1
Q
Describe the homeostasis phase of healing.
A
- vasoconstriction to reduce loss and prevention of infection
- fibrin plug is formed
- 10-15 minutes after injury
- occurs after growth factors are released
2
Q
Describe the inflammation phase of healing.
A
- 24-48 hours
- cardinal signs of inflammation become apparent due to vasodilation of non-injured vessels to allow leukocytes and growth factors in the area of injury
- phagocytosis and revascularization
3
Q
What are the 4 key cells in the inflammation phase?
A
- platelets
- leukocytes
- macrophages
- mast cells
4
Q
What phase of the healing process can DM impair?
A
Inflammation phase
5
Q
When does inflammation phase occur?
A
24-48 hours after injury
6
Q
When does homeostasis phase occur?
A
10-15 minutes after injury
7
Q
What are the 4 primary events that occur during the granulation/proliferation/fibroblastic phase?
A
- angiogenesis
- granulation formation
- wound contraction
- epithelialization
8
Q
What are the 3 primary cells associated with the granulation phase? What do they provide?
A
- myofibroblasts (wound contraction)
- fibroblasts (collagen, elastin, and glycosaminoglycan production)
- epithelial cells (epithelialization)
9
Q
When does the maturation/matrix formation stage occur?
A
2-4 weeks after injury
can last up to years- collagen synthesis and alignment)
10
Q
When is a wound pink during maturation phase?
A
Weeks 6-12
11
Q
When is a wound lavender/soft pink during maturation phase?
A
months 12-15
12
Q
What medications can delay wound healing?
A
- corticosteroids
- chemotherapy
- NSAIDS
13
Q
diagnosis
excessive dryness of the skin with shedding of the epithelium
A
xeroderma
14
Q
What can xeroderma indicate?
A
- deficiency in thyroid function
- DM
15
Q
What is clubbing?
A
thickened and rounded nail end with spongy proximal fold
16
Q
(true/false) clubbing develops over time
A
false (at birth)
17
Q
What is clubbing indicative of?
A
- crohn’s disease
- cardiac-related cyanosis
- lung cancer/hypoxia
- ulcerative colitis
- biliary cirrhosis
- neoplasm
- GI involvement
18
Q
What is schamroth’s window test used for?
A
clubbing
Loss of diamond shape when nails from each hand are placed back-to-back
19
Q
Changes in nails often indicate what?
A
Systemic issues unless congenital
20
Q
Palmar erythema could indicate what?
A
liver or renal issues
21
Q
What can pallor indicate?
A
- anemia
- internal hemorrhage
- lack of sunlight exposure
22
Q
What skin change is seen with the following:
- arterial insufficiency
- syncope
- chills
- shock
- vasomotor instability
- nervousness
A
pallor
23
Q
definition
brownish yellow spots that may be due to aging, uterine and liver malignancies, or pregnancy
A
liver spots
24
Q
Brown skin is often associated with what?
A
Venous insufficiency
25
# definition
Immune disorder that causes white patches of skin to develop due to destruction of melanocytes
- individuals are at greater risk for sunburn, skin cancer, hearing loss, and eye problems
vitiligo
26
Coolness of the skin can indicate what?
- poor circulation
- obstruction (vasomotor spasm, thrombosis, hypothyroidism)
27
Excessive salt intake can lead to an (increase/decrease) in skin temperature
increase
28
(true/false) Warmth from cellulitis and/or infection is global
False (local warmth)
29
Those with hypothyroidism have (thinning/thickened) hair
thinning hair
30
# Diagnosis
Male pattern hair growth within women
hirsutism
31
What can hirsutism indicate?
- polycystic ovary syndrome
- cushing's syndrome
- tumor
- inherited trait
32
# definition
ulcer that is slow to heal; not painful
indolent ulcer
33
# definition
Skin inflammation/eczema caused by a reaction to light
actinic
34
# definition
Describe what acute eczema looks like.
- red
- oozing
- crusty rash
- extensive erosions
- exudate
- pruritic vesicles
35
Describe what subacute eczema looks like.
- erythmatous skin
- scaling
- plaques
36
Describe what chronic eczema looks like.
