Skin conditions
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| show | -thermoregulation
-sensation
-synthesis of Vitamin D
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| Name the layers of the skin | show 🗑
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| Epidermis | show 🗑
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| show | -Keratinocytes= 80-90% of cells in epidermis, produce nails and hair
-Melanocytes= produce melanin (pigment)
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| Functions of the Epidermis | show 🗑
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| Dermis | show 🗑
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| Two sub layers of the dermis | show 🗑
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| Papillary Dermis | show 🗑
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| show | -forms base of dermis
-contains complex of cutaneous blood vessels
-has thick dense collagenous fibers which give structural support
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| Cells in the Dermis | show 🗑
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| Macrophages | show 🗑
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| Lymphocytes | show 🗑
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| show | secretory cells that produce chemical mediators of inflammation (histamine)
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| show | secrete collagen and elastin
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| show | -collagen: major structural protein
-elastin: provides skin with elastic recoil
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| show | -separates dermis from epidermis
-anchors epidermis to dermis
-layer where blisters form
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| Rete Ridges | show 🗑
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| Hypodermis | show 🗑
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| skin changes with age | show 🗑
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| show | 1. Inflammatory
2. Proliferative
3. Remodeling
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| Inflammatory Phase | show 🗑
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| show | -color change in skin
-increased skin temperature
-increased swelling
-increased pain
-loss of function
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| Proliferative Phase | show 🗑
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| Important Cells in the Proliferative Phase | show 🗑
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| show | reconstruction of injured epithelium by kerotinocytes
-occurs in the proliferative phase
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| show | -begins after granulation tissue forms and continues 1-2 years post injury
-increases tensile strength in the scar
-final max strength of scar will be 80% of pre-injury tissue
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| Chronic Wound Characteristics | show 🗑
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| What to Include in a Wound Assessment | show 🗑
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| show | -wound location (position on a clock; 12:00=head)
-wound size (measure and tell directions of measurements- also depth)
-tissue type and colors -include % of each
-amount, color and odor of drainage
-condition of skin surrounding
-include a photograp
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| Tunneling | show 🗑
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| show | -eroded area extending under the skin beyond the visible wound edges
-wider than tunneling
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| show | temporary scaffolding of vascularized connective tissue
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| show | granulation tissue that has grown above the level of the surrounding skin
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| show | -slough
-usually yellow or tan
-stringy or soft
-leathery appearance if dry
-Eschar
-black
-can be soft or hard
-usually dry and thick
-indication that underlying damage is most likely severe
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| show | -not very deep
-wound heals faster
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| Unattached Wound Edges | show 🗑
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| show | associated with deeper wounds
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| show | associated with superficial wounds where epithelialization is occuring
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| Rolled Wound Edges | show 🗑
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| show | -decreased turgor is a sign of decreased hydration
-Lightly pinch skin. if it does not quickly return to normal shape, sign of decreased turgor
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| Induration | show 🗑
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| show | can indicate ischemic damage due to pressure (important in staging pressure ulcers)
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| Periwound Skin color- Pale | show 🗑
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| show | can indicate severe or prolonged ischemia
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| Wound Drainage- Serous | show 🗑
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| show | red or dark brown, consistency more like blood
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| Wound Drainage- Serosanguinous | show 🗑
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| show | -usually yellow, thicker consistency
-can indicate infection or could be liquifying necrotic tissue
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| Wound Drainage- blue or green color | show 🗑
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| Wound Drainage | show 🗑
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| show | -documented as present or absent
-can indicate infection
-so occlusive dressing will cause odor (not infection)
