least 50% of patients who are affected
- begins as a small painful papule vesicle
27
Interventions for pyodermal gangrenosum
- typical corticosteriods
- oral immunosuppressive agens
- local wound care: gentle and limited debridment, gauze or moisture retentive dressing
- very slow healing: 69% resolve after 1 year, 95% resolve after 3 years
28
Necrotizing fasciitis
| what is it and what is the treatment
- flesh eaing bacteria
- typically idiopathic
- often mixture of aerobic and anaerobic bacteria that erode fascial planes and necrotize subcutaneous tissue
- overlying skin must be excised to halt progression of necrosis
- may be left open requiring daily irrigation and packing of pockets or excised tissue
- patient usually presents with painful, edematous, and erythematous areas quickly progressing to anesthetic and dusky
29
Cryoglobulinemia
- the presence of abnormal proteins in the blood that coagulate or become thick/gel like in temperature below body temp
- clog small vessels resulting in vasculitic damage: hypoxic skin changes, ischemic wounds, wound damage
- may be reversible if tissue is warmed quickly
- may be caused by blood cancers, chronic inflammatory conditions: hep c and lupus
30
treatment for cyroglobulinemia
- treat infection
- pain management
- non-adherent dressings
31
Herpes virus
- type 1: oral/cold sores
- type 2: genital herpes
- virus remains latent and can be reactivated in immune-compromised individuals leading to a local infection, chronic ulcers, mucus membrane damage or systemic infections in NS, GI tract and the ocular system
- Herpes zoster-chicken pox and shingles
| `
32
Common dermatologic conditions
- eczema and dermatitis: inflammatory skin reaction of epidermis and dermis
- itch, rash, excoriations
- treatment needs to remove cause/irritant
- topical corticosteriods moist dressing, systemic meds
33
contact dermatitis
- allergic or irritant
- in contact and reacts with skin barrier to activate an immune response
- can be immediate or delayed
- response usually increases in severity after repeated exposure
34
Psoriasis
| -
## Footnote
-
- chronic recurrent inflammatory disease
- characterized by round red, dry, scaling plaques covered by silvery white scales
- no cure
- treated with systemic or topical agents
- UV effective for antiproliferative effects on keratinocytes
35
Common foot problems with integ
- tinea pedis
- onychomycosis
- xerosis and anhidrosis
- callouses and fissues
- onychauxis: hypertrophic toenails that result from ttrauma, age, genetics
36
Xerosis and anhidrosis
- dry flaky skin on heels and bottoms of feet
- avoid prolonged soaking in hot water
- use emollients and petrolatum based products
- wear proper footwear and socks as a barrer between skin and shoe
37
Fissues and callouses
- cracks in the dermis that cause a partial thickness wound
- common on the heel
- tx: reduce keratotic tissue around perimeter vis mechanical or chemical debridement, use film, hydrocolloid or sheet hydrogel to close the wound, keep moist and wear shoes vs slippers or sandals
38
tinea pedis aka athletes foot
- results from infection by dermatophytes (aerbic fungi) that feed on keratin in dead lyers of skin, hair and nails
- responds to this infection by increased proliferation, leads to scaling and thickening
- most commn source is from infected indivduals and their belongings, towels and bath mats
- warmth and humidity contribute
- pruruitis, scaling, redness, odor, uncomfortable breaks in the skin
39
onychomyosis
- fungal organims invade the nail via nail bed
- left untreated destroys the nail plate
- precipitated by environmental factors including microtrauma, sweat, heat
- discoloration
- hyperkeratosis and debris, separation of the nail plate form the nailbed
- tx: good foot hygiene, topical antifungal debridement oral systemic meds
40
Tinea corporis: signs and symptoms/treatment
- enlarged raised red rings with clear centers
- itching
- scales
- hair loss
- tx: topical steroids and antifungal meds
41
common integ signs
- muscle wasting/alopecia/dry skin/peripheral edema: under or malnurtition
- redness/warmth/pain/poorly defined borders/fever/chills: cellulitis or dermatitis
- rash or blisters alone dermatome: herpes zoster/shingles
- clubbing of fingers/ttoes: COPD
- uticaria: hives
- jaundrice/palmar erythemia/ascities
- bulls eye rash: lyme disease
- butterfly rash: SLE
