Acute Wound Care Overview

Front 1

What cells are located in the epidermis

Back 1

kerainocytes
melanocytes
langerhans cells
merkle cells
growth factors

Front 2

what cells are located in the dermis

Back 2

fibroblasts
microphages
lymphocytes
mast cells
extracellular matrix
Elastin
collagen
hair follicles
sebaceous glands
sweat glands
fingernails
toenails

Front 3

what is located in the hypodermis

Back 3

blood vessels
adipose

Front 4

T/F: there is ALWAYS pain when a wound occurs

Back 4

False: is a wound is deep enough, there will be no pain because the mechanism of injury caused damage to the nerve. Once healing occurs, pain will return

Front 5

T/F: wounds heal from inside out

Back 5

False: they heal from outside in.

Front 6

Roles of skin

Back 6

protection from invasion by microorganisms (physical barrier, immune system)
thermoregulation
Vitamin D metabolism
excretion of waste and excess salt
sensation

Front 7

Why do you need to use lotion on your hands with excess handwashing?

Back 7

To restore the pH of your skin. With handwashing the pH will change for 7-14 hours, with excessive handwashing this can lead to cracks in the skin.

Front 8

what are the clinical implications of understanding the anatomy and physiology of the skin?

Back 8

you can understand the level of damage that occurred in terms of depth, structures involved and extent.

Front 9

Name the four age related changes that occur in the epidermis

Back 9

flattening of the dermal-epidermal junction
changes in basal cells
decreased number of Langerhans' cells
decreased number of melanocytes

Front 10

What affect does the following have:
flattening of the dermal-epidermal junction

Back 10

altered skin permeability

Front 11

What affect does the following have:
changes in basal cells

Back 11

decreased inflammatory responsiveness

Front 12

What affect does the following have:
decreased number of Langerhan's cells

Back 12

decreased immunologica responsiveness; increased risk of skin cancer

Front 13

What affect does the following have:
decreased number of melanocytes

Back 13

impaired wound healing; loss of protection with increased risk of skin cancer

Front 14

What age related changes occur in the dermis

Back 14

decreased dermal thickness; degeneration of elastin fibers
decreased vascularization

Front 15

What affect does the following have:
decreased dermal thickness; degeneration of elastin fibers

Back 15

decreased elasticity, increased wrinkling, slow wound healing, less scar tissue

Front 16

What affect does the following have:
decreased vascularization

Back 16

decreased vitamin D production

Front 17

what age related changes occur in terms of the dermal appendages/
accessory structures

Back 17

decreased number and distorted structure of sweat glands
decreased number and structure of specialized nerve endings
decreased hair bulb melanocytes and decreased number of hair follicles

Front 18

What affect does the following have: decreased number and distorted structure of sweat glands

Back 18

decreased sweating; altered skin thermoregulation
impaired sensory perception; increased pain threshold
change in hair color; hair loss

Front 19

T/F: Biological repair process is same of all wound- regardless of etiology

Back 19

true

Front 20

What are the phases of wound healing process

Back 20

-establishment of hemostasis
-inflammation
-repair/proliferation
-remodeling/maturation

Front 21

What are the inflammatory cells

Back 21

neturophils
lymphocytes
mast cells
monocytes/marcophages

Front 22

what are the repair cells

Back 22

fibroblasts
myofibroblasts
fibrocytes

Front 23

what are the epithelial cells

Back 23

keratinocytes

Front 24

what are the soluble proteins

Back 24

cytokines
chemokines
enzymes
growth factors

Front 25

what signs indicate that hemostasis is occuring

Back 25

clot forms to stop blood

Front 26

what are the signs of inflammation

Back 26

pain
red
heat
swelling(raised edges, leaking fluid possibly)
loss of function

Front 27

what are the signs that repair occuring

Back 27

shrinking of the wound (marginalization and contraction)
Red beefy granulation base, filling of bed from below

Front 28

How does a scab occurring effect the function of epithelial cells.

Back 28

They have to burrow under the scab because the scab is too dry, and will take longer to heal.