- thickened skin
- scattered scaling plaques
- fibrotic papules
- fibrotic nodules
- post-inflammatory pigmentation changes
- possible relapsing course
37
# Diagnosis
superficial skin infections caused by staphylococci or streptococci
- associated with inflamed, small vesicles accompanied with itching
- highly contagious
- common in children and the elderly
impetigo
38
# definition
- suppurative inflammation of cellular or connective tissue in or close to the skin that tends to be poorly defined and widespread
- caused by streptococcal or staphylococcal infection
- can be contagious
- skin is hot, red, edemous
cellulitis
39
What can cellulitis turn into if not treated?
- gangrene
- lymphangitis
- abscess
- sepsis
40
What populations are at an increased risk of developing cellulitis?
- DM
- wounds
- malnutrition
- steroid therapy
41
What is an abscess?
- cavity containing pus and surrounded by inflamed tissue
- result of localized infection
- commonly a staphylococcyl infection
42
# diagnosis
- itching and soreness, followed by vesicular eruption of the skin on the face or the mouth (cold sore or fever blister)
- spread by contact
herpes 1 (herpes simplex)
43
What is the common cause of vesicular genital eruption?
herpes 2
44
How is herpes 2 spread?
sexual contact
45
What can herpes 2 cause in newborns?
meningoencephalitis or can be fatal
46
# diagnosis
- caused by varicella-zoster that causes chickenpox
- virus is reactivated after lying dormant in the cerebral ganglia or ganglia of the posterior nerve roots
herpes zoster (shingles)
47
What are the s/s of herpes zoster (shingles)?
- pain and tingling affecting the spinal or cranial dermatome
- progression to red papules along distribution of affected nerve
- red papules progress to vesicles along dermatome
- fever/chills
- malaise
- GI disturance
- pain
- CN III and V involvement
48
What CN III symptoms are seen with herpes zoster (shingles)?
- eye pain
- corneal damage
49
What CN V symptoms are seen with herpes zoster (shingles)?
loss of vision
50
(true/false) there is a curative agent for herpes zoster.
FALSE
## Footnote
- Antiviral drugs slow progression
- symptomatic treatment for itching and pain
51
(true/false) Herpes zoster is contangious to everyone the person comes in contact with.
False
| only those who have not had chickenpox before
52
What modalities are contraindicated for those with herpes zoster? why?
a. US and heat
b. can increase severity of symptoms
53
What population is the shingles vaccination recommended for?
Healthy adults > 50 y/o
54
Warts are a common, benign infection caused by what?
HPV
55
How is HPV transmitted?
- direct contact
- autoinoculation
56
How is ringworm transmitted?
contact
57
(true/false) Pain caused by shingles can last weeks, months, or years
true
58
What areas of the body does ringworm affect?
Fungal infection involving the hair, skin, and nails
59
How is ringworm treated? How long does treatment last?
- topical antifungal drugs
- oral antifungal drugs
- treatment can last for months even with subsiding symptoms
60
What are the side effects of antifungals?
- HA
- GI disturbance
- fatigue
- insomnia
- photosensitivity
61
# diagnosis
Infection that is caused in skin folds due to excessive moisture
yeast (candidiasis)
62
What are the s/s of yeast infection?
Mouth:
- soreness and redness
- oral patches
- pain
Genital:
- erythema
- inflammation
- itching
- burning urination
- pain with sex
- white discharge
Topical:
- redness
- rash
- soreness
63
# Diagnosis
Chronic autoimmune disease of the skin characterized by erythematous plaques covered with silver scales
- common complaints: itching and pain
- common on ears, scalp, knees, elbows, and genitalia
psoriasis
64
# Diagnosis
What is lupus erythematosus?
chronic, progressive autoimmune inflammatory disorder of connective tissues
65
What does lupus erythematosus look like?
red rash with raised scaly plaques
66
What are the two types of lupus?
