Wounds

Question 1

what is the outer most layer of skin called?

Answer 1

epidermis

Question 2

what is the second layer of skin called?

Answer 2

dermis

Question 3

which two dermal layers are involved as total loss in full-thickness wounds?

Answer 3

epidermal and dermal layers

Question 4

acute wounds are generally repaired/healed in what timeframe?

Answer 4

stepwise and predictable process that occurs over a few days or weeks

Question 5

chronic wounds are defined as…

Answer 5

wounds that have not healed within 12 weeks of initial injury
*often begin as minor acute wounds, but become chronic due to various factors that adversely affect the healing process (infection, malnutrition, meds, comorbidities)w

Question 6

what are the 3 phases of wound healing?

Answer 6

inflammatory, proliferative (“constructive”), maturation (“remodeling”)

Question 7

how long does inflammatory phase of wound healing typically last?

Answer 7

~4-6 days

Question 8

how does inflammatory phase of wound healing impact need for energy, protein, and micronutrients?

Answer 8

increases need

Question 9

when does proliferative phase of wound healing start and how long does it last?

Answer 9

begins within 3-4 days after initial injury; may continue for up to 2 weeks

Question 10

what BMIs are more at risk for developing pressure injuries?

Answer 10

outside of range ie <18.5 and >30

Question 11

energy needs for wound healing

Answer 11

30-35 kcal/kg

Question 12

protein needs for wound healing

Answer 12

1.25-1.5 g/kg

Question 13

functions of vitamin A in wound healing

Answer 13

-maintains integrity of epithelial and mucosal surfaces
-stimulates fibroblasts which increase collagen synthesis

Question 14

how can vitamin A deficiency impact wound healing?

Answer 14

-associated with alterations in immune function
-increases risk of infection (diarrheal and respiratory)

Question 15

evidence regarding vitamin A supplementation in wound healing

Answer 15

no evidence of benefit, though some experts recommend supplementation during inflammatory and proliferative phases

Question 16

functions of vitamin E in wound healing

Answer 16

-antioxidant
-inhibits collagen synthesis, decreases tensile strength of wounds

Question 17

how can vitamin E deficiency impact wound healing?

Answer 17

no clinically significant effects are known

Question 18

functions of vitamin C in wound healing

Answer 18

-collagen synthesis
-required for angiogenesis (part of proliferative phase)
-impacts immune function

Question 19

how can vitamin C deficiency impact wound healing?

Answer 19

-associated with decreased wound tensile strength and increased wound dehiscence
-old wounds may break down in very severe deficiency

Question 20

vitamin C supplementation in wound healing

Answer 20

research inconclusive, though 500-1000 mg/d in healthy individuals and 1-2 g/d at high risk for deficiency

Question 21

functions of vitamin D in wound healing

Answer 21

-anti inflammatory properties
-immune modular
-promotes re epithelization

Question 22

how can vitamin D deficiency impact wound healing?

Answer 22

-may affect glucose homeostasis which may decrease wound healing
-may promote pro-inflammatory environment
-reduced innate immune response

Question 23

vitamin D supplementation in wound healing

Answer 23

supplement based on individual’s vitamin D status

Question 24

role of vitamin K in wound healing

Answer 24

cofactor for synthesis of prothrombin and clotting factors

Question 25

how can vitamin K deficiency impact wound healing?

Answer 25

deficiency can cause excessive bleeding to occur in wounds and predispose patients to wound infection

Question 26

role of iron in wound healing

Answer 26

-cofactor in hydroxylation of lysine and proline for collagen synthesis -oxygen transport to wounded tissue -component of many enzymes

Question 27

role of zinc in wound healing

Answer 27

component of many enzyme systems (various growth factors, fibroblast synthesis, DNA, RNA)

Question 28

how does zinc deficiency impact wound healing?

Answer 28

-associated with impaired wound strength -depressed immunity even in mild deficiency

Question 29

role of copper in wound healing

Answer 29

-essential for collagen cross-linking