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134 Cards in this Set
- Front
- Back
capillaries of the skin are concentrated __ |
superficially |
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name the layer of the epidermis from deep to superficial |
stratum basale, stratum spinosum, stratum granulosum, stratum lucidum, stratum corneum |
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where does cellular division in teh epidermis take place? |
stratum basale |
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the __ layer of the epidermis is made of dead skin cells which are filled with keratin and resistant to temperature, pH, enzymatic digestion, and invasion by foreign particles |
stratum corneum |
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what happens to cells as they move from the stratum basale to the stratum corneum? |
cells become filled with waxy keratin and die as they move outward. they are used for protection and preventing water loss |
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what is teh basement membrane? |
acellular layer that separates the epidermis from the dermis
|
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is an interface between epidermis and dermis
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basement membrane |
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structure in teh basement membrane that resists shear and has minimal regeneration |
rete pegs and dermal papillae |
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what are the living cells in teh basement membrane? |
melanocytes, merkel cells, langerhans cells |
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cells that produce melanin, located in teh stratum basale |
melanocytes |
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mechanoreceptors that are embedded int eh stratum basale |
merkel cells |
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immune cells in teh basement membrane which are dendritic cell which specializes in capturing foreign particles and presenting them to T cells |
langerhans cells |
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the vascular layer of the skin with blood vessels and lypmphatics present |
dermis |
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the dermis is made of primarily __ and is mostly __ with they primary cell type being __ |
connective tissue, acellular, fibrolast |
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the upper layer of the dermis forms the __, protrusions into the epidermis |
dermal papillae |
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what two kinds of proteins are the primary structual proteins of the dermis (provides tensil strength) |
collagen type I and II |
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what two cells are found in the dermis layer? |
macrophages and lymphocytes |
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what are the three main differences between teh two layers of teh dermis? |
papillary layer: superficial, loose collagen bundles, vascular eminences rise into epidermis
reticular layer: deep, dense collagen bundles, merges with hypodermis |
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skin layer made up of loose connective tissue taht supports the skin. includes adipocytes, fibroblasts, and macrophages
much of the bodies fat is stored in this layer |
hypodermis |
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deep source of epidermal cells (lined by stratum basale)
no new units are formed after birth
nails, hair, sebaceous glands, and sweat glands |
epidermal appendages |
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where are sensory nerve receptors located? |
in teh epidermis and dermis |
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how does the skin provide protection from bacteria and viruses |
T cells, macrophages, kertain outer layer |
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how does teh skin provide from mechanical or chemical trauma? |
keratin keeps chemical out
dermal papillae and rete pegs protect against mechanical trauma |
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how does teh skin protect against the loss of fluid? |
keratine |
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explain the cellular process of tissue healing |
inflammatory phase: days 1-6
proliferative phase: days 3-20
maturation/remodling phase: day 9-up to 2 years |
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are the phases of tissue healing distinct and exact? |
NO |
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what are the four manifestations of inflammation? |
warmth and redness, welling/edema, pain, loss of function |
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what causes warmth and redness during inflammation? |
vasodilation and increased blood flow to the area (causes swelling) |
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what causes swelling/edema during inflammation? |
increased vascular permiablity and blockage of lymphatic and venous drainage (causes pain) |
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what causes pain during inflammation? |
physical pressure and chemical stimulation of pain receptors |
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what causes loss of function from inflammation |
pain and swelling |
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what occurs during the inflammatory phase of tissue repair? |
tissue injury-->platelet activation-->activation of clotting cascade-->complement cascade-->release of chemicals that:
increase vascular permiability and vasodilation, promote growth and migration of cells for tissue repair, recruit neutrophils, THEN macrophages |
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immune cells that are one size fits all. respond to all immune events |
neutrophils |
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immune cells that eat up dead tissue |
macrophages |
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a defense against infections and bridge between tissue injury and new cell growth/tissue healing |
inflammation |