- discoid lupus erythematosus (DLE)
- systemic lupus erythematosus (SLE)
67
# Diagnosis
- Type of lupus that only affects the skin
- flare-ups with sun exposure
- lesions can cause atrophy, scarring, or pigment changes.
discoid lupus
68
# diagnosis
- type of lupus that affects multiple organ systems (skin, joints, kidneys, heart, nervous system, mucous membranes)
- can be fatal
systemic lupus
69
What kind of lupus can be fatal?
systemic
70
What are the s/s of systemic lupus?
- malaise
- butterfly rash on nose
- skin lesion/rash
- chronic fatigue
- arthralgia
- arthritis
- photosensitivity
- anemia
- hair loss
- raynaud's phenomenon
71
What diagnosis is indicated when a patient has a "butterfly rash" on the bridge of their nose?
systemic lupus
72
(true/false) There is a cure for all types of lupus
false
73
What are side effects of corticosteroids?
- edema
- weight gain
- acne
- HTN
- bruising
- purple stretch marks
## Footnote
Increased risk of developing cushing's syndrome, DM, osteoporosis, myopathy
74
What usually accompanies systemic sclerosis (scleroderma)?
raynaud's phenomenon
75
# s/s
- taught, firm, edematous skin that is firmly bound to subcutaneous tissue
- fibrosis of skin, joints, blood vessels, and internal organs
scleroderma
76
What are the differences between limited systemic sclerosis and diffuse systemic sclerosis?
Limited systemic sclerosis:
- symmetrical skin involvement of distal extremities and face
- late visceral and pulmonary HTN involvement
- CREST syndrome
Diffuse systemic sclerosis:
- symmetrical, widespread skin involvement of the extremities, face, and trunk
- rapid progression of skin changes
- early visceral involvement
77
What immune disorder of the skin is associated with CREST syndrome?
Limited systemic scleroderma
78
What is CREST syndrome?
Calcinosis
Raynaud's phenomenon
Esophageal dysfunction
Sclerodactyly
Telangiectasias
79
# diagnosis
Autoimmune myopathies that are characterized by edema, inflammation, and degeneration of proximal muscles (shoulder, pelvic girdle, neck, pharynx)
Polymyositis (PM)
80
(true/false) polymyositis has a asymmetric distribution.
false (symmetrical)
81
What term is used if polymyositis has a characteristic skin rash?
dermatomyositis (DM)
- interstitial lung disease and sclerodactyly are commonly associated with dermatomyositis
82
(true/false) the onset of polymyositis and dermatomyositis is gradual.
FALSE
| can be gradual or rapid
83
(true/false) polymyositis and dermatomyositis can be fatal due to possible cardiac and/or pulmonary involvement
True
| may cause need for ventilatory assistance and tube feeding
84
What medications are used for treatment of polymyositis and dermatomyositis?
corticosteroids and immunosuppressants
85
Benign or malignant?
Seborrheic keratosis
Benign
86
What is seborrheic keratosis?
proliferation of basal cells leading to multiple raised lesions
87
Where do people commonly experience seborrheic keratosis?
Multiple lesions on the trunk of older individuals
88
Benign or malignant?
Actinic keratosis
benign
| flat, round, irregular lesion with dry scale on sun-exposed skin
89
(true/false) actinic keratosis can lead to squamous cell carcinoma
true
90
What changes to a common mole can indicate possible melanoma?
- new swelling
- redness
- scaling
- oozing
- bleeding
91
# Diagnosis
slow-growing epithelial basal cell tumor that is characterized by a raised patch with ivory appearance or as a reddened area of eczema
- rolled border with indented center
basal cell carcinoma
92
# diagnosis
malignant tumor that has poorly defined margins and presents as a flat red area, ulcer, or nodule that grows more rapidly
- can be invasive to surrounding tissues
squamous cell carcinoma
93
(true/false) basal cell carcinoma has a higher risk to metastasize compared to squamous cell carcinoma
FALSE
94
Mucosal and lingual squamous cell carcinoma are often associated with what risk factors?
alcohol and/or tobacco use
95
What is the most common type of malignant melanoma?
Superficial spreading melanoma
96
# diagnosis
tumor that arises from melanocytes
- lesions can have swelling or redness beyond the border, oozing or bleeding, or sensations of burning, itching, or pain
malignant melanoma
97
What are the clinical signs for malignant melanoma?
