Wound Care Exam 1

Front 1

capillaries of the skin are concentrated __

Back 1

superficially

Front 2

name the layer of the epidermis from deep to superficial

Back 2

stratum basale, stratum spinosum, stratum granulosum, stratum lucidum, stratum corneum

Front 3

where does cellular division in teh epidermis take place?

Back 3

stratum basale

Front 4

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

Back 4

stratum corneum

Front 5

what happens to cells as they move from the stratum basale to the stratum corneum?

Back 5

cells become filled with waxy keratin and die as they move outward. they are used for protection and preventing water loss

Front 6

what is teh basement membrane?

Back 6

acellular layer that separates the epidermis from the dermis

Front 7

is an interface between epidermis and dermis

Back 7

basement membrane

Front 8

structure in teh basement membrane that resists shear and has minimal regeneration

Back 8

rete pegs and dermal papillae

Front 9

what are the living cells in teh basement membrane?

Back 9

melanocytes, merkel cells, langerhans cells

Front 10

cells that produce melanin, located in teh stratum basale

Back 10

melanocytes

Front 11

mechanoreceptors that are embedded int eh stratum basale

Back 11

merkel cells

Front 12

immune cells in teh basement membrane which are dendritic cell which specializes in capturing foreign particles and presenting them to T cells

Back 12

langerhans cells

Front 13

the vascular layer of the skin with blood vessels and lypmphatics present

Back 13

dermis

Front 14

the dermis is made of primarily __ and is mostly __ with they primary cell type being __

Back 14

connective tissue, acellular, fibrolast

Front 15

the upper layer of the dermis forms the __, protrusions into the epidermis

Back 15

dermal papillae

Front 16

what two kinds of proteins are the primary structual proteins of the dermis (provides tensil strength)

Back 16

collagen type I and II

Front 17

what two cells are found in the dermis layer?

Back 17

macrophages and lymphocytes

Front 18

what are the three main differences between teh two layers of teh dermis?

Back 18

papillary layer: superficial, loose collagen bundles, vascular eminences rise into epidermis

reticular layer: deep, dense collagen bundles, merges with hypodermis

Front 19

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

Back 19

hypodermis

Front 20

deep source of epidermal cells (lined by stratum basale)

no new units are formed after birth

nails, hair, sebaceous glands, and sweat glands

Back 20

epidermal appendages

Front 21

where are sensory nerve receptors located?

Back 21

in teh epidermis and dermis

Front 22

how does the skin provide protection from bacteria and viruses

Back 22

T cells, macrophages, kertain outer layer

Front 23

how does teh skin provide from mechanical or chemical trauma?

Back 23

keratin keeps chemical out

dermal papillae and rete pegs protect against mechanical trauma

Front 24

how does teh skin protect against the loss of fluid?

Back 24

keratine

Front 25

explain the cellular process of tissue healing

Back 25

inflammatory phase: days 1-6

proliferative phase: days 3-20

maturation/remodling phase: day 9-up to 2 years

Front 26

are the phases of tissue healing distinct and exact?

Back 26

NO

Front 27

what are the four manifestations of inflammation?

Back 27

warmth and redness, welling/edema, pain, loss of function

Front 28

what causes warmth and redness during inflammation?

Back 28

vasodilation and increased blood flow to the area (causes swelling)

Front 29

what causes swelling/edema during inflammation?

Back 29

increased vascular permiablity and blockage of lymphatic and venous drainage (causes pain)

Front 30

what causes pain during inflammation?

Back 30

physical pressure and chemical stimulation of pain receptors

Front 31

what causes loss of function from inflammation

Back 31

pain and swelling

Front 32

what occurs during the inflammatory phase of tissue repair?

Back 32

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

Front 33

immune cells that are one size fits all. respond to all immune events

Back 33

neutrophils

Front 34

immune cells that eat up dead tissue

Back 34

macrophages

Front 35

a defense against infections and bridge between tissue injury and new cell growth/tissue healing

Back 35

inflammation

Front 36

what is the most important stage in wound health

Back 36

inflammation

Front 37

the stage of inflammation that is dominated by neutrophils with the goal of protecting against invading bacteria

Back 37

early inflammation

Front 38

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

Back 38

late inflamamtion

Front 39

what cells degrade non-viable tissue and participate in neovacularization?

Back 39

macrophages

Front 40

that cells perform neovascularization (capillary formation)?

Back 40

endothelial cells

Front 41

what cells are involved in collagen/extracellular matrix production?

Back 41

fibroblasts

Front 42

what cells are involved in wound contracture?

Back 42

myofibroblasts

Front 43

what cells are involved in epithelialization

Back 43

epithelial cells (basal epidermal cells)

Front 44

macrophages __ neovascularization

Back 44

stimulate

Front 45

when epithlial cells on teh surace of the skin grow over the top of the wound

Back 45

epithelialization

Front 46

why do you need neovacularization?

Back 46

there must be adequate O2 t generate healthy extracellular matrix/granulation tissue and allow re-epithelialization

Front 47

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

Back 47

extracellular matrix

Front 48

how is the extracellular matrix produced

Back 48

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)

Front 49

what happens in the proliferative phase?