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what is the most important stage in wound health |
inflammation |
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the stage of inflammation that is dominated by neutrophils with the goal of protecting against invading bacteria |
early inflammation |
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stage of inflammation that is dominated by macrophages which release chemicals stimulating tissue repair. macrophages are more effective at tissue debridement and stimulate production of vascular and granulation tissue |
late inflamamtion |
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what cells degrade non-viable tissue and participate in neovacularization? |
macrophages |
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that cells perform neovascularization (capillary formation)? |
endothelial cells |
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what cells are involved in collagen/extracellular matrix production? |
fibroblasts |
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what cells are involved in wound contracture? |
myofibroblasts |
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what cells are involved in epithelialization |
epithelial cells (basal epidermal cells) |
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macrophages __ neovascularization |
stimulate |
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when epithlial cells on teh surace of the skin grow over the top of the wound |
epithelialization |
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why do you need neovacularization? |
there must be adequate O2 t generate healthy extracellular matrix/granulation tissue and allow re-epithelialization |
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the connective tissue substance that provides a structure for cell migration via contact guidance and a supporting matrix. it is vascularized and is free of tissue debris, making a appropriate environment for cellular growth |
extracellular matrix |
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how is the extracellular matrix produced |
macrophages remove tissue debris and secrete factors which stimulate the fibroblast to proliferate, migrate and produce teh matrix. it consists of collagen type III and I (III mainly) |
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what happens in the proliferative phase? |
wound contracture: fibroblasts differentiate into myofibrolasts
myofibroblasts can stimulate wound "contraction" via intracellular microfilaments containing actin |
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what three things happen during the epithelialization stage of tissue repair |
epidermal cells on teh edge of teh wound proliferates
cells disconnect from teh basement membrane to allow migration
the epidermal cells migrate across teh extracelluar matrix of teh wound from periphery toward teh center
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in epithelialization, the presence of non-viable tissue, like eschar, or a scarb will __ cell growth |
impede |
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where do epidermal cells come from? |
stem cells |
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what 4 things occur during the maturation and remodeling phase as the extracellular matrix matures? |
increase in collagen type I vs III as type I is stronger
fibers align to increase the tensile strength of the scar, decrease the size of teh scar and softens the tissue
collagen turnover occurs, balancing collagen synthesis and lysis
new collagen is laid down along lines of stress to increase tensile strength of the scar |
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how long does the maturation/remodeling phase last? |
day 9 on |
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new tissue after maturation and remodeling phase is prone to __ |
injury |
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a scar that is red, raised, and fibrous, but stays within the confines of teh original wound |
hypertrophic scar |
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a scar that is similar in character to a hypertorphic scar but it extends beyond the boundry of the original wound |
keloid scar |
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when healing connective tissue, __ is critical to maintain strength of tissues |
alignment of collagen |
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with alignemtn of collagen, fibers align along __ |
lines of stress |
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type of wound healing done with sutrue wound edges |
primary closure/healing by primary intention |
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type of healing for open, large full-thickness wounds |
secondary closure/healing by secondary intention |
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type of wound healing used if a wound is heavily contaminated or at risk for infection, it is left open for a period of time and sutured later |
delayed primary closure/healing by tertiary intention |
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what happens to a wound if only the epidermis is injured? |
epithlialization (epithelial cells can come from outer edge and from hair follicles) |
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what happens if teh dermis is injured? |
granulation and contraction of the wound |
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skin tears, abrasions, tape damage, bilisters, dermatitis, and donor sites are all __ wounds |
partial thickness wounds |
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lower extremity ulcers, surgical wounds, abscess formation, and pressure ulces are __ wounds |
full thickness wounds |
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what are the three functions of the immune system? |
host defense, tissue clearance, tissue repair |
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the primary function of the immune system is to defend against foreign pathogens such as bacteria and viruses |
host defense |