Asymmetrical
Border: irregular, notched
Color: black/blue/red mixture
Diameter > 6 mm
Elevated- can also be flat and/or change over time
98
What are the AWARE guidlines used for? What are they?
--> used for skin cancer prevention
A: avoid protected sun exposure
W: wear protective clothing
A: apply sunscreen
R: routine skin check
E: educate others
99
# Diagnosis
Lesions of a vascular endothelial cell
- red, dark purple, blue macules that progress to nodules or ulcers
- itching and pain present
- common in LEs
- angioproliferative tumor
kaposi's sarcoma
100
How did kaposi's sarcoma become so prominent in the united states?
Human herpes virus 8
101
Where is kaposi's sarcoma more prominent?
LEs
102
(true/false) kaposi's sarcoma can involve internal structures producing lymphatic obstruction
true
103
(true/false) Arterial insufficiency may coexist with venus ulcers.
true
104
What are the following clinical features of a venous ulcer?
Area:
pulse:
pain?
Color:
Temperature:
edema
skin changes:
ulcers?
gangrene?
**Area**: LEs (commonly medial malleolus)
**Pulse**: normal
**Pain**: possible aching pain in dependent position
**Color**: normal or cyanotic, hemosiderin stain
**temperature**: normal
**Edema**: present
**skin changes**: liposclerosis or lipodermatosclerosis is possible (fibrotic); pigmentation change; atrophic blanche lesions; stasis dermatitis; good granulation
**Ulceration**: shallow and wet with large amount of exudate
**gangrene**: absent
105
Venous ulcers are typically (shallow/deep) and (regular/irregular).
shallow and irregular located over bony areas
106
What is venous insufficiency pain described as?
- burning
- throbbing
- cramping
- aching
- fatigue
107
What ABI contraindicates high compression?
< 0.7
108
What ABI contraindicates ALL levels of compression?
< 0.6
| +/- active DVT
109
What are the following clinical features of an arterial ulcer?
Area:
pulse:
pain?
Color:
Temperature:
trophic changes:
ulcers?
gangrene?
**Area**: LE (common over toes, feet, bony areas of trauma), lateral malleolus, anterior tibia
**pulse**: poor or absent, intermittent claudication
**pain**: severe, intermittent, progressing to pain at rest, exacerated with limb elevation
**Color**: pale or cyanotic (with foot elevation); dusky rubor (on dependency)
**temperature**: cold
**trophic changes:** loss of hair on foot and toes, thickened nails
**Ulcers**: toes or feet - can be deep
**Gangrene**: yes - adjacent to ulcer
110
(true/false) With the presence of a venous ulcer, pain is exacerbated when feet are elevated.
False
| legs are comfortable when elevated
111
(true/false) Arterial and venous ulcers have drainage
FALSE
| only venous
112
What is TcPO2? What does it measure?
a. Transcutaneous partial pressure of oxygen - reflects the amount of total O2 is available, closely representing PaO2
b. Used to determine which wounds have an increased chance of healing
113
What TcPO2 is indicative of a good chance of healing?
> 40 mmHg
114
What TcPO2 is indicative of a decreased chance of healing?
< 20 mmHg
115
A doppler skin perfusion pressure of ____ mmHg is indicative that the wound is unlikely to heal.
< 30 mmHg
116
What test is helpful to detect early sensory loss?
Vibration testing
117
What are the scores of the wagner classification system?
0 - no open lesions; high risk of ulcers
1- superficial ulcer
2- tendon, capsule, or bone is exposed
3- ulcer w/ abscess, osteomyelitis, or joint infection
4- localized gangrene
5- gangrene is not localized
118
What is the wagner classification system used for?
staging neurotrophic ulcers
119
Describe a stage I pressure injury.
- non-blanchable erythema of intact skin
- may have skin changes
- may have altered sensation
120
Describe a stage II pressure injury.
- partial-thickness skin loss (epidermis, dermis, or both)
- superficial ulcer
- presents as a blister or abrasion
121
Describe a stage III pressure injury.
