Npte - Integumentary Systems

Front 1

Phases of healing and duration

Back 1

Inflammatory - 1-10 days - clotting and debris removal/bactieral elimination
Proliferative - 3-21 days - capillary buds and granulation tissue form; collagen matrix formed. Wound closed and skin integrity restored
Maturation - 7 days to 2 years - fiber reorganization, scar tissue remodeling

Front 2

Newly repaired tissues have ___ % of original tensile integrity

Back 2

15%
Up to 80% after maturation phase and full remodeling

Front 3

Primary intention

Back 3

wound heals by edges touching each other. sutures, staples, or adhesives, or healing by epithelial migration.
Minimal scarring

Front 4

Secondary intention

Back 4

Wounds close on their own without superficial closure.
When wound edges cannot be approximated due to infection debris, necrotic tissue, etc.
These require ongoing wound care and often have larger scars than primary intention

Front 5

Tertiary Intention

Back 5

Delayed primary intention
- wound temporarily left open then closed by primary intention

Front 6

Contaminated, colonized, or infected

Back 6

Contaminated - non-replicating bacteria present. No additional tissue injury
Colonized - replicating bacteria on a wound surface that does not invade or further injure tissues. Does not stimulate inflammatory immune response
Infection - replicating bacteria that invade viable tissue in and beyond the wound

Front 7

How to assess protective sensation

Back 7

Failure to perceive 10 gm monofilament applied perpendicular to target area indicates loss of protective sensation

Front 8

Arterial Insufficiency Ulcers

Back 8

Result from inadequate circulation of oxygenated blood.
Recommendations:
- Rest
- Limb protection
- Risk reduction education
- Inspect legs and feet daily
- Avoid unnecessary leg elevation
- Avoid using heating pads or soaking feet in hot water
- Wear appropriately sized shoes with clean, seamless socks

- Lack granulation tissue; tend to be deep
- Severe pain
- Diminished or absent pedal pulses
- Decreased skin temperature
- Leg elevation increases pain
- Hair loss

Front 9

Venous Insufficiency Ulcers

Back 9

Inadequate circulation secondary to imparied functioning of the venous system leads to eventual tissue damage and ulceration.
- Proximal to medial malleolus
- Irregular shape; shallow
- Moderate/heavy exudate
- Increased edema
- Skin temperature normal
- Leg elevation lessens pain

Front 10

Neuropathic Ulcers

Back 10

Usually associated with a combination of ischemia and neuropathy, particularly in diabetes mellitus
- Good granulation tissue
- Diminished or absent pedal pulses
- Skin temperature decreased
- Loss of protective sensation

Front 11

Superficial Wound

Back 11

Epidermis intact
Ex. non-blistering sunburn
Heals by inflammatory process

Front 12

Partial-thickness wound

Back 12

Through epidermis and part of the dermis
Ex. Abrasions, blisters, skin tears
Heals by re-epithelialization or epidermal resurfacing depending of depth of injury

Front 13

Full-thickness wound

Back 13

Through epidermis, dermis, and into deeper tissues such as subcutaneous fat
Usually over 4 mm
Heal by secondary intention

Front 14

Subcutaneous wound

Back 14

Through integumentary tissues, involving deeper structures such as subcutaneous fat, muscle, tendon, or bone
Heal by secondary intention

Front 15

Wagner Ulcer Grade Classification Scale - for neuropathic, eschemic, or arterial etiology

Back 15

0 - No open lesion, but may possess pre-ulcerative lesions; healed ulcers; presence of bony deformity
1 - Superficial ulcer not involving subcutaneous tissue
2 - Deep ulcer with penetration through subcutaneous tissue; potentially exposing bone, tendon, ligament, or joint capsule
3 - Deep ulcer with osteitis, abscess or osteomyelitis
4 - Gangrene of digit
5 - Gangrene of foot required disarticulation

Front 16

Pressure Ulcer Staging

Back 16

Stage I - Intact skin with non-blanchable redness
Stage II - partial thickness tissue loss; shallow open ulcer with red or pink wound bed
Stage III - Full thickness tissue loss with possible subcutaenous fat exposure. No bone, tendon, or muscle exposure
Stage IV - Full thickness tissue loss with exposred bone, tendon, or muscle that is visible or directly palpable. Slough or eschar may be present
Unstageable - Full thickness tissue loss with base of ulcer covered by slough and/or eschar.

