Wound Overview

Question 1

what are four major characteristics of the epidermis

Answer 1

1. avascular
2. water resistant protective barrier
3. melanocytes
4. regenerates quickly in healthy people

Question 2

the dermis is the thickest layer. what are four occupants of the dermis

Answer 2

1. BV
2. lymph
3. nerves
4. glands

Question 3

what does the hypodermis do? (2)

Answer 3

1. provides stability to the integument system

2. CT and fat cells provide insulation and protection to underlying layers

Question 4

what is the most important layer in prevention of pressure injuries

Answer 4

hypodermis

Question 5

how does aging affect the epidermis (4)

Answer 5

1. variable skip permeability
2. decreased inflammatory response (basal cell)
3. increased risk of skin cancer and allergen response (Langerhans’)
4. loss of photo protection (melanocytes)

Question 6

how does aging affect the dermis (2)

Answer 6

1. decreased elasticity (elastin)

2. decreased vascularity

Question 7

how does aging affect the dermal appendages (3)

Answer 7

1. decreased sweating/altered thermoregulation (dec # of sweat glands)
2. impaired sensory (altered nerve endings)
3. hair color and loss (dec follicles/melanocytes)

Question 8

wound healing occurs in three overlapping phases. Describe the wound healing process

Answer 8

the first event is hemostasis followed by

1. inflammatory phase
2. repair and proliferative phase
3. remodeling and maturation phase

Question 9

what are some inflammatory cells involved in wound healing

Answer 9

neutrophils, lymphocytes, mast cells, monocytes/macrophages

Question 10

what are some repair cells involved in wound healing

Answer 10

fibroblasts, myofibroblasts, fibrocytes

Question 11

what are epithelial cells involved in wound healing

Answer 11

keratinocytes

Question 12

what are soluble proteins involved in wound healing

Answer 12

cytokines, chemokines, enzymes, growth factors

Question 13

what signs would indicate that hemostasis is occuring

Answer 13

clot formation and cessation of active bleeding

Question 14

what are signs of the inflammatory process

Answer 14

drainage/pus, loss of function, and usual culprits

Question 15

what are events of the inflammatory process

Answer 15

cessation of bleeding, fibrin clot, inflammatory mediators migrate to wound

Question 16

what are early signs of the reparative phase and what does it mean

Answer 16

granulation tissue is a sign of fibroblast migration and neovascularization to provide a surface for migration of keratinocytes

Question 17

what are the late signs of the reparative phase and what does it mean

Answer 17

red to pink appearance of the skin denotes epithelialization and wound closure

Question 18

what are signs of remodeling (3)

Answer 18

1. strengthening of the scar
2. reduction of neovascularization (reduced redness as pink turns to white)
3. raised and rigid to flat and flexible

Question 19

what is wound healing by primary intention

Answer 19

closure by healthcare providers

surgery, staples, stitches, grafts, and flaps

Question 20

what is the advantage of healing by primary intention

Answer 20

fibroblast and proliferation is minimal cuz the cells are approximated

Question 21

what is the advantage of delayed primary intention

Answer 21

allows for swelling/exudate/infection to resolve prior to closure

Question 22

when would you use healing by secondary intention

Answer 22

pressure injuries and deeper wounds

Question 23

what are two unique features of superficial wound healing

Answer 23

epidermis only and no scar formation

Question 24

how far does a partial-thickness wound go?

Answer 24

damage to the dermis occurs but dermal appendages are spared

Question 25

what types of patients tend to have no inflammation?

Answer 25

individuals taking steroids, older folks, immune compromised, malnourished

Question 26

what causes wounds to have chronic inflammation

Answer 26

wounds with foreign bodies, continued trauma, and cytotoxic agents

Question 27

what is hypogranulation defined by and how is it managed

Answer 27

characterized by no proliferative stage and managed by lightly packing the wound/surgery

Question 28

what is hypergranulation defined by and how is it managed

Answer 28

proliferation occurs even after closure and acts as a deterrent to epithelialization - managed by special dressings, cleaning agents, and pressure

Question 29

what is hypertrophic scarring

Answer 29

overproduction of immature collagen seen as red, raised, fibrous lesions within the confines of the original wound

Question 30

what are interventions for hypertrophic scarring

Answer 30

compression garments, silicone gel sheets, scar mobs, steroid injections, and surgery

Question 31

what are keloids and how do they differ from hypertrophic scarring

Answer 31

excessive collagen synthesis similar to hypertrophic scarring except keloids extend beyond the confines of the original wound

Question 32

what is wound dehiscence

Answer 32

separation of wound edges due to insufficient collagen formation or tensile strength

Question 33

what types of patients experience wound dehiscence

Answer 33

long term steroiders, older patients, malnutrition, immune pts

Question 34

why is proper nutrition important for wound healing

Answer 34

active cells require carbs, but if not present they will rely on other sources of fuel

Question 35

what is the ideal wound healing environment

Answer 35

moist, warm, minimal dead tissue, no excess exudate

Question 36

how does dead tissue impact wound healing

Answer 36

slough and necrotic tissue will keep wound in early phases of healing and prevent keratinocyte migration from periphery to center

Question 37

how does excess exudate impact wound healing

Answer 37

too much exudate can cause edema and neighboring skin irritation

Question 38

what is strikethrough

Answer 38

exudate soaks through the gauze creating a portal from the environment into the body