- full-thickness skin loss
- damage or necrosis to the subcutaneous tissue
- may extend to top of the fascia
- presents as a deep crater
122
Describe a stage IV pressure injury.
- full-thickness skin loss
- extensive destruction, tissue necrosis, or damage to the muscle, bone, or supporting structures
- undermining or sinus tracts may be present
123
Describe an unstageable pressure injury.
tissue depth is obscured due to slough or eschar - extent of damage cannot be determined
124
What is a deep tissue injury?
Discolored area of tissue that is not reversible and will likely progress to a full-thickness injury.
125
What are the percentages of each area of the body when following the rule of 9s?
- head and neck
- arms
- anterior trunk
- posterior trunk
- legs
- perineum
Head and neck: 9%
Arms: 9% each (18% total)
Anterior trunk: 18%
Posterior trunk: 18%
Legs: 18% each (36% total)
Perineum: 1%
126
Describe the three zones of a burn.
1. Zone of coagulation: cells are irreversibly injured and cell death occurs
2. Zone of stasis: cells are injured and can die without treatment after 24-48 hours
3. Zone of hyperemia: minimal cell injury - cells should recover
127
What zone of a burn is more sensitive to infection and trauma?
Zone of stasis
128
What TBSA classifies a burn as critical?
Children and older adults (one of the following):
- >10% TBSA with full-thickness burns
- >20% TBSA with partial-thickness burns
Any patient:
- >25% of TBSA
- burns to the eyes, face, ears, hands, and/or perineum
- presence of any impairment due to burn(s)
129
What TBSA classifies a burn is moderate?
Children and older adults:
- <10% TBSA of full thickness burns *and* 10-20% TBSA of partial-thickness burns
Any adults:
- <15-25% TBSA with mixed partial/full-thickness burns
## Footnote
**Burns cannot involve the hands, face, feet, genitalia, perineum, and/or major joints**
130
What TBSA classifies as a minor burn?
Children and older adults (one of the following):
- < 2% TBSA of full-thickness burns
- <10% TBSA of partial-thickness burns
Any adult:
- < 15% TBSA of partial-thickness turns
## Footnote
**Burns cannot involve the hands, face, feet, genitalia, perineum, and/or major joints**
131
What are suspicious signs indicating possible smoke inhalation injury?
- singed nose hairs
- burns to face
132
What pulmonary complications can occur with smoke inhalation?
- pneumonia
- pulmonary edema
- restrictive lung disease (if involving burns to the trunk)
- airway obstruction
133
A burn victim experiences (hyper/hypo)metabolism
hypermetabolic state
| results: decreased energy and nitrogen balance, weight loss
## Footnote
- May persist for months or years after a major burn
134
Those with burns greater than ____% TBSA have decreased renal perfusion and increased risk of developing AKI
> 30%
135
How does healing occur for first degree burns?
| epidermal burn
Spontaneous within 3-7 days
- no scarring
136
How does healing occur for superficial partial-thickness burn?
| second degree burn
spontaneous healing within 7-21 days
- minimal to no scarring; discoloration may be present
137
How does healing occur for a deep partial-thickness burn?
| second degree burn
- slow
- occurs through re-epithelialization and scar formation
- excessive scarring can occur without preventive treatment
138
How does healing occur for a full thickness burn?
| third degree burn
- removal of eschar and use of skin grafting due to the destruction of the epidermis and dermis
- hypertrophic scarring and wound contracture are likely to develop without preventive measures
139
How does healing occur for a subdermal burn?
| fourth degree burn
- skin grafting
- scarring
- extensive surgery with possible amputation
140
What layers of the skin and structures are damaged in superficial partial-thickness burns?
epidermis and upper layers of the dermis
141
What layers of the skin and structures are damaged in deep partial-thickness burns?
- epidermis and dermis
- nerve endings
- hair follicles
- sweat glands
142
What degree of burn has little to no pain present due to nerve endings being destroyed?
