LU Lewis and Lecture notes
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| Epidermis | top layer, 0.05-1.5 mm layer, langerhan and dendritic cells first level of defense
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| dermis | collagen and elastic fibers, 0.3-3.0mm glands and hair follicles
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| subcutaneous | fat, varies from person to person, regulates body temperature
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| Assessing wounds | size, location, redness, edema, ecchymosis, drainage, approximation
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| vascular response | vasoconstriction (limit bleeding), followed by vasodilation (bring WBC to area, allows fluid to leak out of vascular) fibrin forms
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| cellular response | neutrophils, monocytes,
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| neutrophils | arrive first at injury (phagocytes). Eat, digest and produce waste products (pus), comes from the bone marrow
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| Shift to the left | infection in body so great depeletes mature WBC and the bone marrow sends out immature neutrophils (called bands) to help the fight. Check CBC for bands
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| monocytes | arrive 3-5 days after injury, get rid of waste produced by phagocytes, macrophages release fibrenogin and starts to heal and knit together
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| Chemical Response to injury | Complement system, 1-9 types. Complement deficiency means one is missing.
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| Kines, histamines, prostaglandins, serotonin | chemical response, all irritate skin and cause pain and swelling, part of healing
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| prostaglandins | activate pathways that cause production of leukotrines (which cause anaphylactic reaction)
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| arterial problem | not much swelling, but can't get stuff to the area of damage
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| venous problem | swollen, can't get the bad stuff back out
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| Cillins (PCN) | cidal, GI issues and rash, no toxicity, watch for anaphylaxisis, Gram +
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| cephlosporins (Keflex, ceclor) | cidal, GI issues, no toxicity, cross reacts with PCN, Gram + and -. Most common antibiotics
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| Tetra (cycline) | NO CHILDREN, static, GI Issues and yeast, renal toxic, Adverse coumadin, milk, sunlight and stains teeth, Gram + and -
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| macrolides (myicin) | static, GI and hepatic toxicity, OTO toxic and renal, take with water, no grapefruit juice, Gram +
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| aminoglycosides (genatmycin, vancomycin) | cidal, rash, GI, fatigue, irreversible Ototoxic, nephro toxic, Measure peaks and troughs, can affect coumadin. Gram - and some +
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| fluroquinolins (cipro No PG, oxins No Kids) | static, GI, dysrhythmias, hepatotoxicity, tendon ruptures, anaphylactic, BS elevation, Gram + and pseudomonus
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| Sulfa (bactrim) | static, rash (up to 6 weeks), aplastic anemia, fatal blood abnormality, Gram + and -
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| Fever | thermostat in hypothalmus, prostoglandins act on it to increase them, causes shiver, sweating etc to lower temp. Epi released increases metabolism, treet 100.1 and above
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| NSAIDS | antiprostaglandin meds. antipyretic, antiinflammatory, analgesic. mild to moderate GI effects
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| ASA | lasts for a couple of days, renal toxic. Reye's syndrome in children
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| Tylenol | analagesic, high rate of death (in multiple meds patients OD without meaning to). liver toxic. Max dose 4000mg QD. Antidote is mucomist
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| Cox 2 | celebrex, block receptors. NOT antipyretic, no GI effects but possible cardiac effects
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| nosocomial infections | hospital acquired
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| Factors impede healing | smoking, immobility, nutrition, chronic diseases, meds, skin breakdown, environment
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| Phases of Wound Healing | Inflammatory phase, proliferative phase, remodeling phase
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| Inflammatory phase | immediate to 2-5 days, hemostasis (vasoconstriction, platelets, clotting). Inflammation (vasodilation, phagocytosis)
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| Proliferative phase | 2 days to 3 weeks. Granulation (fibroblasts lay new collagen, fills defects and makes caps). Contraction (wound edges pull together). Epitheliazation (crosses moist surfaces 3 cm from good cell in all directions)
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| remodeling phase | 3 weeks to 2 years. New collagen forms (for strength) and scare tissue grows
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| suprainfections | yeast, black tongue, caused by antibiotic use
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| antifungal meds | diflucan, lamasil. Live toxic, use with caution in Liver patients
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| antivirals | valtrex, treat virus. Liver toxic
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| tamiflu | to shorten the length of flu, and to prevent it after exposure
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| RYB wounds | Red (trauma or surgical wound: protect and clean)
Yellow (prescence of slough and exudate: cleaning and removal of non viable tissue)
Black (necrotic tissue: debridement)
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| Types of Dressings | gauze, nonadherent dressings, transparent films, hydrocolloids, foams, absorptive dressings, hydrogel, alginates, antimicrobials
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| Reduce risk of pressure sore in Wheelchair | shift weight every 20 min
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| vasoconstriction | initial inflammatory response
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| arachidionic pathway | leukotrienes and prostoglandins
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| liver function decreases | decrease dosage
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