Wound Skin Integrity

Card Set Information

Author:
ccolon3
ID:
240105
Filename:
Wound Skin Integrity
Updated:
2013-10-11 18:31:26
Tags:
wounds
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Description:
wound care
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  1. What are the structures of the skin?
    • 1. epidermis- top layer, no blood vessels
    • 2. dermis- middle layer, nerves and hair
    • 3. sub q- bottom layer, ct, adipose, fat, blood and lymph
  2. What are eight skin functions?
    • 1. protection
    • 2. temp regulation
    • 3. self esteem
    • 4. sensation
    • 5. vit. D production
    • 6. immunological
    • 7. absorption
    • 8. elmination
  3. What are some factors affecting skin intergrity?
    • -younger then 2- skin thiner and weaker
    • -infant skin can be easily injured
    • -structure of the skin changes as they age
  4. What are factors of state health to the skin?
    • -very thin and obese people suffer skin injury
    • -dehydration
    • -excessive sweating
    • -jaundice
    • -disease of the skin- eczema
  5. What is a wound?
    a break/disruption in the normal integrity of the skin/tissue

     mechanical force/physical force
  6. What is a pressure ulcer?
    compromised circulation secondary to pressure or pressure combined with friction
  7. What is a venous ulcer?
    injury and poor venous return, resulting from underlying conditions-
  8. What are arterial ulcers?
    injury and underlying ischemia
  9. What are diabetic ulcers?
    injury and underlying diabetic neuropathy
  10. intentional
    • planned invasive therapy or treatment (surgery)
    • -less chance of infection
    • -wound edges are aproximated
  11. unintentional
    • accidental/trauma
    • -edges are jagged
    • -higher risk of infection
    • -may have multiple wounds
    • -longer healing time
  12. open wounds
    • -skin broken-portal entry
    • -increase infection
    • -delayed healing
  13. closed wounds
    • results of blow,force, or strain
    • skin surface not open
    • ecchymosis -bruising
    • hematoma-clot
  14. acute wounds
    • heals within a few days/weeks
    • -wound edges approximated
    • lower risk of infection
  15. chronic wounds
    • does not progress through normal healing
    • wound edges are not approximated
    • increase infection
    • healing time delayed
  16. primary intention of wound healing
    • well approximated
    • surgical incisions usually heal
    • if delayed healed in secondary intention
  17. Secondary intention of wound healing
    • not well approximated
    • large open wounds
    • longer to heal and more scar tissue
  18. tiertiary intentions
    • delayed primary
    • wound left open for days
    • edema /infection to resolve/drain and close
  19. step 1 of healing
    • hemostasis-
    • immediately after injury
    • vessels constrict and clotting starts
    • platelet activated
    • pus formed
  20. step 2 of healing
    • inflammatory phase
    • 4-6 weeks
    • wbc -move in
    • leukocytes-kill bacteria
    • macro phages- begins growth
  21. Step 3- of healing
    • proliferation phase
    • -last several weeks¬†
    • -new tissue built
    • -granualtion tissue- scar tissue
    • -firbroblast activated
  22. step 4- healing process
    • maturation phase
    • - about 3 weeks after injury
    • - new collagen ---scar
  23. factors affecting wound healing
    LOCAL
    • 1. pressure-disrupts blood supply
    • 2. Desiccation- cell death
    • 3. Maceration- too moist bc of fecal and urine
    • 4.trauma
    • 5. edema- not enough oxygen--swelling
    • 6. infection
    • 7. necrosis
  24. factors affecting wound healing
    SYSTEMIC
    • 1.age
    • 2.circulation
    • 3.nutritional status
    • 4. wound condition
    • 5.meds and health stat
    • 6. immunosuppression

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