Back 49

wound contracture: fibroblasts differentiate into myofibrolasts

myofibroblasts can stimulate wound "contraction" via intracellular microfilaments containing actin

Front 50

what three things happen during the epithelialization stage of tissue repair

Back 50

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

Front 51

in epithelialization, the presence of non-viable tissue, like eschar, or a scarb will __ cell growth

Back 51

impede

Front 52

where do epidermal cells come from?

Back 52

stem cells

Front 53

what 4 things occur during the maturation and remodeling phase as the extracellular matrix matures?

Back 53

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

Front 54

how long does the maturation/remodeling phase last?

Back 54

day 9 on

Front 55

new tissue after maturation and remodeling phase is prone to __

Back 55

injury

Front 56

a scar that is red, raised, and fibrous, but stays within the confines of teh original wound

Back 56

hypertrophic scar

Front 57

a scar that is similar in character to a hypertorphic scar but it extends beyond the boundry of the original wound

Back 57

keloid scar

Front 58

when healing connective tissue, __ is critical to maintain strength of tissues

Back 58

alignment of collagen

Front 59

with alignemtn of collagen, fibers align along __

Back 59

lines of stress

Front 60

type of wound healing done with sutrue wound edges

Back 60

primary closure/healing by primary intention

Front 61

type of healing for open, large full-thickness wounds

Back 61

secondary closure/healing by secondary intention

Front 62

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

Back 62

delayed primary closure/healing by tertiary intention

Front 63

what happens to a wound if only the epidermis is injured?

Back 63

epithlialization (epithelial cells can come from outer edge and from hair follicles)

Front 64

what happens if teh dermis is injured?

Back 64

granulation and contraction of the wound

Front 65

skin tears, abrasions, tape damage, bilisters, dermatitis, and donor sites are all __ wounds

Back 65

partial thickness wounds

Front 66

lower extremity ulcers, surgical wounds, abscess formation, and pressure ulces are __ wounds

Back 66

full thickness wounds

Front 67

what are the three functions of the immune system?

Back 67

host defense, tissue clearance, tissue repair

Front 68

the primary function of the immune system is to defend against foreign pathogens such as bacteria and viruses

Back 68

host defense

Front 69

how does the skin help with thermoregulation?

Back 69

sweat glands, superficial capillaries, fat from hypodermis

Front 70

what is the difference between an acute and chronic wound?

Back 70

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

Front 71

what are the four major cateogories of deterrents to expedient wound healing?

Back 71

characteristics of the wound itself

local factors within the wounded area

systemic factors related to the individual with the open wound

inappropriate wound managment

Front 72

what are 8 characteristics of wounds that affect wound healing?

Back 72

mechanism of onset, time of onset, wound location, wound dimensions, temperature, wound hydration, necrotic tissue/foreign bodies, and infection

Front 73

how can mechanism of onset affect wound healing?

Back 73

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

Front 74

how can time since onset affect wound healing?

Back 74

time of onset can be used to predict acute wound healing but not chronic.

Front 75

what are four instances where wound location affects healing?

Back 75

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

Front 76

__ wounds heal slower than __ wounds which heal slower than __ wounds

Back 76

circular, square/rectangular, linear

Front 77

what is the optimal temp a wound should be kept at and why does this encourage healing?

Back 77

37-38 celcius (dilates vasculature, tissues less vulnerable to infection and O2 is increased)

Front 78

a dry wound progesses through the phases of inflammation more __ than a moist wound

Back 78

slowly

Front 79

why do dry wounds heal slower than hydrated ones?

Back 79

drying slows cell migration by increasing the distance they have to travel. it requires more enzyme production to break down the dried crust

Front 80

exposed wounds are more __ than covered wounds

Back 80

painful

Front 81

when a wound is hydrated, the fluids it produces stimulate __, induce __ and cause __

Back 81

collagen synthesis, angiogenesis, wound contracture

Front 82

what happens if a wound is wet?

Back 82

the peri-wound will become macerated making the skin more fragile and possibly increasing the size of the wound

Front 83

how does necrotic tissue or the presence of foriegn bodies affect wound healing?

Back 83

epithelial cells can only migrate over viable tissue. dead tissue provides food for microbes encouraging infection

Front 84

the invasion and multiplication of microorganisms in body tissues

Back 84

infection

Front 85

the presensce of microbes

Back 85

colonization

Front 86

does colonizaiton imply that a wound is infected? why?

Back 86

NO, b/c some are normal fauna

Front 87

explain how infection slows wound healing in chronic wounds

Back 87

microbes compete with wound tissues for O2 and energy. also secrete cytotoxic substances

Front 88

when a wound considered "infected"

Back 88

10^5 microbes/gram of tissue

Front 89

what are three major changes in chronic wounds that cause them to heal slower than acute wounds?

Back 89

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

Front 90

what are three local factors that affect wound healing?

Back 90

circulation, sensation, and mechanical stress

Front 91

is a pulse a good indicator of whether or not a wound has proper circulation?

