Week 1 Wound Healing

Question 1

what are the three phases of healing

Answer 1

inflammation
proliferation
maturation and remodeling

Question 2

what two responses do you get in inflammation

Answer 2

vascular and cellular response

Question 3

what is the goal of the vascular response

Answer 3

control bleeding, fight infectious agents

Question 4

describe the vascular response

Answer 4

transudate leaks out of the vessel walls, and you get local edema. This cases local blood vessels to constrict. platelets aggregate and active and a plug is formed, which walls off area and closes lymph channels. MORE edema. so chemical mediators are released

Question 5

within 30 minutes of vasoconstriction, what occurs

Answer 5

vasodilation

Question 6

what 3 things result from vasodilation

Answer 6

localized redness, warmth and edema

Question 7

what are the cardinal signs of inflammation

Answer 7

edema, redness, warmth, pain, decreased function

Question 8

what is the cellular inflammatory response

Answer 8

you get an increase in leakiness vessel walls, and pushes polymorphonuclearneutrophils (PMNs) to the sides of the vessel walls. the macrophages arrive and kill pathogens and direct the repair process. Finally, mast cells produce histamine and secrete enzymes to accelerate the riddance of damaged cells

Question 9

what are the key cells in the cellular inflammatory response

Answer 9

platelets, PMNs, macrophages, mast cells

Question 10

what are the first to arrive at the site of the injury, what do they do? and what do they secrete

Answer 10

PMNs arrive within the first 24 hours, kill bacteria and clean, then secrete matrix metalloproteases (MMPs)

Question 11

what is proliferation

Answer 11

this is where you get angiogenesis (formation of new blood vessels), granulation tissue and wound contracture. finally, you get epithelialization

Question 12

what is angiogenesis

Answer 12

formation of new blood vessels

Question 13

what si granulation tissue

Answer 13

fibroblasts lay down extracellular matrix, which will eventually be replaced by scar tissue

Question 14

what is wound contracture

Answer 14

myofibroblasts pull wound margin together

Question 15

what is epithelialization

Answer 15

keratinocytes and epidermal appendages multiply and migrate across the wound bed

Question 16

what happens in the maturation phase

Answer 16

granulation tissue must be strengthened and reorganized, rapid collagen synthesis

Question 17

how long does maturation last

Answer 17

up to 2 years following the wound closure

Question 18

when do you see the greatest change in the maturation phase

Answer 18

in the first 6-12 months

Question 19

TF: tissue strength returns to 100%

Answer 19

false, only 80%

Question 20

TF: you are unable to sweat in a wound

Answer 20

true, because you lose the glands.

Question 21

TF: your skin becomes less sensitive to touch and temperature

Answer 21

true

Question 22

what are 8 general factors that affect wound healing

Answer 22

• mechanism of onset
• time since onset (acute or chronic)
• location (blood supply, bones and prominences)
• wound dimensions
• temperature
• wound hydration
• necrotic tissue
• infection

Question 23

does thin or thick skin heal faster

Answer 23

thin is faster

Question 24

in what order, in speed of healing, do wounds heal

Answer 24

circular is the slowest
then square or rectangle
linear is the fastest

Question 25

what temperature is the best

Answer 25

37-38

Question 26

what are the three local factors

Answer 26

circulation sensation mechanical stress

Question 27

what things fall under the circulation category of local factors

Answer 27

macro and micro circulation and SNS response to cold, fear, pain

Question 28

how does sensation affect wound healing

Answer 28

decreased knowledge of pain and you can get additional trauma to the area

Question 29

what is mechanical stress

Answer 29

friction, shear, weight bearing and pressure

Question 30

what are the 5 systemic factors that affect wound healing

Answer 30

``` age nutrition cormorbidities medications behavioral risk taking ```

Question 31

TF: your immune response is faster when you age

Answer 31

false it is slowed

Question 32

TF: you have decreased collagen synthesis as you age

Answer 32

true

Question 33

TF: you have epidermal and dermal atrophy

Answer 33

true you have thinner skin

Question 34

TF: as you age, you have less sweat and oil glands

Answer 34

true

Question 35

TF: you have decreased pain perception and decreased inflammatory response when you age

Answer 35

true

Question 36

what other things do you have more of when you age

Answer 36

more co-morbidities more susceptible to infection more medications

Question 37

what kind of nutrition do we need and why

Answer 37

carbs for energy, and protein for cellular repair and regeneration

Question 38

TF: if you are protein deficient, your wounds will heal slower.

Answer 38

true

Question 39

TF: you heal slower when you are immunocompromised like when you have HIV AIDS or DM

Answer 39

true

Question 40

does oxygen perfusion affect wound healing,

Answer 40

yes, like when you have PVD, anemia and COPD and heart conditions

Question 41

how does activity limitations affect wound healing

Answer 41

you lose strength and ROM, and have an increase in shear forces in the area, and then decrease in healing

Question 42

how do medications affect healing

Answer 42

steroids, chemo and NSAIDS all mess with healing

Question 43

what are some behavioral risks that people take

Answer 43

smoking and using alcohol | smoking will decrease oxygen perfusion and alcohol will cause malnutrition and will impair judgement.

Question 44

how does O2 perfusion change 1 hour after smoking

Answer 44

decreased by 30%,less oxygen, less healing.

Question 45

what are some inappropriate wound care techniques by the clinician

Answer 45

- prolonged or inappropriate use of antiseptics - wrong dressing (dries it out, or too wet) - failure to detect and treat - inappropriate irrigation and debridement and compression - poor wound exploration - poor temperature management

Question 46

what are some appropriate wound care things that still affect healing

Answer 46

- initial use of antiseptics to kill all - maintenance care is not priority - use of iodine to encourage/maintain non-viable tissue desiccation