Skin conditions
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| Functions of the Skin | show 🗑
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| show | epidermis and dermis
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| show | -outer layer
-thin (.006 to .6 mm)
-lines hair follicles, sweat and sebaceous glands
-fingernails and toenails
-cellular, avascular- depends on dermis for blood supply
-constantly being renewed (26-42 days)
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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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| show | -outer most layer of dermis
-forms dermal papillae that contain capillary loops that supply epidermis
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| Reticular Dermis | show 🗑
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| Cells in the Dermis | show 🗑
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| show | phagocytosis of bacteria and damaged tissue
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| Lymphocytes | show 🗑
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| Mast cells | show 🗑
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| Fibroblasts | show 🗑
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| show | -collagen: major structural protein
-elastin: provides skin with elastic recoil
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| Basement Membrane Zone | show 🗑
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| show | -basement membrane
-epidermal protrusions into dermis
-height of ridges decrease with age, making you more at risk for skin tears
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| Hypodermis | show 🗑
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| skin changes with age | show 🗑
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| Phases of Wound Healing | show 🗑
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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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| show | -fibroblasts
-myofibroblasts
-endothelial cells
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| Epithelialization | show 🗑
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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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| show | -failure or delay of healing
-cells unresponsive or senescent
-often caused by disease or condition
-medications such as steroids or immunosuppressive drugs can affect healing
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| What to Include in a Wound Assessment | show 🗑
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| Data About the Wound | show 🗑
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| show | -a small tight area of depth extending out from the wound base
-also referred to as sinus tract or just tract
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| show | -eroded area extending under the skin beyond the visible wound edges
-wider than tunneling
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| Granulation Tissue | show 🗑
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| show | granulation tissue that has grown above the level of the surrounding skin
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| Necrotic tissue | show 🗑
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| Attached Wound Edges | show 🗑
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| show | usually deeper damage or undermining
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| show | associated with deeper wounds
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| Undefined Wound Edges | show 🗑
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| show | -indicate chronic wound
-healing can be stalled
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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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| show | -abnormal firmness surrounding wound bed
-can indicate infection
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| nonblanchable erythema | show 🗑
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| show | can indicate decreased blood supply
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| Periwound Skin color- blue or ourole | show 🗑
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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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| show | -indicates Pseudomonas infection- notify physician
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| Wound Drainage | show 🗑
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| Wound odor | show 🗑
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| show | -area of tissue necrosis caused when soft tissue is compressed between a bony prominence and a firm surface over a long period of time
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| show | over 1.3-3 million Americans
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| Highest pressure areas (regarding pressure ulcers) | show 🗑
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| show | -shear
-friction
-moisture
-impaired mobility
-malnutrition
-impaired sensation
-advanced age
-previous pressure ulcer
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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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| Friction | show 🗑
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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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| show | -nonblanchable erythema of intact skin
-in those with highly pigmented skin, it may appear purple, blue or violet
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| show | -partial thickness loss of dermis
-presents as shallow, open ulcer with red/pink bed
-no slough
-may be an intact or rupture blister
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| Pressure Ulcer: Stage III | show 🗑
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| Pressure Ulcer: Stage IV | show 🗑
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| show | -full thickness tissue loss in which actual depth of the ulcer is completely obscured by slough and/or eschar
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| show | -Purple or maroon area of discolored intact skin or blood filled blister
-tissue may be painful, firm, mushy, boggy, warmer or cooler as compared to adjacent skin
-likely to evolve into deeper damage
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| Lower Extremity Arterial Ulcers | show 🗑
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| Signs of PAD | show 🗑
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| show | -decreased delivery of oxygen
-tissue ischemia
-tissue loss
-decreased ability to fight infection
-decreased healing
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| show | -hyperlipidemia
-smoking
-one cigarette decreases wound &
tissue O2 saturation by 30% in
one hour in healthy indiv.
-Diabetes
-increased prevalence of calcific
arterial insufficiency, increased
prevalence of microvascular
disease
-adva
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| show | -palpate pedal pulses
-capillary refill (normal < 3 secs)
-rubor of dependency
-Ankle Brachial Index
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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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| show | -1-2% of pop is diagnosed
-venous insufficiency ulcers are most common type of leg ulcer (70-90% of all ulcers)
-up to 91% pf venous ulcers can be resolved through conservative measures
-recurrence rate ranges from 13 to 81% (often due to noncompliance
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| Signs and Symptoms of Chronic Venous Insufficiency | show 🗑
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| Hemosiderin staining | show 🗑
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| Superficial Veins | show 🗑
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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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| Vein Facts | show 🗑
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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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| Lipodematosclerosis | show 🗑
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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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| Incidence of Diabetic/Neuropathic Ulcers | show 🗑
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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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| show | -affects intrinsic mm of ft
-results in weakness & structural changes that cause increased plantar pressures & shear forces, making skin break down more easily
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| Autonomic Neuropathy | show 🗑
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| Signs of Neuropathic feet | show 🗑
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| show | -Neuropathic fracture and dislocation
-results in structural change in foot; arch reverses ("rocker bottom" foot)
-causes increased plantar pressures
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| Risk Factors for Diabetic Ulceration | show 🗑
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| show | -assess for signs of decreased circulation
-joint ROM & strength
-sensory assessment
-inability to perceive 10g of monofilament indicates loss of protective sensation
-assess for dry skin, foot deformities, callus formation
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| Treatment if Diabetic Ulcers | show 🗑
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| Types of burns | show 🗑
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| Superficial Burns | show 🗑
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| Superficial partial Thickness Burns | show 🗑
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| show | -compare to 2nd degree
-epidermis and almost all of dermis affected
-re-epithelialization is very slow
-grafting usually done
-lack of blister formation
-dry, white or charred skin
-minimal pain
-high risk for infection
-healing=2-3 months
-sever
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| Full Thickness Burn | show 🗑
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| Debridement | show 🗑
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| Indications for Debridement | show 🗑
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| Contraindications for debridement | show 🗑
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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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| show | -type of mechanical debridement
-use gauze or a sponge
-non-selective so can damage and granulation tissue present
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| Wet to Dry dressings | show 🗑
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| show | -type of mechanical debridement
-softens necrotic tissue
-increases circulation
-cleanses wound of exudate
-loosens debris
-removes residual topical agents
-hydrates the wound bed
-eases ROM for burn patients
-can decrease pain
-nonselective
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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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| Pulsed Lavage with Suction | show 🗑
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| Sharp Debridement | show 🗑
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| Electrical Stimulation on Wound Healing | show 🗑
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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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| show | -primary or secondary
-partial thickness wounds
-stage I or II PU's
-low exudating wounds
-see through
-promotes autolytic debridement
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| hydrocolloids | show 🗑
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| show | -incr circulat & decr edema
-inhib bacterial growth
-incr epidermal cell prolif & migration
-incr derminal fibroblastic activity- collagen secretion
-incr phagocytosis bc attraction of macrophages & neutrophils
-lysis of necrotic tissue
-stim gran t
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