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how does the skin help with thermoregulation? |
sweat glands, superficial capillaries, fat from hypodermis |
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what is the difference between an acute and chronic wound? |
acute: induced by surgery or surgery in otherwise healthy people
chronic wounds: wounds induced by varying causes whose progression is affected b/c of underlying conditions |
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what are the four major cateogories of deterrents to expedient wound healing? |
characteristics of the wound itself
local factors within the wounded area
systemic factors related to the individual with the open wound
inappropriate wound managment |
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what are 8 characteristics of wounds that affect wound healing? |
mechanism of onset, time of onset, wound location, wound dimensions, temperature, wound hydration, necrotic tissue/foreign bodies, and infection |
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how can mechanism of onset affect wound healing? |
surgical and most acute wounds have less tissue damage and heal rather quickly. insidious/chronic wounds usually have underlying pathology (arterial disease) which deter healing |
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how can time since onset affect wound healing? |
time of onset can be used to predict acute wound healing but not chronic. |
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what are four instances where wound location affects healing? |
areas of decreased vacularity heal more slowly (malleoli vs head and neck)
wounds over bony prominences like greater trochanters heal slower b/c of increased tissue tension
wounds in areas of fewer epidermal appendiges resurface slower than others
wounds where skin is thicker heal slower b/c of more tissue to rebuild |
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__ wounds heal slower than __ wounds which heal slower than __ wounds |
circular, square/rectangular, linear |
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what is the optimal temp a wound should be kept at and why does this encourage healing? |
37-38 celcius (dilates vasculature, tissues less vulnerable to infection and O2 is increased) |
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a dry wound progesses through the phases of inflammation more __ than a moist wound |
slowly |
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why do dry wounds heal slower than hydrated ones? |
drying slows cell migration by increasing the distance they have to travel. it requires more enzyme production to break down the dried crust |
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exposed wounds are more __ than covered wounds |
painful |
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when a wound is hydrated, the fluids it produces stimulate __, induce __ and cause __ |
collagen synthesis, angiogenesis, wound contracture |
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what happens if a wound is wet? |
the peri-wound will become macerated making the skin more fragile and possibly increasing the size of the wound |
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how does necrotic tissue or the presence of foriegn bodies affect wound healing? |
epithelial cells can only migrate over viable tissue. dead tissue provides food for microbes encouraging infection |
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the invasion and multiplication of microorganisms in body tissues |
infection |
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the presensce of microbes |
colonization |
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does colonizaiton imply that a wound is infected? why? |
NO, b/c some are normal fauna |
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explain how infection slows wound healing in chronic wounds |
microbes compete with wound tissues for O2 and energy. also secrete cytotoxic substances |
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when a wound considered "infected" |
10^5 microbes/gram of tissue |
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what are three major changes in chronic wounds that cause them to heal slower than acute wounds? |
cells are senescent (are metabolically active but do everything else slower)
have increased levels of inflammatory mediators leading to breakdown of extracellular matrix and inhibits granulation tissue formation
have a greater bioburden than acute wounds |
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what are three local factors that affect wound healing? |
circulation, sensation, and mechanical stress |
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is a pulse a good indicator of whether or not a wound has proper circulation? |
NO! macrocirculation can be fine but microcirculation close to the wound bed can be impaired |
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conditions that promote a __ response can affect wound healing by impairing circulation |
sympathetic |
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what are four causes of impaired circulation? |
imapired macro/micro circulation
cold
fear
pain |
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how do sensation deficits affect wound healing? |
if a pt can't sense tissue damage they can cause worse damage or not seek necessary treatment b/c of lack of pain |
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__ like pressure, shear, friction, edema, or tension on wound edges all deter wound healing |
mechanical stresses |
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age__ wound healing |
decreases |
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what are 5 systemic factors affecting wound healing? |
age, inadequate nutrition, comorbidities, medication, behavioral risk taking |
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what is one explanation that inadequate nutrition causes slowed wound healing? |
if cells don't have carbs to burn they use proteins which would otherwise be used in healing. |
