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Medical Conditions 3 > wound care > Flashcards

wound care Flashcards

(68 cards)

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1
Q

Layers of epidermis

A

Stratum corneum
Stratum lucidum
Stratum granulosum
Stratum spinosum
Stratum basale
Basement membrane

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2
Q

Stratum corneum

A

o Tough outer layer – acts as primary barrier
o Promotes protection from mechanical and chemical injury
o Constantly sloughing
o Consists of dead keratinized cells (15-20 layers)
o Can indicate hydration

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3
Q

Stratum lucidum

A

o Transparent, thin, transitional layer
o Present only at “stress points” (palms, soles of feet)

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4
Q

Stratum granulosum

A

o Metabolically active
o Contain keratinocytes & Langerhans cells
 Develops keratin
 Important for immune function/macrophage activity

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5
Q

Stratum spinosum

A

o Contains desmosomes that function as a cell to cell junction
o “spiky” or “spiny” projections
o Also contains Langerhans immune cells

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6
Q

Stratum basale (basal layer)

A

o Innermost, most continuous layer of epidermis
o 1-3 layers of active keritanocytes (regenerates the epidermis)
o Merkel cells (touch receptors)
o Melanocytes (pigment production)
o Cells take 2-3 weeks to migrate from basal layer
o Rete ridges/rete pegs protrude downward into dermis
 Anchor epidermis to dermis

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7
Q

Dermis contents

A

o Blood vessels
o Lymphatic vessels
o Nerve endings
o Appendages
 Hair
 Sebaceous glands
 Sudoriferous glands
 Nails

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8
Q

Dermis primary functions

A

o Thermoregulation
o Storage of water/maintaining hydration
o Provides nutrients and waste removal
o Houses epidermal appendages
o Assists with infection control
o Provides sensation

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9
Q

Dermis

A

thickest layer
papillary region
reticular region

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10
Q

Hypodermis

A
  • Subcutaneous tissue
  • Attaches skin to underlying bone and muscles
  • Contains loose connective tissue, adipose, elastin
    o Contains 50% of body fat
  • Insulation and shock absorption
  • Pacinian cells and free nerve endings for cold and pressure
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11
Q

Keratinocytes

A

develop keratin

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12
Q

Langerhans cells

A

immune cells, fight infection, macrophage activity

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13
Q

Melanocytes

A

produce melanin, protects from UV radiation

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14
Q

Merkel cells

A

mechanoreceptors for light touch sensation

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15
Q

Phases of wound healing

A

inflammatory
proliferative
maturation

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16
Q

inflammatory phase

A
  • Begins when the wound develops
  • 4-6 days
  • Edema, erythema, inflammation, pain
  • Healing process triggering
  • Immune system works to prevent microbial colonization
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17
Q

proliferative phase

A
  • 2-24 days
  • Angiogenesis: capillaries form buds and grow
  • Granulation tissue fills in the wound
  • Fibroblasts lay collagen in the wound bed, strengthening new granulation tissue
  • Wound edges begin to contract (myofibroblasts)
  • Epithelial cells migrate from the wound margins (epithelialization)
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18
Q

maturation phase

A
  • 21 days to 2 years
    o Greatest change in 6-12 months
  • Collagen fibers transform from immature type 3 to mature type 1 and reorient along lines of stress
  • Length of time depends on patient and wound related complicating factors
  • Filled-in wound is covered and strengthened
  • Scar tissue forms
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19
Q

Primary intention

A
  • Clean, straight line
  • Edges well approximated with sutures
  • Rapid healing
  • Usually best cosmetic outcome
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20
Q

secondary intention

A
  • Larger wounds with tissue loss
  • Edges not approximated
  • Heals from the inside out
  • Granulation tissue fills in the wound
  • Longer healing time
  • Larger scars
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21
Q

tertiary intention

A

(delayed primary)
- 3-5 day delay before injury is sutured
- Used to manage infected or unhealthy wounds
- Larger scars

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22
Q

local factors affecting wound healing

A

circulation
sensation
mechanical stress

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23
Q

red skin color indicates

A

o Infection
o Inflammation
o Cellulitis
 Flat texture, shiny
o Dermatitis
 Raised bumps
o Erythema
o Stage 1 pressure injury
o 1st degree burn