Front 29

What are the signs of remodeling

Back 29

wound is closed
decreased redness

Front 30

why is there redness in the area during wound healing

Back 30

redness indicates increased vascularization in order to feed the fibroblasts that are busy laying down collagen.

Front 31

Describe healing with primary intention

Back 31

wound edges are pulled together via surgery. This will decrease the amount of granulation that will occur

Front 32

what does "intention" refer to in regards to wound healing

Back 32

that there is debris, edema, drainage etc occuring

Front 33

describe delayed primary intention

Back 33

due to other factors (excess debris) the wound may not be surgically closed for 3-5 days after injury to allow some of the embedded debris to become superficial.

Front 34

describe healing by secondary intention

Back 34

wound is left open to heal by regenerating tissue that has been destroyed

Front 35

why does puckering occur in large wounds

Back 35

myofibroblasts are trying to pull together the edges of the wound.

Front 36

what can affect the rate of wound closure by secondary intention?

Back 36

depth
size
location

Front 37

what structures are involved with superficial wound healing

Back 37

epidermis ONLY

Front 38

describe what happens in superficial wound healing

Back 38

regeneration of epithelial cells on the wound surface due to loss of contract inhibition, and migration of epidermal cells across the surface

Front 39

T/F: there IS scar formation with superficial wound healing

Back 39

FALSE

Front 40

what layers are damaged with partial-thickness wound

Back 40

damage to dermis, BUT dermal appendages are spared

Front 41

describe how wound healing occurs with partial-thickness wounds

Back 41

reepithelialization from wound edges and dermal appendages. Budding from the hair follicle

Front 42

what layers are damaged with full-thickness wound

Back 42

damage through entire dermis

Front 43

describe how healing occurs with a full-thickness wound

Back 43

reeopitherlization from wound edges and contraction

Front 44

T/F: large scar or surgical closure are the two options for a full thickness wound

Back 44

true

Front 45

Absence of inflammation can be seen in what populations of patients

Back 45

taking high doses of steroids, malnourished, elderly, immune system disorders

Front 46

chronic inflammation results in an increase in:

Back 46

macrophage and fibroblasts proliferation

Front 47

chronic inflammation can be caused by:

Back 47

presence of foreign body in wound, repetitive mechanical trauma, use of cytotoxic agents

Front 48

what modality can a PT use in order to kickstart inflammation

Back 48

E-Stim

Front 49

describe hypogranulation

Back 49

absence of successful proliferative stage
not enough granulation tissue to fill wound bed

Front 50

What effect would not having enough granulation tissue to fill the wound bed have on wound healing

Back 50

epithelial cells wound not be able to bridge the gap, closure would be delayed.

Front 51

How is hypogranulation managed

Back 51

protecting and enhancing granulation tissue formation via lightly packing the wound or surgical intervention.

Front 52

hypergranulation occurs when

Back 52

after the wound defect has been filled and granulation tissue is still forming

Front 53

What effect does hypergranulation have on epithelialization

Back 53

deterrent

Front 54

what interventions that are used for hypergranulation

Back 54

pressure causing ischemia, silver nitrate, surgical excision

Front 55

what is silver nitrate used for

Back 55

cauterization

Front 56

describe hypertrophic cause

Back 56

overproduction of immature collagen during proliferative and remodeling phase

Front 57

Describe the lesions of hypertrophic scars

Back 57

red, raised, fibrous lesions that stay within the confines of original wound

Front 58

T/F: Contractures are often associated with hypertrophic scarring

Back 58

True

Front 59

What interventions are included with hypertrophic scarring

Back 59

compression garments, silicon gel sheets; scar mobilizations; steroid injections; surgery

Front 60

What is the purpose of compression garments for hypertropic scaring

Back 60

to starve and minimize scaring

Front 61

describe keloids

Back 61

excessive collagen synthesis, that is similar to hypertrophic scarring except it extends beyond the confines of the original wound

Front 62

what is dehiscence

Back 62

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

Front 63

when is dehiscence usually thought of

Back 63

sternal and abdominal adhesion.

