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skin sys & condition
Integu system conditions, exam, and interventions
| Question | Answer |
|---|---|
| Pre albumin: list norm, malnutrition, days of half life | Pre-albumin: 20-40 mg/dL=normal <15mg/dL=malnutrition 2 days of half life=short term gauge for nutrition. |
| Albumin levels: list norm, malnutrition, days of half life | Albumin: 3.5-5.5 mg/dL=normal <3.5mg/dL=malnutrition 18-20 days of half life=long term gauge for nutrition |
| Glucose-fasting levels list norm, indications? | 70-115 mg/dL indicates for short-term management of DM |
| Glycosylated hemoglobin (HbA1) Levels list norm, indications? | 4-6% indicated for long-term DM |
| Norms for Rubor dependency test and capillary refilll | Rubor: <15 secs. Capillary refill <3secs |
| Melanoma ABCD's the size of D | 6mm (pencil eraser) |
| Ankle-Brachial Index | <.25 severe PAD, <.4sx at rest, <.8 pain with ex, <.95 1 or more vessels affect, 1.0 normal |
| Iontophoresis used with which meds can be used to promote healing? | Zinc and Histamine both are anodes |
| Ultrasound general parameters | low intensity, pulsed 3x/wk |
| E-stim general related to wound healing | HVPC with pulsed current or Low volt with continuous current. Overall e-estim anode(+) promotes epithelial migration during inflammatory phase. Cathode(-) promotes granulation, controls inflammation and inhibits certain bacteria |
| Vacuum Assisted Closure(VAC),When is it indicated? | would not closing, lack of arterial perfusion, or excessive exudate that can't be controlled with dressings, arterial wounds are primarily use of VAC, applied continously and can be used with infection |
| Scar formation time length and color indication | 6-12 weeks bright pink-immature scar, 12-15 months soft lavendar fated pink. typically mature scar will be soft white and flat |
| If a beefy red appearance within wound indicates? | healthy healing |
| what type of wound is seen with secondary union? | decubitus ulcer healing |
| What is tertiary union? | delayed primary union such as delay in sutures in presence of wound contamination. |
| decrease venous or arterial perfusion increases risk for ulcers? | arterial |
| What is prevention schedule for ulcers? What are two risk assessments? | relieve pressure 3-4x/hour, Assessments: Braden or Norton |
| Describe Arterial Ulcer: causes, pain, locations | causes: arteriosclerosis obliterans often with DMs. DEEP AND PAINFUL, primarily at lateral malleolus and toes |
| Describe Arterial Ulcer Rx and ABI below what indicates? | Head of bed elevated moderately, stop smoking, wound care, ROM, ABI below 0.5 wound will not heal without medical intervention such as surgery or meds |
| Venous Ulcers: causes, pain, location | causes: venous thrombosis, varicose veins, PVD. PAINLESS and superficial, good pulses. Edema is present skin is hemosiderinosis adn location on medial side of malleolus. |
| Venous Ulcers: Rx | Elevation of LE, compression-unna boot with zinc-oxide(decr edema & infection). Active ex helpful with support garments and elevation. Compression socks necessary for long-term management. Whrilpool NOT HELPFUL***Dependent position! |
| What is staging according to with DM foot ulcers? | Wagner's Scale |
| DM foot ulcer: Rx, Contraindication, shoe modification | debride necrotic tissue, promote moist wound healing Contra: total contact cast for infection or ulcer greater depth than width shoe mod: rocker bottom on sole |
| Zone of coagulation | irreversibly damaged cells |
| Zone of Stasis | injured cells that may die within 24-48 hours without specialized treatment |
| Zone of hyperemia | site of minimal cell damage and tissue recover within 7 days with no lasting ill effects |
| Superficial burn: AKA, layer of skin damaged, characteristics, healing time | First degree: epidermis(sunburn), erythema, slight edema, tenderness and no blistering, spontaneous healing 2-5 days |
| Superficial partial-thickness AKA, layer of skin damaged, characteristics, healing time | Second degree burn: damage to upper layers of dermis and epidermis, blisters, inflammation, severe pain, healing 7-10 days without surgical intervention, min scarring with residual skin color changes |
| Deep partial-thickness AKA, layer of skin damaged, characteristics, healing time | Second degree burn: dermis destroyed wih injury to the hair follicles, nerve endings, and sweat glands. Red and white appearance, edema, blistering, severe pain. Healing 3-5 weeks, hypertrophic scarring and keliod scarring |
| Full-thickness burns: AKA, layer of skin damaged, characteristics, healing time | 3rd degree burn: complete of the epidermis, dermis & subcutaneous tissues w/ some muscle damage. Tissues are white, gray or black w/ dry surface, edema, eschar formation & insenate or little pain, escharotomy & skin grafts for healing, hypertropic & keloi |
| Subdermal burn: AKA, layer of skin damaged, characteristics, healing time | 4th degree, complete destruction of epi, derm, subcut layers involves bone and muscle, skin is charred, dry or mummified, destruction of vascular=necrosis,Amputation or paralysis common, extensive surgery and rehab is needed. |
| Pulm complications with burn injuries | smoke inhalation, death due to pneumonia, restrictive lung disease who have moderate burns over trunk |
| Metabolic complications with burn injuries | overall INCR with meta & catabolic activity resulting in rapid decr in body wt, NEG nitrogen balance and decr energy stores |
| Cardiac & circulatory complications with burn injuries | loss of plasma and intravascular fluid, initially decr CO when gradually incr to normal or above normal CO |
| Dermal healing | accomplished by scarring |
| if production of collagen exceeds breakdown then? | hypertrophic or keloid scarring may result |
| Topical meds for burns 6 different types | nitrofurazone/Furacin, silver sulfadiazine/silvadene, mafenide aceate, sulfamylon, bacitracin, neosporin |
| What drug does the pt receive when allograft is used? | cyclosporine |
| How long does pressure garments can be worn up to? | 1-1 1/2 years |
| Ex designed post burn? | promote deep breathing and chest expansion wiht amb used to prevent pneumonia |
| When should splinting and position begin with burn pts? | day of admissions |
| Anterior neck flexion contracture position for correction/prevention? | hyperextension with firm cervical brace |
| should adduction and IR contracture position for correction/prevention? | abductions ER use of airplane splint |
| elbow flexion and pronation contracture position for correction/prevention? | extension and supination splint |
| Hand: claw hand or flexion & adduction contracture position for correction/prevention? | claw hand: wrist ext, MCP Flex, IP ext. Flexion & Add: extension & abduction |
| knee flexion contracture position for correction/prevention? | extension and posterior knee splint |
| ankle PF contracture position for correction/prevention? | DF or splint in neutral with AFO |
| Hydrogels are generally used for? | partial/full thickness with min exudate |
| Exudate absorbers generally used for? | partial thickness with INCR exudate |
| Foam generally used for? | Full thickness or heavy exudate |
| Enzymes generally used for? | black yellow color/exudate with all depths |
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