3rd degree (full-thickness burn)
143
# Burn appearance
- pink/red appearance
- dry surface with no blistering
- minimal edema
- tenderness
- delayed pain
first degree
144
# Burn appearance
- bright pink/red appearance
- blanching with brisk capillary refill
- blisters present
- moist surface and weeping
- moderate edema
- painful, sensitive to touch, temperature changes
superficial partial-thickness burn
145
# Burn appearance
- mixed red and waxy white appearance
- lanching with slow capillary refill
- broken blisters
- moist surface
- marked edema
- sensitive to pressure but insensitive to light touch
deep partial-thickness burn
146
# Burn appearance
- Skin is white (ischemic), charred/black, and/or tan
- no blanching is present
- dry, leather-like surface
- depressed area
- little to no pain
full thickness burn (third degree)
147
# Burn appearance
- charred appearance
- destruction of vascular system and layers of the skin
subdermal burn
| fourth degree
148
# Definition
Raised scar that stays within the boundaries of the burn wound and is red, firm, and raised
hypertrophic scar
149
# definition
flat and depressed scar
hypotrophic scar
150
What is sulfamylon used for? What does it do?
a. used for burn injuries
b. penetrates through eschar
| antibacterial agent
## Footnote
- avoid with sulfur allergies
151
What is the most common topical medication for burns?
Silver sulfadiazine
| Antibacterial agent
## Footnote
- avoid at full-term pregnancy
- do not use for infants < 2 months
- avoid with sulfur allergies
152
# Type of graft
use of another human skin
allograft (homograft)
153
# Type of graft
use of skin from another species
xenograft (heterograft)
154
# Type of graft
combination of collagen and synthetic materials
biosynthetic graft
155
# Type of graft
laboratory grown from a patient's own skin
cultured skin
156
# Type of graft
use of patient's own skin
autograft
157
# Type of graft
graft that contains the epidermis and upper layers of the dermis from the donor site
split-thickness graft
158
# Type of graft
contains epidermis and dermis from the donor site
full-thickness graft
159
What procedures are necessary with circumferential burns of the extremities when compression from increased edema and fluid retention occur within a confined anatomical space?
escharotomy and fasciotomy
160
What are the 5 types of wound debridement?
1. autolytic dressings
2. surgical/sharp
3. enzymatic
4. biological
4. mechanical
161
What are the most common contractures seen at the following joints?
- anterior neck
- shoulder
- elbow
- hand
- hip
- knee ankle
Anterior neck: FLX
Shoulder: ADD and IR
Elbow: FLX and PRON
Hand: claw hand
Hip: FLX and ADD
Knee: FLX
Ankle: PF
162
What anticontracture positioning should you put the neck in?
Common contracture:
FLX
anticontracture position:
- stress hyperEXT with the use of a firm cervical orthosis
163
What anticontracture position should you place the shoulder in?
Common Contracture:
ADD and IR
Anticontracture position:
- stress ABD, EXT, and ER
- use of an airplane splint (axillary splint)
164
What anticontracture position should you place the elbow in?
Common Contracture:
FLX and PRON
Anticontracture position:
- stress EXT and supination with the use of a posterior arm splint
165
What anticontracture position should you put the hand in?
Common Contracture:
Claw hand
Anticontracture position:
- wrist ext (15 degrees)
- MP FLX (70 degrees)
- PIP/DIP EXT
- Thumb AD
*Place in intrinsic plus position using a resting hand splint
166
What anticontracture position should you put the hip in?
Common Contracture:
FLX and ADD
Anticontracture position:
- stress hip EXT and ABD while in neutral rotation
167
What anticontracture position should you place the knee in?
Common Contracture:
FLX
Anticontracture position:
- stress EXT with use of a posterior knee splint
168
What anticontracture position should you place the ankle in?
Common Contracture:
PF
Anticontracture position:
- stress DF by placing the ankle in a neutral position with an AFO
169
After placing a graft, exercise must be deferred for how long to allow healing to occur?
defer for 3-5 days
170
What principle is used to ensure proper wound preparation? What does it stand for?
**"TIME"
**
Tissue (viable v. non-viable)
Infection/inflammation
Moisture balance
Edges of wound
171
What are contraindications for use of negative-pressure wound therapy (vacuum-assisted closure/wound vac))?
- malignancy within the wound
- exposure nerve or vasculature structure
- untreated osteomyelitis
- significant eschar
172
What occurs during hyperbaric oxygen therapy?