Front 17

Don't remove eschar where?

Back 17

On the heel

Front 18

Components of wound examination and documentation

Back 18

- Etiology
- Location
- Wound type/classification
- Clinical signs of infection
- Area, depth, and shape of wound
- Condition of wound margins/edges
- Undermining or tunnelling
- Involvement of underlying structures
- Stage of healing
- Color of base
- Odor
- Exudate type and volume
- Chronicity
- Response to previous tx
- Surrounding skin/scar assessment
- Presence of necrosis

Front 19

Hyperkeratosis

Back 19

Callus

Front 20

Which modalities have shown to improve wound healing?

Back 20

Pulsed (non-thermal) ultrasound - used during inflammatory and proliferative phases. Enhances strength and elasticity of scar tissue

High-volt pulsed current - enhances healing for multiple types of wounds. Stiulates angiogenesis and epithelial migration

Also - Negative pressure wound therapy (NPWT)
- Hyperbaric Oxygen
- Growth factors

Front 21

Hydrocolloids

Back 21

Consist of gel-forming polymers backed by a strong film or foam adhesive.
Attaches to surrounding skin
Used for partial and full-thickness wounds
Advantages:
- Provides a moist environment for wound healing
- Enables autolytic debridement
- Offers protection from microbial contamination
- Provides moderate ABSORPTION
- Does not require a secondary dressing
- Provides a waterproof surface
Disadvantages:
- May traumatize surrounding intact skin upon removal
- May tend to roll in areas of excessive friction
- Cannot be used on infected wounds

Front 22

Hydrogels

Back 22

Moisture-retentive and commonly used on superficial and partial-thickness wounds that have minimal drainage
- Moist environment
- Cannot be used on wounds w significant drainage
- Typically requires secondary dressing

Front 23

Foam Dressings

Back 23

Provide protection and absorption over partial and full-thickness wounds with varying levels of exudate. Can be used as secondary dressings of hydrogels
- Moist environment
- Protection and cushioning
- Moderate absorption
- May roll
- May traumatize periwound area on removal
- Lack of transparency makes wound inspection difficult

Front 24

Transparent film

Back 24

- Water resistant
- Usfeful for superifical and partial-thickness wounds with minimal drainage
- Moist environment
- Allow visualization of the wound
- Cost effective over time
- May result in periwound maceration

Front 25

Gauze

Back 25

- Used on infected or non-infected wounds of any size
- Can be wet-to-wet, wet-to-moist, wet-to-dry
- Cost effective and available
- Tendency to adhere to wound bed, traumatizing viable tissue on removal
- Requires frequent dressing changes
- Increased infection rate compared to occlusive dressings

Front 26

Alginates

Back 26

- Derived from seaweed extraction
- Highly absorptive, highly permeable
- Often used on infected wounds
- May require frequent dressing changes depending on amount of exudate
- Require a secondary dressing

Front 27

Sidelying - Bony Prominences

Back 27

Ears
Acromion
Lateral head of humerus
Lateral epicondyle
Greater trochanter
Head of fibula
Lateral malleolus
Medial malleolus

Front 28

Supine - Bony Prominences

Back 28

Occiput
Spine of scapula
Inferior angle of scapula
Vertebral spinous processes
Medial epicondyle
Posterior iliac crest
Sacrum
Coccyx
Heel

Front 29

Prone - Bony Prominences

Back 29

Forehead
Anterior portion of acromion
Anterior head of humerus
Sternum
ASIS
Patella
Dorsum of foot

Front 30

Sitting - Bony prominences

Back 30

Spine of scapula
Vertebral spinous processes
Ischial tuberosities

Front 31

Exudate classifications

Back 31

Serous - clear, watery. Normal
Sanguineous - red, watery. Indicates new blood vessel growth or disrution of blood vessels
Serosanguineous - light red or pink, watery. Normal
Seropurulent - cloudy or opaque. Yellow or tan, watery. Indicates impending infection
Purulent - yellow or green, thick. Infection.