Front 64

what systemic factors affect wound healing

Back 64

malnutrition
immunosuppression
infection
medications
vascularity
incontinence
social/health habits
functional status and activity level
aging
psychological function
diseases

Front 65

what psychological factors can affect wound healing

Back 65

stress
memory
anxiety

Front 66

what diseases can affect wound healing

Back 66

diabetes mellitus
PVD
CAD
COPD

Front 67

What local factors would affect wound healing

Back 67

infection
sensation
mechanical stress
blood supply
edema
topical medications
dressings
moisture
nonviable tissue
lack of growth factors
hypergranulation
presence of foreign tissue

Front 68

what mechanical stressors affect wound healing

Back 68

pressure, friction, and shearing

Front 69

What mechanisms in regards to blood supply affect wound healing

Back 69

perfusion and oxygenation

Front 70

what is the most common and serious complication of wound healing

Back 70

bacterial infection

Front 71

what does infection cause

Back 71

decreases synthesis and increases lysis of collagen by altering regulation of collagen synthesis

Front 72

T/F: osteo myelitus can occur from infection

Back 72

TRUE

Front 73

what are some factors that can lead to bacterial infections

Back 73

what was in the area when the injury occurred
if precautions were not followed
if patients are on immunosuppressants

Front 74

How do most bacteria enter the wound bed?

Back 74

etiology, environment- including health care professionals hands

Front 75

what are the clinical indicators of infection

Back 75

abnormally exudate smell (stinks)
red streaks away from site
increased pain
delayed wound healing
if was healing and is now breaking down

Front 76

How can wound infections be prevented

Back 76

precautions
sterlize
antimicrobal
cultures
team members checking

Front 77

what is the ideal wound healing environment

Back 77

moist, warm, dead tissue removed, no excess exudate, protected from invading pathogens, protected from trauma caused during dressing removal

Front 78

What are the benefits of having a moist environment

Back 78

facilitates action of growth factors, cytokines and chemokines

Front 79

facilitating action of growth factors, cytokines and chemokines, does what for what for wound healing

Back 79

promotes cellular growth and collagen proliferation

Front 80

how does a moist environment influence fibroblasts

Back 80

has greater numbers of fibroblasts which synthesize collagen

Front 81

how does a moist environment influence epithelial cells

Back 81

migrate quicker because doesn't have to break through scab or fibrous tissue underneath it in order to cross the wound

Front 82

T/F: acute wound exudate is rich in growth factors

Back 82

True

Front 83

what growth factors are in exudate

Back 83

platelet-derived growth factor (PDGF), fibroblasts growth factor, epithelial growth factor

Front 84

What do growth factors promote

Back 84

proliferation of fibroblasts, keratinocytes and endothelial cells

Front 85

how does having a moist environment effect electrical gradient

Back 85

provides an increased electrical gradient between the wound and the wound margin and base

Front 86

providing an increased electrical gradient between the wound and the wound margin and base does whaqt

Back 86

promotes migration of kerainocytes into the center of the wound base

Front 87

what effect does a warmer temperature have on wound healing

Back 87

mitotic activity slows down
leucocytic activity and oxyhemoglobin dissociation are severely disturbed
oxyhemoglobin release is slower

Front 88

what temperature is optimal for wound healing

Back 88

95

Front 89

what temperature does a typical band-aid provide

Back 89

80

Front 90

what effect does the presence of dead tissue have on granulation and epithelization: Slough and necrotic tissue

Back 90

slough and necrotic tissue will keep wound in the early phases of healing

Front 91

what effect does the presence of dead tissue have on granulation and epithelization: Formation of eschar

Back 91

slows the ability of regenerative cells (keratinocytes) to migrate from the wound periphery into the center

Front 92

What can the presence of too much exudate cause

Back 92

edema
maceration of surrounding tissue
destruction of healthy tissue

Front 93

what is strikethrough

Back 93

is when exudate is seeping out from the bandage that provides the link between the wound and the exterior environment

Front 94

How may trauma occur due to removing a dry dressing

Back 94

granulation and epithelial cells may have begin to adhere to the bandage, so when remove, you remove the granulation and possibly epithelial cells, you cause another trauma to the area.