Patient breathes in 100% oxygen while in an elevated atmospheric pressure chamber
--> hyperoxygenation reverses tissue hypoxia and increases wound healing
173
What are indications for hyperbaric wound therapy?
- compromised skin grafts
- acute ischemia
- osteomyelitis
- necrotizing infections
- thermal burns
- wounds not healing due to hypoxia
174
What are contraindications for use of hyperbaric oxygen therapy?
- untreated pneumothorax
- use of anti-neoplastic medications
175
What amount of pressure is recommended for wound irrigation techniques?
4-15 psi
176
# definition
Type of debridement that uses the body's enzymes and moisture beneath a dressing making non-viable tissue become liquefied.
- provides fast healing with less pain
autolytic debridement
177
What dressing types are used for autolytic deridement?
- hydrocolloids
- hydrogels
- transparent films
178
# definition
type of debridement that involves the application of a topical agent that chemically liquefies necrotic tissue
enzymatic debridement
179
What type of debridement is commonly used in long-term settings due to there being less pain and the ability to apply daily?
enzymatic deridement
180
# definition
Type of debridement that involves the use of maggots grown in a sterile environment with a dressing keeping them in the area of the wound-
may stimulate granulation formation and epithelialization
biological debridement
181
# definition
Type of debridement that removes foreign material and contaminated tissue by physical forces
-- involves irrigation, hydrotherapy, and wet-to-dry dressings
mechanical debridement
182
(true/false) Do not debride heel ulcers if it is dry without the presence of edema, erythema, fluctuence, or drainage.
true
183
What kind of debridement can be used with the following?
- individuals on anticoagulant therapy
- those who cannot tolerate other forms of debridement
- necrotic wounds in medically-stable patients
autolytic
184
What kind of debridement can be used with the following?
- all moist necrotic wounds
- eschar after cross-hatching
- homebound individuals
- people who cannot tolerate surgical deridement
enzymatic
185
What kind of debridement can be used with the following?
- wounds with moist necrotic tissue or foreign material present
mechanical
186
What kind of deridement can be used with the following?
- scoring and/or excision of leathery eschar
- excision of moist necrotic tissue
- biofilm removal
sharp
187
What kind of debridement can be used with the following?
- advancing cellulitis w/ sepsis
- immunocompromised individuals
- removal of biofilm
- excision of granulation and scar tissue
surgical
188
What method of deridement can be used to do the following?
- selective removal of necrotic tissue and biofilm
- reducing bioburden
- increase angiogenesis
- wound bed preparation for grafting or flap closure
kilohertz US
189
What kind of debridement can be used with the following?
- all non-healing necrotic wounds in patients who are medically stable
- for individuals who cannot tolerate other forms of debridement
biological
190
What are the contraindications for autolytic debridement?
- infection
- immunosuppressed patient
- dry gangrene or dry ischemic wounds
191
What are the contraindications for enzymatic debridement?
- ischemic wounds
- dry gangrene
- clean, granulated wounds
192
What are contraindications for mechanical debridement?
clean, granulated tissue
193
What are contraindications for sharp debridement?
- advancing cellulitis w/ sepsis
- when infection threatens the individual's life
- use of anticoagulants and/or coagulopathy
194
What is the normal range of albumin?
3.5-5.5
195
What albumin range is indicative of malnutrition?
< 3.5
196
Those with wounds require at least how much water per day?
3L
197
(true/false) Those who are on air-fluidized bed require less hydration
False (more)
198
Where are pressure injuries commonly seen on neonates?
head
199
What measurement tool estimates the size of a burn through TBSA while also accounting for variations in age and body size?
Lund-browder charts
## Footnote
Rule of nines does NOT account for variations in age and body size
200
What is the braden score used for?
Risk assessment for development of scores
201
What braden score is indicative of a higher risk for sores?
<18
| score: 6-23 possible
202
The walking impairment scale examines treatment effects on walking impairments and symptoms in patients with ______________ .
PAD with claudication
203
What scale is used for pressure sore risk assessment in children 21 days - 8 y/o?