Front 32

Dressings - from most occlusive to non-occlusive

Back 32

Hydrocolloids
Hydrogels
Semipermeable film
Semmipermeable foam
Impregnated gauze
Alginates
Traditional gauze

Front 33

Dressings - from most to least moisture retentive

Back 33

Alginates
Semipermeable foams
Hydrocolloids
Hydrogels
Semipermeable films

Front 34

Contusion

Back 34

Injury that does not disrupt skin integrity
Pain, edema, discoloration caused by blood seepage under surface of skin

Front 35

Dehiscence

Back 35

Separation, rupture, or splitting of a wound closed by primary intention

Front 36

Desquamation

Back 36

Peeling or shedding of outer layers of epidermis. Normally occurs in small scales, although certain conditions, injuries, and medications may cause peeling in largrr scales or sheets and extend into deeper layers of skin

Front 37

Ecchymosis

Back 37

Discolration occuring below intact skin resulting from trauma to underlying blood vessels

Bruise

Front 38

Erythema

Back 38

Diffuse redness of the skin often resulting from capillary dilation and inflammation

Front 39

Friable

Back 39

Tissue that readily tears, fragments, or bleeds

Front 40

Hematoma

Back 40

Localized swelling or mass of clotted blood confined to a tissue, organ, or space usually caused by a break in a blood vessel

Front 41

Keloid

Back 41

Abnormal scar formation comprised of irregularly distributed collagen bands. Typically exceeds boundaries of original wound appearing red, thick, raised, and firm

Front 42

Maceration

Back 42

Skin softening and degeneration that results from prolonged exposure to water or other fluids

Front 43

Normotrophic scar

Back 43

Scar with organized formation of collagen fibers that align in a parallel fashion

Front 44

Turgor

Back 44

The relative speed with which the skin resumes its normal appearance after being lightly pinched. An indicator of skin elasticity and hydration which normally occurs more slowly in older adults.

Front 45

Zones of injury

Back 45

Zone of coagulation - irreversible cell damage
Zone of stasis - area of less severe injury with reversible damage
Zone of hyperemia - inflammation

Front 46

Superficial Burn

Back 46

Involves only epidermis. May be red with slight edema.
Heals in 2-5 days

Front 47

Superficial Partial-Thickness Burn

Back 47

Epidermis and outer layer of dermis
Extremely painful.
May blister
Heals in 5-21 days with minimal to no scarring

Front 48

Deep Partial-Thickness Burn

Back 48

Complete destruction of epidermis and majority of dermis
Blisters and edema
Moderate levels of pain due to damaged nerve endings.
Heals in 21-35 days and may scar

Front 49

Full-Thickness Burn

Back 49

Complete destruction of epidermis and dermis, with partial damage to subcutaneous fat.
Typically presents with eschar and minimal pain
Skin grafts required

Front 50

Subdermal burn

Back 50

Through epidermis, dermis, and subcutaneous fat.
May involve muscle/bone

Front 51

Rule of 9's

Back 51

9 - Head and neck
18 - anterior trunk
18 - posterior trunk
9 - bilateral anterior or posterior arm (18 for total arms)
18 - bilateral anterior or posterior leg (36 total for legs)

Front 52

Child values - rule of 9's

Back 52

9% taken from LE and added to head and neck region.
Each year of life, 1% is distributed to the back en LE until age 9 when head is same proportion as adult.

Front 53

Compression Garments - Pressure and wearing schedule

Back 53

15-35 mm Hg
Worn for 22-23 hours/day until the scar has matured

Front 54

Cellulitis

Back 54

Fast spreading inflammation that occurs as a result of bacterial infection of the skin and connective tissues.

Front 55

Contact Dermatitis

Back 55

Superficial irritation of skin resulting from localized irritation (poison ivy, latex, etc)

Front 56

Eczema

Back 56

Also known as dermatitis
Chronic skin inflammation typicall due to an immune system abnormality, allergic reaction, or external irritant.

Front 57

Gangrene (dry)

Back 57

loss of vascular supply resulting in local tissue death.
Hardened tissue is not painful, but may be painful along edges.
Occurs in DM or atherosclerosis

Front 58

Gangrene (wet)

Back 58

When there is a bacterial infection.
Can develop after a severe burn, frostbite, etc
Requires immediate tx because it can spread quickly and be fatal.

Front 59

Onychomycosis

Back 59

Fungal infection of toenails and nailbeds

Front 60

Plaque Psoriasis

Back 60

Chronic autoimmune disease
Skin cells accumulate in raised red patches on the skin

Front 61

Tinea Pedis

Back 61

Athlete's foot
Superficial fungal infection which causes epidermal thickening and scaly skin appearance.