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med surg
nursing
| Question | Answer |
|---|---|
| inflammatory response | a sequential reaction to cell injury |
| removes necrotic materials, and establishes an environment suitable for healing and repair | inflammatory response |
| Inflammation is an immediate | protective response by the body to any kind of injury to its cells and tissue. |
| The vascular response results in | vasodilation causing hyperemia (increased blood flow in the area) and increased capillary permeability. |
| vascular response results in increased fluid moving into tissues causing | redness, heat, and swelling at the site. |
| the cellular response | neutrophils and monocytes move to the inner surface of the capillaries (margination) and then through the capillary wall (diapedesis) to the site of injury. |
| Chemotaxis is the | migration of WBCs to the site of injury |
| chemotaxis results in an | accumulation of neutrophils and monocytes at the focus of injury |
| Pus is a | creamy substance resulting from dead neutrophils, digested bacteria and other debris |
| the first leukocytes to arrive at the site of injury (usually 6-12 hours) and have a short life span (24-48 hours) | neutrophil |
| neutrophils phagocytize | bacteria, other foreign material and damaged cells |
| the second type of phagocytic cells that migrate from circulating blood are | monocytes |
| monocytes transform into | macrophages |
| macrophage role is to | clean area before healing can occur |
| lymphocytes are related to | humoral and cell-mediated immunity |
| Complement system (C1-C9) is the | major mediator of the inflammatory response |
| Exudate consists of | fluids and leukocytes that move to the site of injury |
| local response of inflammation includes | redness, heat, pain, swelling and loss of function |
| systemic manifestations of inflammation includes | an increase of WBC count with a shift to the left, malaise, nausea an anorexia, increased pulse and respiration rate and fever |
| inflammation is always present with | infection |
| infection is not always present with | inflammation |
| infection means an | invasion of tissues or cells by microorganisms such as bacteria, fungi and viruses |
| neutropenic means that your | WBC is depleted, and you may not be able to manifest an inflammatory response. |
| a low neutrophil count is called | neutropenic |
| inflammation is based on the | severity of the injury and the capacity for the person to respond |
| vascular response results from | capillaries constricting and this releases hit amine which causes vasodilation. |
| hyperemia is the | increased blood flow to an area |
| fibrinogen leaves the blood and is | activated to fibrin |
| fibrin strengthens a | blood clot formed by platelets |
| in a blood clots platelets release | growth factors that start the healing process |
| bone marrow releases immature neutrophils are called | bands |
| Phagocytosis | engulf foreign matter and debris |
| purulent Pus is a | creamy substance resulting from dead neutrophils, digested bacteria and other debris |
| an increase in WBC can be due to an | acute bacterial infection |
| leukocytosis is the | increase in WBC |
| monocytes arrive at the site of infection in about | 3-7 days |
| Serous fluid results from | low cell and protein count, seen in early stages of inflammation (skin blisters) |
| Catarrhal | – mucous – runny nose with URI |
| histamine is stored in | granules of basophils, mast cells, and platelets. |
| histamine causes | vasodilation and increased capillary permeability |
| serotonin is stored in | platelets, mast cells enterochromaffin cells of the GI tract |
| serotonin stimulates | smoother muscle contraction |
| Purulent fluid is | a Combo of WBCs, dead cells, microorganisms – abscess, cellulitis, furuncle |
| granuloma is when a | monocytes clump together to eat a larger particles |
| prostaglandins are generally considered | proinflammatory and prolong the inflammatory response and are potent vasodilators contributing to increased blood flow and edema |
| prostaglandins have a role as pyrogens in | causing febrile (fever) |
| leukotrienes are more likely to cause | anaphylaxis |
| anaphylaxis cause a | vasoconstriction of smooth muscles of the bronchi, which causes a narrowing of the airway |
| aldosterone is a | pro-inflammatory which controls sodium ( hangs with water) and causes BP and HR to go up |
| Fever above 105.8 F damages | regulation by the hypothalamic temperature control center becomes impair, and damage can occur to many cells, including brain cells |
| cortisol is an | anti-inflammatory that inhibits the inflammatory response |
| sero-sanguineous fluid is | found during the midpoint in healing after surgery or tissue injury. composed of RBC and serous fluid |
| the onset of fever is triggered by | the release of cytokines |
| the shivering response is the body's method of | raising the body's temperature until the new set point is attained |
| exudate fluid are | leukocytes that move to the site of injury. |
| there is a decrease in mobility due to | pain and swelling |