-assess for odor throughout treatment as odor may be present on dressings but disappear after wound bed is cleaned
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| Pressure Ulcers | show 🗑
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| Prevalence of Pressure Ulcers | show 🗑
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| show | -supine= occiput, sacrum, coccyx, heels
-sitting= ischial tuberosities
-sidelying= trochanters
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| Risk Factors for PUs | show 🗑
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| show | -force parallel to soft tissue
-common cause is hospital bed with head elevated causing pt to slide down in bed
-stretch on the tissues causes ischemia
-undermining is commonly seen
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| show | -caused when two surfaces move across each other
-as in sliding a pt from a bed to a cart
-does not directly cause PUs but can weaken skin and put pt more at risk
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| show | -wet skin is more easily abraded, more permeable and more readily colonized by bacteria
-caused by wound drainage, perspiration or incontinence
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| Prevention of Pressure ulcers | show 🗑
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| Scales for assessing PU risk | show 🗑
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| Pressure Ulcer: Stage I | show 🗑
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| Pressure Ulcer: Stage II | show 🗑
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| show | -full thickness tissue loss
-subcutaneous fat may be visible but no bone, tendon or muscle exposed
-may include undermining or tunneling
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| Pressure Ulcer: Stage IV | show 🗑
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| Pressure Ulcer: Unstageable | show 🗑
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| Pressure Ulcer: Suspected Deep Tissue Injury | show 🗑
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| show | -caused by a decrease in arterial blood supply, or arterial insufficiency (PVD or PAD)
-most common etiology is arteriosclerosis
-most common problem seen by vascular surgeons
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| show | -thin atrophic skin
-dependent rubor
-pallor with elevation
-absence of pedal pulses
-non-healing wounds
-muscle wasting
-hair loss
-hypertrophic nails
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| Pathophysiology of PAD/Arterial Ulcers | show 🗑
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| Risk Factors of PAD | show 🗑
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| Assessing Arterial ulcers | show 🗑
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| show | (ABI)= non-invasive measure of peripheral tissue perfusion
-ratio of systolic blood pressure of LE to that of UE
-easily done in clinic
-just need hand held doppler and blood pressure cuff
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| show | 1.1-1.3= Vessel Calicification
0.9-1.1= Normal
0.7-0.9= Mild to mod arterial insuff.
0.5-0.7= Mod arterial insuff, intermitt claudication
>0.5= Severe areterial insuff, rest pain
>0.3= Rest pain and gangrene
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| Arterial Ulcer characteristics | show 🗑
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| Chronic Venous Insufficiency | show 🗑
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| show | -pain
-spider veins
-varicose veins
-leg heaviness and fatigue
-swollen limbs
-skin changes and skin ulcers
-hemosiderin staining
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| Hemosiderin staining | show 🗑
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| show | -just beneath skin
-drain into deep veins through perforator veins
-can form varicose veins
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| show | -connect superficial and deep veins
-perforate deep fascia ans they connect
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| show | return blood to the heart
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| show | -have thinner walls and increased diameter compared to arteries
-90% of venous blood moves due to the calf muscle pump
-venous insufficiency caused by incompetent valves due to thrombus or venous wall distension causing venous hypertension
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| Fibrin Cuff Theory | show 🗑
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| show | -venous hypertension & distension=> congestion
-decr BF => WBC to marginate on vessel walls impeding circulation
-WBCs become activated & begin inflamm process
-WBCs move into interstitium & release inflamm substances, further contribute to cell damage
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| show | Fibrin Cuff Theory
White Blood Cell Trapping Theory
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| Risk Factors for Venous Ulcers | show 🗑
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| show | -progressive replacement of skin and subcutaneous tissue by fibrous tissue
-skin will be thick, hard, contracted and tight
-ankle is narrower- "inverted champagne bottle"
-conversion to scar tissue
-sign of long standing venous insufficiency
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| show | -dull pain or heaviness incr standing
-most common on med aspect of LE or med malleolus
-rarely on knee, never on plantar surface
-superf & irreg w/ mod to high amts of drain
-ruddy gran tissue or slough
-edema
-periwound w/ dermatitis & dry scaling
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| show | *compression
-check ABI before using compression
-underlying arterial disease= contraindication
-lifetime compression (no cure for venous insuff)
-maintenance of edema
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| show | -caused by neuropathy (which is most often caused by diabetes)
-incidence= as high as 25%
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| show | -30-40% of people with type II