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which is more important to wound healing: a pt recent food intake or what they've consumed in the last few weeks? |
their recent food intake |
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why are pt's with wounds more prone to develop malnutirtion? |
the wound is catabolic (needs lots of energy) |
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what are 5 goals for wound managment ? |
control wound exudate
deal with infection
protect skin
heal pressure ulcers
address pt comfort |
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what are three things that arterial insufficincy causes in wounds? |
decresased O2
chronic wounds
increased susceptibiltiy to infection |
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what are three things that venous insufficiency cuase? |
edema
fibrin in teh tissue
high risk for developing infection |
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how do steroids affect wound healing? |
decrease collagen synthesis
suppress immune system |
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how do NSAIDS affect wound healing? |
vasconstriction, suppress inflammation and collagen synthesis |
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how do chemo drugs affect wound healing? |
interfere with cell proliferation
prolong inflammation
inhibit protein and collagen synthesis |
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how do antineoplastic drugs affect wound healing? |
fibroblast production |
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how does diabetes affect wound healing? |
accelerated atherosclerosis (decreased circulation)
neuropathy
abnormal collagen synthesis |
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how do vascular diseases affect wound healing? |
decreased blood supply and tissue perfusion |
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how do immunicompromising diseases affect wound healing? |
increased infection, affects phagocytosis |
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how do renal dysfunctin diseases affect wound healing? |
granulation and fibroblasts |
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how does lymphedema affect wound healing |
delays it |
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changes in cellular activity, decreased vascularization and atrophy of the dermis, slower healing, decreased synthesis of collagen and fibroblast production, and a decreased inflammatory response are all factors in __ that affect wound healing |
age |
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how does alcohol abuse affect wound healing? |
malnutrition
increased risk of injury
delayed medical care |
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how does smoking affect wound care? |
vasconstriction
increased platelet aggregation
decreased O2 b/c of CO |
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stress/depression or anxiety all __ wound healing |
decrease |
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__ is a nonselective debridement which can damage healthy tissue |
wet to dry |
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__ dressings will cause dehydration of the wound |
dry gauze |
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what is a primary goal of wound dressing? |
to maintain a moist wound bed |
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__, __, and __ will perpetuate and initiate presure ulcers and neuropathic ulcers |
pressure, shear, friction |
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why does edema delay wound healing? |
decreased tissue perfusion due to decreased blood flow |
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decreased mobility secondary to pain can cause __ |
DVT, pressure ulcers |
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what are the four parts to a wound evaluation? |
history, subjective exam, objective exam, assessment |
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what are the three parts of a history? |
general history, previous history, social history |
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what 5 questions would you ask during a general history? |
age, sex, occupation
when did teh wound develop
how did it develop
psychological, cultural, and economic that impact the pt
what the wound means to the pt |
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diabetes, PVD< HTN, CHF, medications, allergies, and prevous wound hisotry and tratements would all be part of the __ part of a wound eval |
previous history |
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what four things should you ask in a social history? |
smoker?, dietary intake?, alcohol use, describe a usual day |
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what three things should you ask in a subjective exam? |
symptoms (pain level and location, when it occurs, consequences, characteristics)
where its located
behavior of symptoms |
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what are four things you would do in teh objective part of the exam |
risk assessment tools, wound calssification, observations, clinical measurements |
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what are three things to look for for wound classificatoin during teh objective part of the exam |
partial or full thickness
color
4 stages system for pressure ulcers |
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what are 5 observations to make during teh objective part of the exam |
skin color, texture of the skin, temperature of the skin, skin integrity, foreign debris or necrotic tissue |
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what are 6 clinical measurements to make during the objective part of the exam? |
clutre, location, size/depth, drainage, temperature, and girth |
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what are three tests to assess the venous system? |
trendelenburg, doppler US, homans sign (DVT) |
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what are four steps to assessment for wound care |
determine accurate wound diagnosis
short term/long term goals
determine plan of care
make recomendations for treatment |