| acute inflammation the healing occurs in | 2-3 weeks and usually leaves no residual damage and neutrophils are the predominant cell type at the site of inflammation |
| subacute inflammation has | the same features of acute inflammation but last longer |
| chronic inflammation lasts for | weeks, months or even years, with predominate cell types being lymphocytes and macrophages |
| the best management of inflammation is the | prevention of infection, trauma, surgery, and contact with potentially harmful agents |
| older people have a blunted | febrile response to infection |
| antipyretic drugs are used to | reduce fever |
| to prevent acute swings in temperature | antipyretic drugs are given around the clock |
| key concept in treating soft tissue injuries and related inflammation | RICE |
| R in rice stands for | rest and it helps the body use its nutrients and oxygen for the healing process. lets fibrin and collagen to form across the wound edges with little disruption |
| I in rice stands for | ICE, and cold application is usually appropriate at the time of initial trauma to cause vasoconstriction and decrease swelling and pain |
| when can heat be added to inflammation? | 24-48 hours after and promotes healing by increasing the circulation to the inflamed site |
| E in rice stands for | Elevation, reduces edema at the site of inflammation by promoting venus and lymphatic return |
| C in rice stands for | Compression, serves to counter the vasodilation effects and development |
| regeneration is the | replacement of lost cells and tissues with cells of the same type |
| repair is the | healing as a result of lost cells being replaced by connective tissue |
| most common type of healing that result in a scar forming | repair |
| epithelial cells | readily divide and regenerate |
| skin and lining of the blood vessels are | epithelial cells |
| connective tissue are | bone, cartilage, tendons and ligaments and blood |
| smooth muscle | regeneration usually possible, particularly in the GI tract |
| cardiac muscle | damage is replaced by connective tissue |
| skeletal muscle | connective tissue replaces severely damaged muscle |
| primary intention healing takes place when | a wound margins are neatly approximated, as in a surgical incision or a paper cut |
| the initial inflammatory phase lasts for | 3-5 days, approximation of incision edges, fibrin clot forms meshwork for starting capillary growth |
| the granulation (fibroblastic, reconstructive) phase is the | second step and last from 5 days to 3 weeks. |
| during the granulation phase the wound is | pink and vascular ( good blood flow) |
| fibroblasts are | immature connective tissue cells that migrate into the healing site and secrete collagen |
| collagen is organized and restructured to | strengthen the healing site, at this stage it is termed scar tissue or fibrous |
| during the maturation phase it begins | 7 days after the injury and continue for several months or years |
| secondary intention are wounds that | occur from trauma, ulceration, and infection have large amounts of exudate and wide, irregular wound margins with extensive tissue loss |
| secondary intention wound edges | cannot be approximated or brought together |
| healing and granulation take place from the | edges inward and from the bottom of the wound upward until the defect is filled |
| tertiary intention healing occurs with the | delayed suturing of a wound in which two layers of granulation tissue are sutured together |
| a contaminated wound is left open and sutured closed after the infection is controlled | tertiary intention |
| wounds are classified by their | cause (surgical or non surgical; acute or chronic) or depth of tissue affected (superficial, partial thickness, or full thickness |
| superficial wound involves | only the dermis |
| partial thickness wounds | extend into the dermis |
| full thickness wounds have the | deepest later of tissue destruction because they involve the subcutaneous tissue and sometimes extend into the fascia and underlying structures such as the muscle, tendon or bone |
| another system used to classify open wounds is based on | the color of the wound (red, yellow, black) |
| adhesions are | bands of scar tissue that form between or around organs, may occur in the abdominal cavity or between the lungs and pleura and may cause intestinal obstruction |
| evisceration occurs when | wound edges separate to the extent that intestines protrude through wound |
| dehiscence is the | separation and disruption of previously joined wound edges |
| dehiscence may be caused by | infection caused by inflammation, granulation tissue not strong enough to withstand forces imposed on wound, obese people are at higher risk because adipose tissue has less blood supply |
| fistula formation is an | abnormal passage between organs or a hollow organ and skin |
| keloid formation is a | great protrusion of scar tissue that extends beyond wound edges and may form tumor like masses of scar tissue. occurs more in african americans |