-even higher percentage of people with type I
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| show | -loss of sensation (starts in ft & can progress to hands)
-gradual and painless (pt often unaware)
-pt will not detect injury to ft & ulcer can develop
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| Motor Neuropathy | show 🗑
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| show | -loss of sweat & oil production
-skin integrity is decreased and skin can be dry and cracked, making it vulnerable to breakdown
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| Signs of Neuropathic feet | show 🗑
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| Charcot Foot | show 🗑
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| Risk Factors for Diabetic Ulceration | show 🗑
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| Assessment for Diabetic Ulcers | show 🗑
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| show | -refer to vascular surgeon if ABI warrants
-dressing management
-eliminate pressure over wound bed
-change footwear if necessary
*plantar ulcers must be offloaded (different boots/casts available- total contact casting=gold standard)
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| show | -scalds: liquid, grease, steam
-contact burns
-fire: flash & flame burns
-chemical
-electrical
-radiation
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| show | -compare to 1st degree
-epidermal damage only
-redness, dry skin
-painful to touch
-peeling skin
-blanch with pressure
-complete healing, no scarring
-sunburn/flash injuries
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| show | -compare to 2nd degree
-entire epidermis and upper part of dermis is affected
-blisters
-wet, pink wound beds
-good blood supply
-low risk of infection
-heals in 10-12 days w/o scarring
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| Deep Partial Thickness Burn | show 🗑
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| Full Thickness Burn | show 🗑
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| Debridement | show 🗑
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| show | -necrotic tissue is impeding wound healing
-epibole at wound edges
-callus formation periwound
-blisters
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| show | -viable tissue
-stable heel ulcers: dry eschar need not be removed if they do not have edema, erythema, fluctuance or drainage
-muscle, tendon, ligament, capsule, fascia, bone, nerves, tendons & blood vessels (surgery)
-gangrenous tissue
-ischemic wou
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| show | -uses body's own enzymes to digest necrotic tissue through use of moisture-retentive dressing; left in place for several days
-non-invasive
-doesn't destroy healthy tissue (selective)
-may be used along w/ other types of debridement
-painless & simple
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| show | -apply topical debriding agent to devitalized tissue on wound surface
-Collegenase-Santyl: provides selective debr of collegen in necrotic tissue
-selective
-rarely painful
-cross-hatch thick eschar to allow better penetration
-prescription from phys
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| show | use of force to remove necrotic tissue, foreign material and debris
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| Wound Scrubbing | show 🗑
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| Wet to Dry dressings | show 🗑
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| Whirlpool in wound debridement | show 🗑
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| show | -may cause maceration
-increase edema
-can disrupt or damage healty granulation tissue
-risk of cross contamination
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| show | -type of mechanical debridement
-pulsed irrigation for cleansing combined w/ suction
-good for large/multiple wound beds
-return suction assists w/ debridement
-can perform bedside
-can be used on tunneling & undermining w/ use of diff application ti
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| show | -involves use of forceps,scissors,scalpel to remove devitalized tissue
-selective debridement
-fastest methos after surgical interv.
-can be painful (premidicate)
-can be used with other methods
-only certain people can perform
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| show | -efficacy supported by research
-High Volt most common
-after 30 days of failed treatments, Estim is covered my medicare and medicaid
-more appropriate for chronic,nonhealing wounds or patients at risk for wound healing
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| show | -research not very strong
--indicated for chronic, nonhealing wounds that are clean or infected
-wound bed is covered by protective barrier- transparent film dressing or sheet hydrogel
-fill any depth with NS or hydrogel
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| Negative Pressure Wound Therapy (NPWT) | show 🗑
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| Indications for NPWT | show 🗑
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| show | -wounds with eschar
-wounds with less than 70% gran tissue
-untreated osteomyelitis
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| show | -goal is moist wound healing
-a moist wound heals 3-5 times faster than dry wound
-let amt of drainage guide frequency of dressing change but keep to a min
-can be limited by cost & availability
-always cleanse wound bed perform applying dressing
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| primary dressing | show 🗑
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| secondary dressing | show 🗑
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| gauze | show 🗑
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| transparent films | show 🗑
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| hydrocolloids | show 🗑
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| Effects of Estim of Wounds | show 🗑
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