NPTE > integumentary system > Flashcards

integumentary system Flashcards

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1
Q

key functions of integumentary system

A
  • protection
  • sensation
  • thermoregulation
  • excretion of sweat
  • vit D synthesis
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2
Q

phases of normal wound healing

A
  • inflammatory phase (days 1-10): inflammation as initial response
  • clotting, debris and necrotic itssue removed (mast cells, neutrophils, leukocytes), clean wound bed signals restoration to begin, re-epithelialization w/in 24 hours at borders but visually at 3 days
  • proliferative phase (days 3-21): formation of new tissue
  • capillary buds and granulation tissue fill wound bed for migration of epithelial cells, collagen matrix formed
  • maturation phase (days 7-2 years): remodeling, when granulation tissue and epithelial differentiation begin to appear in wound bed

progression halted or delayed in chronic wounds

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3
Q

newly repaired tissues have _ % of pre injury tensile strength and up to - %

A

15%, up to 80%

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4
Q

layers of skin

A

epidermis
dermis
subcutaneous fatty tissue

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5
Q

healing by intension

A
  • primary: acute wounds with minimal to no tissue loss; sutures, staples, adhesives
  • secondary: wounds close on their own without superficial closure
  • tertiary: delayed primary intention healing; if at risk for complications, left open and then closed once risk factors alleviated
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6
Q

bacteria in 3 ways

A
  • contamination: non-replicating bacteria on wound, no additional tissue injury or inflammation
  • colonization: replicating bacteria on wound but not in further tissues, no inflammatory response
  • infection: replicating bacteria that invade and cause inflammatory response
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7
Q

avulsion

A
  • degloving
  • wound resulting from tension that causes skin to become detached from underlying structures
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8
Q

types of ulcers

A
  • arterial insufficiency ulcers
  • venous insufficiency ulcers
  • neuropathic ulcers
  • pressure ulcers
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9
Q

arterial insufficiency ulcer

A
  • d/t inadequate cirulation of oxygenated blood - ischemia
  • lower 1/3 of leg, toes, web space
  • smooth edges, well defined, deep, lack granulation tissue
  • avoid unnecessary leg elevation, heating pads, hot water
  • severe pain
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10
Q

venous insufficiency ulcers

A
  • impaired cenous system, inadequate circulation
  • proximal to medial malleolus
  • irregular shape, shallow
  • mild pain
  • leg elevation helps
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11
Q

neuropathic ulcers

A
  • s/t complications with ischemia and neuropathy, associated with DM but can be any peripheral neuropathy
  • in areas of foot susceptible to pressure or shear in WB
  • well-defined oval or circle with callused rim, crackled periwound tissue, little to no good wound bed
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12
Q

pressure ulcers

A
  • decubitus ulcers
  • from sustained or prolonged pressure at levels greater than that of capillary pressure
  • contributing factors: shear, moisture, heat, friction, meds, muscle atrophy, malnutrition
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13
Q

monofilament testing

A
  • failure to perceive 10 mg monofilament - loss of protective sensation, pt at incr risk for neuropathic ulcer
  • failure to perceive 75 mg monofilament - area insensate
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14
Q

wound depth classifications

A
  • superficial wound: trauma to skin with epidermis intact (non-blistering sunburn), heals w/ inflammatory process
  • partial-thickness wound: through epidermis and into but not through dermis (abrasions, blisters, skin tears), heals w/ re-epithelialization
  • full-thickness: through dermis and deeper into subcuteanous fat - deeper than 4 mm, heal by secondary intention
  • subcutaneous wound: through integ tissue and involve deeper structures like fat, muscle, bone, tendon
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15
Q

wagner ulcer grading

A
  • for diabetic foot ulcers
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16
Q

pressure injury staging

A
  1. non-blanchable erythema of intact skin
  2. partial-thickness with exposed dermis - no adipose tissue, granulation, slough, eschar
  3. full-thickness skin loss - fat visible, slough/eschar may be present but not fascia, tendon, bone, muscle
  4. full-thickness skin and tissue loss - exposed fascia, muscle, tendon
    - unstageable: obscured by slough or eschar, reveals a 3 or 4
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17
Q

