integ4 ulcers
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| Pressure Ulcer | Unrelieved pressure deprives the tissues of oxygen which causes ischemia, subsequent cell death, and tissue necrosis
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| Pressure Ulcer | High risk areas for pressure ulcers include the occiput, heels, greater trochanters, ischial tuberosities, sacrum, and epicondyles of the elbow
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| Pressure Ulcer | Impaired cognition, poor nutrition, altered sensation, incontinence, decreased lean body mass, and infection contribute to the development of a pressure ulcer
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| The integumentary system (or skin) | is the largest organ within the body and consists of the dermal and epidermal layers, hair follicles, nails, sebaceous glands, and sweat glands.
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| Each layer is stratified | into several layers.
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| The dermis | is known as the true skin, is well vascularized, and is characterized as elastic, flexible, and tough.
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| The epidermis | is avascular and consists of the outermost layer of skin.
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| prominences Supine: | Occiput, spine of the scapula, inferior angle of scapula, vertebral spinous processes, medial epicondyle of humerus, posterior iliac crest, sacrum, coccyx, heel
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| prominences Prone: | Forehead, anterior portion of acromion process, anterior head of humerus, sternum, anterior superior iliac spine, patella, dorsum of foot
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| prominences Sidelying: | Ears, lateral portion of acromion process, lateral head of humerus, lateral epicondyle of humerus, greater trochanter, head of fibula, lateral malleolus, medial malleolus
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| prominences Sitting (Chair): | Spine of the scapula, vertebral spinous processes, ischial tuberosities
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| Stage I | An observable pressure related alteration of intact skin whose indicators as compared to an adjacent or opposite area on the body may include changes in skin color, skin temperature, skin stiffness or sensation.
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| Stage II | A partial-thickness skin loss that involves the epidermis and/or dermis. The ulcer is superficial and presents clinically as an abrasion, a blister or a shallow crater.
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| Stage III | A full-thickness skin loss that involves damage or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining adjacent tissue.
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| Stage IV | A full-thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone or supporting structures (e.g., tendon, joint capsule).
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| Wounds resulting from arterial insufficiency occur . | secondary to ischemia from inadequate circulation of oxygenated blood often due to complicating factors such as atherosclerosis
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| Wounds resulting from venous insufficiency occur | secondary to inadequate functioning of the venous system resulting in inadequate circulation and eventual tissue damage and ulceration.
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| Pressure ulcers, often called decubitus ulcers, | result from sustained or prolonged pressure at levels greater than the level of capillary pressure on the tissue. Pressure against the skin over a bony prominence results in localized ischemia and/or tissue necrosis.
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| Factors contributing to pressure ulcers include | shear, moisture, heat, friction, medication, muscle atrophy, malnutrition, and debilitating medical conditions.
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| Neuropathic ulcers are a secondary complication . | usually associated with a combination of ischemia and neuropathy
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| Most often neuropathic ulcers are associated with | diabetes. Neuropathic ulcers are frequently found on the plantar surface of the foot, often beneath the metatarsal heads. neuropathic ulcers The wound is typically well defined by a prominent callus rim.
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| neuropathic ulcers | The wound has good granulation tissue and little or no drainage. Patients rarely report pain with neuropathic ulcers in part due to altered sensation.
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| neuropathic ulcers | Pedal pulses are most often diminished or absent.
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| neuropathic ulcers | The distal limb may appear to be shiny and appear somewhat cool to touch. The periwound skin often appears to be dry or cracked.
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| Factors Influencing Wound Healing | There are a variety of factors that are not inherent to the actual wound that can significantly impact the rate and degree of wound healing.
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| Factors Influencing Wound Healing Age: | A decreased metabolism in older adults tends to decrease the overall rate of wound healing.
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| Factors Influencing Wound Healing Illness: | Compromised medical status such as cardiovascular disease may significantly delay healing. This often results secondary to diminished oxygen and nutrients at the cellular level.
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| Factors Influencing Wound Healing Infection: | An infected wound will impact essential activity associated with wound healing including fibroblast activity, collagen synthesis, and phagocytosis.
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| Factors Influencing Wound Healing Lifestyle: | Regular physical activity results in increased circulation that enhances wound healing. Lifestyle choices such as smoking negatively impacts wound healing by limiting the blood’s oxygen carrying capacity.
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| Factors Influencing Wound Healing Medication: | There are a variety of pharmacological agents that can negatively impact wound healing. Medications falling into this category include steroids, anti-inflammatory drugs, heparin, antineoplastic agents, and oral contraceptives. Undesirable physiologic effe
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| Abrasion: | An abrasion is a wound that occurs from the scraping away of the surface layers of the skin, often as a result of trauma.
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| Contusion: | A contusion is an injury in which the skin is not broken. The injury is characterized by pain, swelling, and discoloration.
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| Hematoma: | A hematoma is a swelling or mass of blood localized in an organ, space or tissue, usually caused by a break in a blood vessel.
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| Laceration: | A laceration is a wound or irregular tear of tissues that is often associated with trauma.
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| Penetrating wound: | A penetrating wound is a wound that enters into the interior of an organ or cavity.
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| Puncture: | A puncture is a wound that is made by a sharp pointed instrument or object by penetrating through the skin into underlying tissues.
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| Ulcer: | An ulcer is a lesion on the surface of the skin or the surface of a mucous membrane, produced by the sloughing of inflammatory, necrotic tissue.
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| Red-Yellow-Black System Description Red | Pink granulation tissue
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| Red-Yellow-Black System Red Goals | Protect wound; maintain moist environment
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| Red-Yellow-Black System Description Yellow | Moist yellow slough
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| Red-Yellow-Black System Goals Yellow | Debride necrotic tissue; absorb drainage
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| Red-Yellow-Black System Description Black | Black, thick eschar firmly adhered
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| Red-Yellow-Black System Goals Black | Debride necrotic tissue
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| Arterial Ulcers | Lower one-third of leg, toes, web spaces (distal toes, dorsal foot, lateral malleolus)
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| Arterial Ulcers | Smooth edges, well defined; lack granulation tissue; tend to be deep
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| Arterial Ulcers | Severe pain
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| Arterial Ulcers pedal pulses | Diminished or absent
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| Arterial Ulcers edema | Normal
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| Arterial Ulcers skin temp | Decreased
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| Venous Ulcers | Proximal to the medial malleolus
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| Venous Ulcers | Irregular shape; shallow
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| Venous Ulcers pedal pulses | Normal
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| Venous Ulcers | Mild to moderate pain
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| Venous Ulcers edema | Increased
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| Arterial Ulcers Leg elevation | increases pain
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| Arterial Ulcers tissue changes | Thin and shiny; hair loss; yellow nails
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| Venous Ulcers Leg elevation | lessens pain
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| Venous Ulcers tissue changes | Flaking, dry skin; brownish discoloration
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