Back 91

NO! macrocirculation can be fine but microcirculation close to the wound bed can be impaired

Front 92

conditions that promote a __ response can affect wound healing by impairing circulation

Back 92

sympathetic

Front 93

what are four causes of impaired circulation?

Back 93

imapired macro/micro circulation

cold

fear

pain

Front 94

how do sensation deficits affect wound healing?

Back 94

if a pt can't sense tissue damage they can cause worse damage or not seek necessary treatment b/c of lack of pain

Front 95

__ like pressure, shear, friction, edema, or tension on wound edges all deter wound healing

Back 95

mechanical stresses

Front 96

age__ wound healing

Back 96

decreases

Front 97

what are 5 systemic factors affecting wound healing?

Back 97

age, inadequate nutrition, comorbidities, medication, behavioral risk taking

Front 98

what is one explanation that inadequate nutrition causes slowed wound healing?

Back 98

if cells don't have carbs to burn they use proteins which would otherwise be used in healing.

Front 99

which is more important to wound healing: a pt recent food intake or what they've consumed in the last few weeks?

Back 99

their recent food intake

Front 100

why are pt's with wounds more prone to develop malnutirtion?

Back 100

the wound is catabolic (needs lots of energy)

Front 101

what are 5 goals for wound managment ?

Back 101

control wound exudate

deal with infection

protect skin

heal pressure ulcers

address pt comfort

Front 102

what are three things that arterial insufficincy causes in wounds?

Back 102

decresased O2

chronic wounds

increased susceptibiltiy to infection

Front 103

what are three things that venous insufficiency cuase?

Back 103

edema

fibrin in teh tissue

high risk for developing infection

Front 104

how do steroids affect wound healing?

Back 104

decrease collagen synthesis

suppress immune system

Front 105

how do NSAIDS affect wound healing?

Back 105

vasconstriction, suppress inflammation and collagen synthesis

Front 106

how do chemo drugs affect wound healing?

Back 106

interfere with cell proliferation

prolong inflammation

inhibit protein and collagen synthesis

Front 107

how do antineoplastic drugs affect wound healing?

Back 107

fibroblast production

Front 108

how does diabetes affect wound healing?

Back 108

accelerated atherosclerosis (decreased circulation)

neuropathy

abnormal collagen synthesis

Front 109

how do vascular diseases affect wound healing?

Back 109

decreased blood supply and tissue perfusion

Front 110

how do immunicompromising diseases affect wound healing?

Back 110

increased infection, affects phagocytosis

Front 111

how do renal dysfunctin diseases affect wound healing?

Back 111

granulation and fibroblasts

Front 112

how does lymphedema affect wound healing

Back 112

delays it

Front 113

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

Back 113

age

Front 114

how does alcohol abuse affect wound healing?

Back 114

malnutrition

increased risk of injury

delayed medical care

Front 115

how does smoking affect wound care?

Back 115

vasconstriction

increased platelet aggregation

decreased O2 b/c of CO

Front 116

stress/depression or anxiety all __ wound healing

Back 116

decrease

Front 117

__ is a nonselective debridement which can damage healthy tissue

Back 117

wet to dry

Front 118

__ dressings will cause dehydration of the wound

Back 118

dry gauze

Front 119

what is a primary goal of wound dressing?

Back 119

to maintain a moist wound bed

Front 120

__, __, and __ will perpetuate and initiate presure ulcers and neuropathic ulcers

Back 120

pressure, shear, friction

Front 121

why does edema delay wound healing?

Back 121

decreased tissue perfusion due to decreased blood flow

Front 122

decreased mobility secondary to pain can cause __

Back 122

DVT, pressure ulcers

Front 123

what are the four parts to a wound evaluation?

Back 123

history, subjective exam, objective exam, assessment

Front 124

what are the three parts of a history?

Back 124

general history, previous history, social history

Front 125

what 5 questions would you ask during a general history?

Back 125

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

Front 126

diabetes, PVD< HTN, CHF, medications, allergies, and prevous wound hisotry and tratements would all be part of the __ part of a wound eval

Back 126

previous history

Front 127

what four things should you ask in a social history?

Back 127

smoker?, dietary intake?, alcohol use, describe a usual day

Front 128

what three things should you ask in a subjective exam?

Back 128

symptoms (pain level and location, when it occurs, consequences, characteristics)

where its located

behavior of symptoms

Front 129

what are four things you would do in teh objective part of the exam

Back 129

risk assessment tools, wound calssification, observations, clinical measurements

Front 130

what are three things to look for for wound classificatoin during teh objective part of the exam

Back 130

partial or full thickness

color

4 stages system for pressure ulcers

Front 131

what are 5 observations to make during teh objective part of the exam

Back 131

skin color, texture of the skin, temperature of the skin, skin integrity, foreign debris or necrotic tissue

Front 132

what are 6 clinical measurements to make during the objective part of the exam?

Back 132

clutre, location, size/depth, drainage, temperature, and girth

Front 133

what are three tests to assess the venous system?

Back 133

trendelenburg, doppler US, homans sign (DVT)

Front 134

what are four steps to assessment for wound care

Back 134

determine accurate wound diagnosis

short term/long term goals

determine plan of care

make recomendations for treatment