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Anatomy and Physiology - applied > The skin and wound healing > Flashcards

The skin and wound healing Flashcards

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1
Q

How much does pressure area care cost the NHS everyday?

A

£1.4 million as 4-10% of hospitalised patients will develop a pressure ulcer

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2
Q

What are the common types of skin damage?

A

Pressure ulcers
Surgical wounds
Traumatic wounds
Ulcerating cancers (fungating wounds)
Burns
Non-infectious/infectious conditions
Chronic LT conditions
Allergies

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3
Q

What is the nurses role in skin care? (7 roles)

A

Asses and monitor the patients skin, skin mapping
Identify risk factors and use methods to reduce them
Carry out wound care - dressings, removal of sutures, debridement
Assist in personal hygiene - continence needs
Reposition the patient according to individual care plan
Refer patients to MDT
Administer prescription medications as directed

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4
Q

What does SSKIN stand for?

A

Surface
Skin inspection
Keep patient moving
Incontinence/moisture
Nutrition/hydration

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5
Q

What does surface of SSKIN refer to?

A

Making sure patients have the right support
Use of equipment

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6
Q

What does skin inspection of SSKIN refer to?

A

Early inspection means early detection, show patients and carers what to look for

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7
Q

What does incontinence/moisture of SSKIN refer to?

A

Patients need to be clean and dry - moisture will damage the Stratum Corneum

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8
Q

What does nutrition/hydration of SSKIN refer to?

A

Help patients have the right diet and plenty of fluids
MUST score, referral to dieticians

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9
Q

What does Keep moving of SSKIN involve?

A

Assessment, repositioning schedule, prevention

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10
Q

What is the assessment tool used to evaluate risk of pressure ulcers in adults?

A

Waterlow Risk Assessment

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11
Q

What is the assessment tool used to evaluate risk of pressure ulcers in children?

A

Braden Q - focus on occipital area

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12
Q

How can skin be assessed using observation?

A

Colour, mottling, dry, loose, oedematous, wounds, abrasion, bruise, deformity, burn, erythema, flakiness, self hygiene

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13
Q

How can skin be assessed using touch?

A

Clammy/sweaty/moist, soiled/wet, sensitive/exaggerated, sensation, dry, cap refill < 2 secs - peripheral, central

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14
Q

How can skin be assessed using positioning?

A

Ability to re-position, pain on movement

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15
Q

How can skin be assessed using clothing?

A

Loose, restrictive, soiled

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16
Q

How can skin be assessed using current medications?

A

Creams, steroids, allergies

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17
Q

How can skin be assessed using skin conditions?

A

Chronic, acute, infectious

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18
Q

What is a Pressure Ulcer (PU)?

A

A localised injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure combination with shear
A number of contributing or confounding factors are also associated with pressure ulcers - microclimate, friction, excessive moisture

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19
Q

What is a Medical Device Related Pressure Ulcer (MDRPU)?

A

A pressure ulcer that has developed due to sustained pressure from a medical device such as plaster casts, splints, oxygen therapy masks, tracheostomy tubing or urinary catheters

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20
Q

What is Moisture Associated Skin Damage (MASD)?

A

A reactive response of the skin to chronic exposure to excessive moisture from sweat, urine, faecal matter or wound exudate, which could be observed as an inflammation and erythema with or without erosion
Typically there is a loss of the epidermis and the skin appears macerated, red, broken and painful

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21
Q

What are the factors to consider in a wound assessment?

A

Mechanisms will affect treatment and healing
Bacterial loading - time, mechanism, initial first aid
Appearance - active bleeding, slough, necrosis
Map the wound/photograph (with patient consent)
Categorise the wound

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22
Q

What can a wound be categorised as in a wound assessment?

A

Vascular - arterial/venous/both
Neuropathic (diabetic)
Moisture associated dermatitis
Skin tear
Pressure ulcer
May be multi-factorial

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23
Q

What are the stages of pressure ulcers?

A

Stage 1 - skin is unbroken but inflamed
Stage 2 - skin is broken to epidermis or dermis
Stage 3 - ulcer extends to subcutaneous fat layer
Stage 4 - ulcer extends to muscle or bone

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24
Q

What are the characteristics of healthy skin?

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A

Subcutaneous layer - contains blood vessels and cushioning fat
Dermis - where new cells are made
Bones - support the body
Sweat glands - lubricate the skin
Epidermis - outer protective covering