Braden Q scale
| Braden + tissue perfusion oxygenation
204
What is the AMPAC used for?
assesses functional outcome measures in post-acute care settings
- measures difficulty, assistance, and limitations of ADLs
| cognition is only assessed in the longer form
205
# Type of dressing
Bandage that is permeable to atmospheric oxygen and moisture vapor but not to water, bacteria, and environmental contaminants
transparent film
206
# Type of dressing
Adhesive wafer containing absorptive particles that interact with wound fluid to form a gelatinous mass over the wound bed
- can be occlusive or semiocclusive
- availale in paste form
hydrocolloids
207
# Type of dressing
Water or glycerine-based gels that are insoluble to water
hydrogels
208
# Type of dressing
semipermeable membrane that can be hydrophilic or hydrophobic.
- varies in thickness, absorptive capacity, and adhesive properties
foams
209
# Type of dressing
soft, absorbent, nonwoven dressings that react with exudate to form a viscous hydrophilic gel mass over the wound area.
- made from seaweed
alginates
210
What is the difference between an alginate and hydrofiber?
Hydrofibers are composed of a polymer instead of seaweed
211
# Type of dressing
Type of dressing that is used when conventional approaches have failed or are unlikely to succeed.
specialty dressings
212
When do full thickness wounds show signs of healing with the use of a specialty dressing?
2-4 weeks
213
When do partial thickness wounds show signs of healing when using a specialty dressing?
1-2 weeks
214
# Type of dressing
Indications:
- stage I and II pressure ulcers
- can be used as a secondary dressing
- autolytic debridement
- skin donor site
- covers hydrophilic powder, paste, and hydrogels
transparent films
215
# Type of dressing
Indications:
- protection for partial-thickness wounds
- autolytic deridement of necrosis or slough
- wounds with mild exudate
hydrocolloids
216
# Type of dressing
Indications:
- partial and full thickness wounds
- wounds with necrosis and slogh
- burns/tissue damage from radiation
hydrogel
217
# Type of dressing
Indications:
- moderate exudate
- secondary dressing for wounds with packing (to provide additional absorption)
- provides protection and insulation
foams
218
# Type of dressing
Indications:
- moderate to large exudate
- wounds with exudate + necrosis
- wounds that require packing and absorption
- infected and non-infected wounds that have exudate
alginates and hydrofibers
219
# Type of dressing
Indications:
- exudate
- packing wounds and dead space
- protection of clean wounds
- autolytic debridement of slough or eschar
- delivery of topicals
gauze
220
(true/false) hydrocolloids may soften or change shape with heat or friction
true
220
(true/false) most hydrogels require a secondary dressing.
true
221
(true/false) transparent film can be used on wounds with fragile surrounding skin or infected wounds
False
222
(true/false) foams can be used for wounds with no exudate
false
223
(true/false) gauze decreases infection rates compared to semiocclusive dressings
false (increases)
224
When should you change alginates and hydrofibers?
every 8 hours to 2-3 days
225
When should you change hydrocolloids?
every 3-7 days
226
When should you change hydrogels?
every 8-48 hours
227
Why should you not tightly pack gauze into a wound bed?
Can compromise blood flow
228
How often should you change foam dressings?
every 1-5 days
229
(true/false) The epidermis contains no blood cells
true
230
What parts of the body contains the stratum lucidum?
Palms and soles of feet only
| formed from dead skin cells
NPTE
flashcards
Decks in class (22)
# Cards
-
MSK218
-
MSK testing163
-
Gait, prosthetics/orthotics, AD Rx169
-
MSK differential Dx297
-
Therapeutic interventions204
-
Safety and protection70
-
Medications60
-
Miscellaneous109
-
NM208
-
NM differential Dx231
-
Cardiovascular and lymphatic system251
-
Cardiovascular differential diagnosis73
-
Pulmonary121
-
Pulmonary differential diagnosis60
-
Integumentary231
-
Immune and GI systems210
-
Reproductive, renal and urological systems146
-
endocrine and metabolic systems68
-
Pediatrics175
-
Geriatrics87
-
Final Frontier readings256
-
Final Frontier 265