what do you do with stable eschar

A

leave it

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18
Q

exudate classifications

A
  • serous: clear, water, normal
  • sanguineous: red, thin, d/t blood, can be normal
  • serosanguineous: light red or pink, normal
  • seropurulent: cloudy, opazque with yellow or tan color, impending infection, always abnormal
  • purulent: yellow of green, thickers, infection, always abnormal
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19
Q

necrotic tissue types

A
  • eschar: hard or leathery, black/brown, dehydrated, firmly adhered to wound bed
  • gangrene: death/decay from interruption of blood flow or bacterial infection
  • hyperkeratosis: callus, white/gray in color
  • slough: moist, string, mucinous, white/yellow
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20
Q

selective debridement

A
  • sharp: use of scalpel, scissors, forceps (PTs can) - remove necrotic tissue
  • enzymatic: topical enzymes to necrotic tissue for infected or uninfected wounds - establish clean wound bed
  • autolytic - body’s mechanisms w/ films, hydrocolloids, hydrogels - non-invasive and painfree, not on infected bc takes longer
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21
Q

non-selective debridement

A
  • wet-to-dry: moistened gauze over necrotic tissue dries and is removed - can cause bleeding and pain, use spareingly
  • wound irrigation: pressurized fluid - for infected or loose debris
  • hydrotherapy: whirlpool tank, can cause maceration
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22
Q

negative pressure wound therapy (NPWT)

A
  • vacuum assisted closure (VAC)
  • manage drainage
  • chronic or acute wounds that cannot be closed by primary intention
  • not for insufficient vascularity, untreated osteomyelitis, pain
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23
Q

hyperbaric oxygen

A
  • inhalation of 100% oxygen delivered at pressure greater than 1 atm, delivered in closed chamber
  • indicated for osteomyelitis, diabetic wounds, crush injuries, radiation necrosis
  • contraindications: terminal illness, pneumothorax, pregnancy
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24
Q

