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Wound Care Flashcards

(63 cards)

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1
Q

What does skin consist of?

A

cells, fibers, and an extracellular matrix

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2
Q

how thick is the outer epidermis?

A

.06-.6mm

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3
Q

Five layers of the outer epidermis

A 
stratum corneum
stratum lucidum
stratum granulosum
stratum spinosum
stratum basale
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4
Q

Functions of the outer epidermis

A 
physical/chemical barrier
regulates fluid
light touch sensation
thermoregulation
excretion
vitamin D production
appearance
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5
Q

Stratum corneum

A

20-30 cells thick
3/4 thickness of the dermis
made of dead keratinocytes

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6
Q

Stratum Lucidum

A

few layers of flattened dead keratinocytes
they appear clear in microscope
ONLY in palms and soles of feet

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7
Q

What do Langerhans cells do?

A

bind antigens

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8
Q

Stratum granulosum

A

3-5 rows flattened cells

increasing concentrations of keratin & Langerhans cells

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9
Q

Stratum spinosum

A

several rows mature keratinocytes
keratinocytes look spiny
contains Langerhans cells

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10
Q

Stratum Basale

A

single row of keratinocytes that continuously divide and produce keratin.
Keratin is attached to dermis via basement membrane containing melanocytes and Merkel cells

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11
Q

What is keratin?

A

a protective protein

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12
Q

How thick is the inner dermis?

A

2-4 mm thick

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13
Q

How many layers in inner dermis & what are they?

A

2 layers that are highly vascular:

Papillary dermis & Reticular dermis

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14
Q

Papillary dermis

A

loosely woven fibers embedded in gelatinous matrix

Blisters occur at the junction of papillary dermis and basement membrane

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15
Q

Reticular dermis

A

dense, irregularly arranged connective tissue

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16
Q

Name a certain type of cell the dermis contains

A

fibroblasts that produce collagen, elastin, macrophages, and WBCs

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17
Q

Functions of the dermis

A 
supports/nourishes epidermis
houses epidermal appendages (hair, nails, glands)
infection control
thermoregulation
sensation
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18
Q

What does the subcutaneous tissue consist of?

A

adipose tissue

fascia

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19
Q

Another name for subcutaneous tissue

A

hypodermis

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20
Q

Adipose tissue

A

highly vascular, loose CT

stores fat to provide energy, cushion, insulation

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21
Q

Fascia

A

fibrous CT
separates & surrounds structures
facilitates movement between adjacent structures