25
What are the characteristics of fragile skin?
Subcutaneous layer - has fewer and flatter fat cells Dermis - produces cells more slowly Bones- protrude Sweat glands - fewer so make less lubrication Epidermis - dry and loses cell layers
26
What are the characteristics of a stage 1 pressure ulcer?
Intact skin with a localised area of non-blanchable erythema (may appear differently in darkly pigmented skin) Presence of blanchable erythema or changes in sensation, temperature, or firmness may precede visual changes Colour changes do not include purple or maroon discolouration - may indicate deep tissue pressure injury
27
What are the characteristics of a stage 2 pressure ulcer?
Partial thickness loss of skin with exposed dermis Wound bed is viable, pink or red, moist, and may also present as an intact or ruptured serum-filled blister Sub Cut/adipose is not visible and deeper tissues are not visible Granulation tissue, slough and eschar are not present
28
What are the characteristics of a stage 3 pressure ulcer?
Full thickness skin loss Subcutaneous fat may be visible but bone, tendon or muscle are not exposed Slough may be present but does not obscure the depth of tissue loss, may include undermining and tunnelling Depth varies by anatomical location - the bridge of the nose, ear, occipital and malleolus do not have subcutaneous tissue (can be shallow) Areas of significant adiposity can develop extremely deep stage 3 ulcers
29
What are the characteristics of a stage 4 pressure ulcer?
Full thickness tissue with exposed bone, tendon or muscle Slough or eschar may be present on some parts of the wound bed Often includes undermining and tunnelling Depth varies by anatomical location Can extend into muscle/supporting structures making osteomyelitis possible Exposed bone/tendon is visible or directly palpable
30
What is slough?
The yellow/white material in a wound bed, usually wet with a soft texture Consists of fibrin, white blood cells, bacteria and debris Result of inflammation
31
What is eschar?
A type of necrotic tissue that adheres to the wound bed Dryer then slough and has a spongy/leather-like appearance
32
What are the characteristics of an unstageable pressure ulcer?
Depth unknown Full thickness tissue loss in which the base of the ulcer is covered by slough or eschar in the wound bed Until enough slough/eschar is removed to expose the base, the stage cannot be determined
33
What are the characteristics of a deep tissue injury?
Persistent, non-blanchable, deep red, purple or maroon areas of intact skin, non-intact skin or blood-filled blisters caused by damage to the underlying soft tissues Common for a thin blister to form over the surface of the dark wound bed, it may become covered by thin eschar Serious form of pressure injury - form in the underlying tissues and are often not visible until they have advanced to the point where treatment is significantly more problematic Deteriorate quickly even under optimal care
34
How can pressure ulcers be prevented?
Barrier creams to prevent moisture lesions Pressure relieving devices Skin massage/rubbing, positioning/repositioning Nutritional interventions including hydration Patient and carer education and training for HCPs Assessment and grading of pressure ulcers Management including debridement and larval therapy Negative pressure wound therapy and hyperbaric oxygen therapy
35
What are the 2 primary risk factors for developing a chronic wound?
Age Diabetes
36
What is wound healing?
The skins response to closing breaches to its barrier
37
What are the mechanisms of haemostasis?
Vasoconstriction - reduce blood flow from damaged vessels (prevents further damage) Platelets detect collagen from damaged vessels and signal the formation of a fibrin clot
38
What does thrombin do?
Triggers platelet activation, encouraging coagulation and clot formation, platelets recruit immune cells to the site
39
What are the secondary functions of eschar (the plug)?
Shielding against bacteria Providing a scaffold for incoming immune cells Harbouring a reservoir of cytokines and growth factors shaping the behaviour of wound cells for early repair
40
What are the 3 stages of wound healing?
Inflammation Proliferation Maturation
41
What is the time frame for inflammation?
1-5 days
42
What happens during inflammation?
Vasodilation and release of histamine Wound becomes red, swollen and hot with tenderness for 1-3 days Neutrophils, macrophages and lymphocytes remove debris and bacteria and secrete cytokines and growth factors
43
What do histamines do during inflammation?
Increases capillary permeability to white blood cells so they exude into the surrounding tissues
44
How does diabetes affect inflammation?
Macrophages are reduced - hypoxia wounds and malnourished wounds mean healing is delayed
45
What is the time frame for proliferation?
3-24 days
46
What happens during proliferation?
Macrophages initiate fibroblasts to divide and produce collagen Angiogenesis Mitosis and epithelial migration Hair follicles can re-grow from damaged appendages but in full thickness wounds they only grow around the outside of the wound
47
What is angiogenesis?
Formation of new blood vessels, join existing blood vessels forming loops - fragile and held within a collagen matrix
48
What is mitosis and epithelial migration?
Re-epithelisation occurs and spans the granulating wound bed, keratinocytes change polarity and span the wound front to rear migrating laterally across the wound
49
What are the factors required for proliferation?
Oxygen Optimal nutritional levels Proteins Carbs Iron Vitamin A&C
50
How is the time frame for maturation?
21 days+
51
What happens during maturation?
Collagen remodels to emulate pre-injury skin Contracture occurs when myo-fibroblasts adhere to one another via desmosomes Elastin that makes a scar more flexible can take months to appear in skin tissue
52
What are the properties of scar tissue?
Avascular, blood vessels are rationalised - thinning and fading of scar tissue The integrity of a scar will never reach that of undamaged skin - only up to 80% of its original strength
53
What is the primary intention of wound healing?
Union of wound edges under aseptic conditions (surgical, traumatic, laceration) with clips, sutures, skin adhesives
54
What is the secondary intention of wound healing?
Left open, heal through contraction and epithelisation Less cosmetic and likely to become infected
55
What is the tertiary intention of wound healing methods?
Delayed primary closure, allow swelling and bleeding to reduce before primary closure
56
How does skin help with thermoregulation?
It loses heat and insulates against heat loss Hypothalamus responds to the temp of blood Arterioles in the dermis constrict decreasing blood flow Arterioles dilate cooling the body & sweat glands are stimulated Inflammatory cells and pyrogens will increase the hypothalamus ‘thermostat’ and the body will retain heat until the increased temp is reached and then through excessive sweating the body cools
57
How does the skin form vitamin D?
Lipid based 7-dehydrocholesterol in the skin is converted to vit D by the sunlight
58
What are the other functions of the skin?
Excretion - sweat, urea Absorption
59
What are the common disorders of the skin?
HPV Herpes Impetigo Cellulitis Ringworm Dermatitis (eczema) Psoriasis Acne Vulgaris Melanoma

Anatomy and Physiology - applied (14 decks)

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