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24
Q

localized edema indicates

A

sign of infection
inflammatory response in immediate wound area

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25
unilateral edema indicates
dvt venous insufficiency poor IV placement
26
bilateral edema indicates
renal insufficiency heart failure
27
induration
extreme edema starts to feel hard/firm tissue changes chronic edema
28
signs of infection
disproportionate edema broad area that is hot to touch fever large amounts of drainage broad, blistering erythema severe pain, disproportionate to wound
29
wound measurement methods
perpendicular clock (most common) volumetric tracing photography length x width x depth
30
granulation tissue
o Red, “beefy” looking o Result of angiogenesis o Composed of new capillaries and extracellular matrix o Carefully protected in good wound management
31
slough
o Soft, lighter necrotic debris  Difficult to grasp with forceps o Byproduct of autolysis o Usually seen beneath eschar o Inflammatory phase of healing
32
necrotic tissue
o Composed of dead cells and fibrin o May be dry and hard or soft and rubbery/leathery o Dry or wet gangrene
33
muscle
o Striated o Reddish when healthy o Brown/gray or black when devitalized o Sensate when healthy, painful when exposed
34
tendons
o Shiny/stringy when healthy o Dull/dry/leathery when devitalized o Covered with fibrous sheath of connective tissue containing synovial flid or fatty fluid
35
bone
o Dark brown when necrotic o Can soften/appear moth eaten o Covered with periosteum when healthy
36
adipose
o Shiny, yellow-white globules when healthy o Shriveled/dry when devitalized o Frequent source of abscess formation
37
even border wound edge
o Typical of arterial wounds o Typically around ankle/foot
38
irregular wound edge
o Typical of venous wounds o May occur as the wound epithelializes
39
epibole
rolled o Signs of a halted healing process o Cells are termed senescent (unable to reproduce)
40
hyperkeratosis
o Overdevelopment of stratum corneum (outermost layer of epidermis) o Appears as thickened skin around the edge of a wound or as a callus
41
maceration
o Softening of skin due to prolonged/excessive moisture
42
arterial ulcer
impaired arterial blood flow muscle atrophy shiny skin reduced hair growth cold skin absent/weak pulse brittle nails punched out wound
43
venous ulcer
chronic venous insufficiency brownish discoloration and scaling of the skin warm skin edema varicose veins
44
neuropathic ulcer
diabetic neuropathy dry, scaly skin sensory loss cracked calluses charcot foot
45
cause of arterial wounds
ischemia micro/macro vascular disease artery obstruction
46
causes of venous insufficiency wounds
DVT recent surgery prolonged standing pregnancy congestive heart failure
47
causes of neuropathic/diabetic wounds
diabetes peripheral vascular disease hansen's disease spina bifida lupus CMT
48
Stage 3 wound
* Tunneling/undermining * Fat tissue exposed * No muscle or bone
49
Stage 4 wound
* Muscle/tendon/bone visible * Slough/eschar * Tunneling/undermining
50
sanguineous exudate
thin, bright red
51
serosanguinous exudate
Thin, watery, pale red to pink
52
serous exudate
Thin, watery, clear
53
purulent exudate
 Thick or thin  Opaque tan to yellow
54
foul purulent exudate
 Thick opaque yellow to green with offensive odor
55
penrose drain
passive soft, flexible tube that drains fluid from a surgical site
56
pigtail catheter
passive  Smaller, less invasive alternative to a chest tube  Drainage for pleural effusion
57
gastrostomy
passive  “g-tube”  Delivers nutrition directly to the stomach  Type of enteral nutrition
58
Active drains
o Negative pressure o Connected to collection device Jackson-pratt (JP) Hemovac
59
purpose of debridement
o Remove necrotic tissue/bacteria o Shorten inflammatory phase o Decrease energy required by the body for healing o Increase ability to assess wound bed
60
indications for debridement
o Necrotic tissue o Foreign material o Debris o Residual topical agents o Blisters o Callus
61
contraindications for debridement
o Granular tissue o Viable tissue o Stable, hard, dry eschar in ischemic limbs o Need for surgical debridement (gangrene, osteomyelitis) o Electrical burns o Deeper tissue
62
non-selective/mechanical debridement
 Wet to dry (like waxing a wound)  Irrigation  Hydrotherapy  Abraded technique
63
selective - autolytic
* Occlusive (hydrocolloid) * Transparent (non-occlusive) * Hydrogel * Medihoney
64
selective - enzymatic
topical application that breaks down proteins in necrotic tissue
65
types of selective debridement
autolytic biosurgical (maggots) enzymatic sharp/surgical
66
excoriation
 Chafing, raw irritated lesion  Linear erosion of the skin by mechanical means
67
denuded
 Loss of epidermis due to exposure to urine, feces, body fluids, exudate, or friction
68
what wounds would benefit from compression?
venous arterial

Medical Conditions 3 (5 decks)

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