integumentary - wound care 1

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  1. What is the Integumentary system?
    • Represents hair, skin, nails
    • Largest organ in body
    • 3,000 square in in the average adult
    • weighs about 6 lbs
    • requires 1/3 of blood ejected from heart
  2. What are the functions of the integumentary system?
    • Protective barrier from invaders and microorganisms
    • insulation from extreme temp changes
    • prevents dehydration in huge amounts
    • eliminates waste via sweat
    • Sensory receptors (touch, etc)
    • Energy storage of fat for energy utilization
    • Personal Identity
  3. What is the thickness of Skin
    • (epidermis + dermis)
    • 1.5 - 4.0 mm variations
  4. What is the Epidermis?
    • Epidermis is the first and thinnest layer of the skin
    • It's Thinner on scalp and eyelids, lips, and thicker on the palm of the hand or heel of the foot
    • Superficially Cells are more dead and have more cell activity with depth
  5. What are the layers of the Epidermis? (From superficial to deep)
    • Stratum Corneum
    • Stratum Lucidum* not always present
    • Stratum Granulosum
    • Stratum Spinosum (part of stratum germinatum)
    • Stratum Basale (part of stratum germinatum)
    • --Basement Membrane-- separates Epidermis with Dermis
  6. What are the specialized cells and functions present in Epidermis?
    • Malanocytes (pigmentation)
    • Langerhans (immune respone in skin eg lesions, infx)
    • Merkel cells (mechanoreceptor in basal layer to sense touch)
    • Keratocytes (most in #, produce keratin ==> protection, barrier, impermeability)
  7. What is the Dermis and its layers?
    • Dermis is the deeper layer of skin 2nd to Epidermis
    • It is thicker than the Epidermis
    • Papillary Layer
    • Reticular Layer - (has appendages e.g. sebaceous glands, erector pilae, and hair follicles)
    • Has Mast Cells for inflammatory response and maccrophages for immune response
  8. What is the Hypodermis?
    • Deep to dermis (subcutaneous)
    • Where superficial fascia is found for further support
    • Isolates skin from the rest of the body
    • where lots of FAT is found (adipose tissue)
  9. What are the 3 phases of Wound Healing?
    • 1. Inflammatory
    • 2. Proliferatibe (Fibroblastic phase)
    • 3. Maturation/Remodelling phase
  10. What are the characteristics of the Inflammatory Phase?
    • Normally Lasts ~ 3-7 days
    • Vascular Changes (initial vasoconstriction to control bleeding, followed by vasodilation)
    • release of prostoglandins (to attract WBC)
    • WBC (neutrophils, macrophages) release growth factors for next phase of healing and engulf devitalized tissue
    • release of platelets
    • Release of Bradykinins and histamine (basophils) to increase capillary membrane permeability
    • CARDINAL SIGNS: calor, dolor, tumor, rubor (heat, pain, swelling, redness)
  11. What are the characteristics of the Proliferative Phase?
    • Can begin from Day 9 - 20 days
    • Can overlap with the inflammatory phase
    • 3 subphases:
    • 1. Angiogenesis - reestablsh blood flow @ base of wound (dark redness)
    • 2. Fibroplasia - laying down of gel matrix + new collagen at base of wound
    • 3. Epithelialization - migration of epidermal scells across surface of wound inward (pink on wound edges, beefy red)
    • Fibroblasts can convert to myofibroblasts pulling ends of tissue inward (Can't happen with out angiogenesis + fibroplasia, first)
  12. What are the characteristics of the Maturation/Remodelling Phase?
    • Can begin from Day 3 - up to 2 years
    • can also overlap
    • Total wound resurfacing of wound
    • new collagen matures and fibers shrink--> increased tension
    • Light people: Starts out red but gets lighter
    • Dark people: Starts out light but then starts to match surrounding
  13. What is Primary Intension Healing?
    • Typically in surgical wounds
    • Wounds that need epithelialization (only)
  14. What is Secondary Intension Healing?
    • Usually pressure and concave wounds, Non surgical wounds
    • Needs all 3 phases (Fibroplasia, Angiogenesis, and Epithelialization)
  15. What are the factors that prevent wounds from healing?
    • 1. Infection (competition with critical colonization, 4 signs)
    • 2. Continuous pressure
    • 3. Trauma from dressing changes (ripping off bandages)
    • 4. Use of cytotoxic agents (may kill granulation tissue)
    • 5. Temperature extremes esp. hypothermia
    • 6. Moisture (lack of)
    • 7. Immunosupressed people (aids, diabetes, chemotherapy)
    • 8. BMI, Low Protein
    • 9. Dehydration
    • 10. Poor perfusion to area (might need CABG, angioplasty)
    • 11. Excess Adipose (obesity)
    • 12. Predisposure (sensory deficits, increased risk)
    • 13. O2 resp deficiencies (COPD)
    • 14. Poor Mobility (immobile)
    • 15. Medications (antiinflammatories, chemotherapy, immunosuppresive Rx's)
    • 16. Poor habits (smoking, alcohol)
    • 17. Incontinence (waste retiention)
    • 18. Stress (emotional, psychological, cortisol dampens immunity)
  16. What are the clinical presentations of non-healing wounds?
    • 1. calor, dolor, rubor, tumor --> chronic inflammatory respone
    • 2. chronic proliferation (hypergranulation)
    • 3. Hypogranulation
    • 4. Hypertrophic scarring (Keloids, Dehiscense(suture line splitting open, Contractures)
  17. What are the considerations for proper wound healing?
    • Control Infection
    • Rid of necrotic tissue
    • Minimize trauma
    • Evaluate Meds
    • Correct dressing
    • Relieve pressiure
    • Good Hydration and Nutrition
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integumentary - wound care 1
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