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22
Q

3 types of wounds

A

superficial
partial-thickness
full-thickness (subcutaneous & subdermal

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23
Q

Superficial wounds

A

only affect the epidermis

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24
Q

Partial thickness wounds

A

involve epidermis and part of the underlying dermis

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25
Full thickness wounds
through epidermis and dermis to the subcutaneous layer
26
Further classifications of full thickness wound
subcutaneous-into subcutaneous tissue | sub dermal- tendons, mm, or bone are involved
27
3 phases of wound healing
Inflammation Proliferation Maturation
28
Inflammation phase of wound healing & how long it lasts
allows body to control blood loss, fend off bacterial invasion, and signal cells needed to repair 1-10 days
29
Vascular response (Inflammation stage)
Increased permeability of vessel walls causes local edema. Platelets aggregate to control blood loss Chemotactic agents attract cells needed for wound repair.
30
Cellular Response (Inflammation stage)
WBCs go to site to destroy bacteria/debris
31
Proliferation phase of wound healing & how long it lasts
builds new tissues & restores epithelial integrity | 3-21 days but can start within 48 hours of injury
32
Angiogenesis (proliferation phase)
buds from blood vessel walls grow into affected area, eventually connecting to form new blood vessels
33
Granulation tissue (proliferation phase)
temp. latticework of CT that fills defect from removal of debris during inflammatory phase. fibroblasts proliferate & migrate across wound bed. As angiogenesis forms new vessels, stimulus for fibroblast proliferation DECREASES
34
Wound contraction (proliferation phase)
fibroblasts--> myofibroblasts that contain actin Pull wound margins together Greater in full thickness wounds Linear wounds contract faster than square or rectanglular. Circle wounds contract SLOWEST
35
Epithelialization (proliferation phase)
as defect is filled w/granulation tissue, epithelial cells begin to multiply and go across wound bed. Epithelialization is slowed by low oxygen and thick debris. Moist clean wound bed facilitate migration
36
Maturation & how long it lasts
reorganizes scar tissue to reach max strength & function. | 7 days- 2 years
37
Maturation phase: rosy scar vs. pale scar
rosy pink: remodeling | pale scar: full remodeled
38
A mature scar has how much of the original tissue's strength?
80%
39
Types of wound closure
Primary intention Secondary intention Tertiary intention
40
Primary intention
simplest & fastest incision is clean edges are physically approximated (decreases distance keratinocytes must migrate) heal best if there is low tension across wound & good vasculature
41
What is Secondary Intention
When wound edges can't be approximated | severely contaminated wounds may also be allowed to close by secondary intention
42
What is needed for secondary intention?
granulation tissue must be built to fill wound defect wound contraction more time & energy needed creates more scar tissue
43
Tertiary intention (aka delayed primary closure)
combo of primary/secondary intention can be used to decrease chance of infection wound is initially cleansed then observed for a few days Once wound is clean, it is surgically closed
44
What can cause abnormal wound healing?
``` absence of inflammation chronic inflammation hypogranulation hypergranulation hypertrophic scarring keloids contractures dehiscence ```
45
Causes for absence of inflammation
high dose steroids malnourished elderly immune system dysfunction Can use E stim of phys. agents to promote inflammation
46
Causes for chronic inflammation
``` Presence of foreign body repetitive mechanical trauma cytotoxic agents (H202, iodine) ```
47
What is hypogranulation/
failure to build enough granulation tissue
48
Hypogranulation is frequent in patients with:
diabetes | malnutrition
49
Interventions for hypogranulation
prevent epithelial cells from migrating down sides by wiping wound edges w/gauze. Lightly packing wound defect. Extreme case: surgical intervention
50
Hypergranulation
granulation tissue formation continues after wound defect has been filled. Wound appears overgrowth. Deters epithelialization because cells have trouble climbing up.
51
How to prevent hypergranulation
Protect fragile epithelial cells from trauma such as: Inappropriate whirlpool use, maceration, too frequent dressing changes, adhesives, be cautious using hydrocolloid dressings.
52
How to resolve hypergranulation
pressure over hypergranular tissue causes local ischemia Silver nitrate Surgical Excision
53
Hypertrophic scarring is caused by
overproduction of immature collagen during proliferative & maturation/remodeling phases Often associated with contractures
54
Hypertrophic scarring
red, raised, fibrous lesion that stays within confines of the original wound Usually regress, at least partially w/o intervention
55
Interventions for hypertrophic scarring
``` compression garments 23/7 silicone gel sheets over scarred area to break up collagen. Scar mobiliation Steroid injections Surgery ```
56
Hypertrophic scarring is more common in wound that:
cross lines of tension in skin with prolonged inflammatory phase burns
57
Keloids
Caused by excessive immature collagen syntheis extend beyond edges of original wound Rarely regress independently have growth phase, then stabilization, then intermittent periods of growth later on.
58
Keloids are often associated with
tissue trauma | familial disposition
59
Treatment for keloids
steroid injections | surgical excision
60
Contractures
More common in wounds that cross a join (usually burns) shortening of scar tissue
61
Dehiscence
Due to insufficient collagen production or tensile strength. wound pulls apart Usually dehisces THEN gets infected
62
Dehiscence is common in those with
decreased healing ability longtime steroid user diabetes mellitus malnutrition
63
Treatment for dehiscence
decrease or eliminate infection | protect from stress or tension

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