growth factors

A
  • derived from naturally occurring protein factors, facilitate healing by stimulating activity of specific cell types
  • for neuropathic ulcers extending into or through subcutaenous tissue w/ adequate circulation to sustain wound healing
  • not for wounds w/ primary intention, hypersensitivty, history of neoplasm
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25
primary dressings
- come in direct contact with wound - can include self-adhesive backing or do not require secondary dressing
26
secondary dressing
- place directly over primary dressing for additional protection, absorption, occlusion, securing primary dressing in place
27
alginates
- derived from seaweed extraction - for partial or full-thickness draining wounds - pressure or venous ulcers - used on infected wounds d/t inc drainage - high absorptive capacity, enables autolytic debridement - disadvantages: may require frequent changes based on exudate levels, requires secondary dressing, no exposed tissues under
28
foam dressings
- hydrophilic polyurethance base that contacts wound surface and hydrophobic outer layer, allow exudate to be absorbed through hydrophilic layer - for protection and absorption over partial and full-thickness wounds with varying levels of exudate - can be secondary dressing - moderate absorption
29
gauze
- can be impregnated with meds - common on infected or non-infected wounds - can be used for wet to dry - highly permeable
30
hydrocolloids
- gel-forming polymers back by strong film or foam adhesive that surrounds wound - absorb exudate by swelling into gel-like mass and vary in permeability, thickness, transparency - for partial or full thickness wounds - can be used for granular or necrotic wounds - moist for wound healing, waterproof - moderate absorption
31
hydrogels
- consist of varying amounts of water and gel foring materials like glycerin - moisture retentive for superficial and partial-thickness wounds with minimal drainage - moist env for wound healing - dressings can dehydrate, not for wounds with signif drainage
32
transparent film
- thin membranes, permeable to vapor and oxygen but not water or bacteria - superficial or partial thickness wounds with minimal drainage - not for infected wounds
33
_ and _ are broad-spectrum antimicrobial agents that have become valuable adjucts for wound healing
- silver and iodine
34
dressings from most occlusive to non-occlusive
- hydrocolloids - hydrogels - semipermeable foam - semipermeable film - impregnated gauze - aligantes - traditional gauze - occlusive: ability of a dressing to transmit moisture, vapor, gases btw a wound and atmosphere (fully - latex glows)
35
dressings from most to least moisture retentitve
- alginates - semipermeable foams - hydrocolloids - hydrogels - semipermeable films
36
in an appropriately moist wound, _ appear earlier and in greater numbers to decrease infection risk
- macrophages - SO collagen synthesis and epithelialization rates enhanced - facilitate more rapid wound closure
37
US for wound healing
- US at low intensity w/ pulsed duty cycle - enhances fibroblasts, endothlial, and WBC activity
38
high voltage pulsed current (HVPC) for wounds
- estim that enhances healing numerous types of wounds including ulcers, burns - sensory or subsensory settings
39
contusion
injury d/t blow that does not disrupt skin integrity - pain, edema, discoloration
40
desiccated
dry out or dehydration of a wound resulting from poor dressing selection that does not control evaporation of wound bed moisture
41
desquamation
- shedding of layers of epidermis - in small scales though can be larger scales or sheets with deeper layers of skin
42
ecchymosis vs erythema
- ecchymosis: discoloration, bruise - erythema: redness from capillary dilation and congestion or inflammatoin
43
epidermis
- avascular - epithelial layer - squamous cells, round basal cells, melanocytes
44
dermis
- vascular - hair follices, sebaceous glands, sweat glands, lymphatic and blood vessels, nerve endings
45
hematoma
localized swelling or mass of clotted blood confined to tissue, organ, space - usually caused by break in BV
46
turgor
speed with which skin resumes normal appearance after being lightly pinched
47
burns zones
- zone of coagulation: area that received most severe injury with irreversible cell damage - zone of stasis: area of less severe injury that possesses reversible damage and surrounds zone of coagulation - zone of hyperemia: area around zone of stasis that presents with inflammation but will fully recover without innervention or permanent damage
48
superficial burn
- only outer epidermis - may be red with slight edema - healing w/o peeling or scarring in 2-5 days
49
superficial partial thickness-burn
- epidermis and upper dermis - painful and blister - minimal scarring - heals 5-21 days
50
deep partial thickness burn
- complete destruction of epidermis and majority of dermis - broken blisters, discolored, edema, damage to nerve endings - moderate pain - hypertrophic or keloid scarring - heals 21-35 days if no infection
51
full thickness burn
- epidermis and dermis destruction with partial damage to subcutaneous fat layer - eschar - minimal pain - healing varies - can require graft
52
subdermal burn
- involves complete destruction of dermis and epidermis w/ subcutaneous tissue - can involve bone and muscle - mult surgeries and extensive healing time
53
rule of 9s
- children under 1 have 9% taken from LE and added to head/neck - 1% distrib to LEs until 9 when "normal"
54
anticipated derformities based on burn location
- ant neck: flexion, lateral flexion - anterior chest and axilla: shoulder add, ext, medial rotation - elbow: flex, pron - hand and wrist: extension of MCP, flexion IP, add/flexion of thumb, flexion of wrist - hip: flexion, add - knee: flexion - ankle: PF
55
compression garments for burns
- for burns requiring > 14 days to heal - use of sustained compression from 15-35 mmHg
56
topical agents for burn care
- silver sulfadiazine - silver nitrate - providone-iodine - mafenide acetate - gentamicin - nitrofurazone | all broad spectrum
57
allograft | homograft
temporary skin graft from another person (cadaver) to cover large burn
58
autograft
permanent skin graft from patient's body
59
heterograft | xenograft
- graft from another species
60
z plasty
surgical procedure to eliminate scar contracture incision in z-shape to change configuration and lengthen scar
61
cellulitis
- localized redness, warm skin, TTP, chills, fever - d/t bacterial infection - rule out other issues, PT for wound care
62
dry gangrene
- loss of vascular supply resulting in local tissue death - slow developing - can lead to autoamputation - mummified skin
63
wet gangrene
- associated bacterial infection - can be complication of untreated wound - after burn, frostbite - cessation of bloodflow -> bacterial invasion at site - red -> brown -> black skin
64
tinea pedis
athlete's foot
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