| hypertrophic scar occurs when | an overabundance of collagen is produced during healing, raised red and hard scar that is non life threatening |
| wound measurements are made | in centimeters |
| tunneling of a wound is when | cotton tip is placed in a wound and there is movement |
| underminin of a wounds is when | there is a lip under the wound |
| tunneling and undermining are charted in respect | to a clock |
| sutures and fibrin sealant are used to | facilitate wound closure and create an optimal setting for wound healing |
| fibrin sealant can be used with | sutures or can used independently to seal wound sites where sutures cannot control bleeding |
| primary intention wounds is common to cover wound with | a dry sterile dressing that is removed as soon as drainage stops, or 2-3 days |
| topical antimicobials shouldn't be used in a clean granulating wound because they | may damage the new epithelium and delay the healing process |
| red wound the purpose of treatment is to | protection of the wound and gentle cleansing |
| for a red wound the dressing material | should keep the wound surface clean and slightly moist is optimal to promote epithelialization |
| transparent films are | semipermeable dressing that permits gaseous exchange between wound and environment, use |
| used for dry noninfected wounds or wounds with minimal drainage | transparent films (tegaderm, transeal, OpSite, BlisterFilm) |
| yellow wound dressing materials should | absorb the exudate and cleanse the wound surface. number of dressing changes is determined by the amount of wound secretions |
| black wound treatment calls for | immediate debridement of the nonviable, eschar tissue |
| hydrocolloid dressings are used to treat | yellow wounds |
| the inner part of hydrocolloid dressings interact with | exudate, forming a hydrated gel over the wound. doesn't allow O2 to diffuse from the atmosphere to the wound |
| type of therapy that uses suction to remove drainage and speed wound healing | negative pressure wound therapy (wound vac) |
| for negative pressure therapy you should monitor the patients | serum protein levels and fluid and electrolyte balance due to losses from the wound |
| gauzes and nonwovens provides absorption of | exudates, supports debridement if applied and kept moist. can be used for cleaning or packing of a wound ( kerlix, kling) |
| nonadherent dressings are | woven or non woven dressings, with either saline, petrolatum or antimicrobials in them. used on minor wounds or as a second dressing |
| foam dressings are | sheets or other shapes of foamed polymer solution with small, open cells capable of holding fluids. used for partial or full thickness wounds or infected wounds ( allevyn, curafoam) |
| absorptive dressings are for | large volumes of exudates that need to be absorbed. for partial or full thickness wounds (ABD pads, Covaderm, Abdominal pads) |
| hydrogel dressing is | available as a sheet, gel or gauze designed to donate moisture to a dry wound and maintain a moist healing environment, serves to rehydrate the wound tissue. provides limited absorption of exudate, partial of full thickness wounds (AquaSite, Tegagel,) |
| angiogenesis is the | production of new blood vessels |
| surgical debridement is the | quick method of debridement to prevent, control, or remove infection |
| mechanical debridement is when | a wet to dry dressing in which open mesh gauze is moistened with normal saline, packed on or into wound surface and allowed to dry |
| a diet high in | protein, carbs, and vitamins with moderate fat intake is necessary to promote healing. |
| a pressure ulcer is a localized | injury to the skin and/or underlying tissue (usually over a bony prominence) |
| pressure ulcers fall under the category of | healing by secondary intention |
| most common site for pressure ulcers is the | sacrum and then the heels |
| shearing force is the | pressure exerted on the skin when it adheres to the bed and the skin layers slide in the direction of body movement |
| risk factors the pressure ulcers include | advanced age, anemia, diabetes, immobility, incontinence, low diastolic BP <60 mmHg, obesity, vascular disease |
| unstageable pressure ulcer is when | (full thickness)the actual depth of the tissue loss is obscured by slough (yellow, tan, gray, green or brown) and/ or eschar (tan, brown, or black) in the wound bed |
| stage 1 pressure ulcer is | a nonblanchable redness of a localized area usually over a bony prominence |
| stage 2 pressure ulcer is | partial thickness loss of dermis manifesting as a shallow open ulcer with red pink wound bed, with out slough |
| stage 3 pressure ulcer is | full thickness tissue loss with subcutaneous fat may be visible but not bone |
| stage 4 pressure ulcer is | full thickness tissue loss with exposed bone, tendon or muscle. slough or eschar may be present on some parts of the wound bed |
| risk assessment should be done using the | braden scale to assess for risks of pressure ulcer |
| document a pressure ulcer based on | stage, size, location, amount of exudate, type of wound, presence of infection or pain |
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