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The underlying layer of skin that anchors the skin layers to the underlying tissues of the body.
The second layer of skin (nerves, hair follicles, glands, and BV)
The part of skin that consists of adipose tissue, is made up of lobules of fat cells, and connective tissue.
Skin that is composed of stratified epithelial cells and forms a protective, waterproof layer of keratin material.
A break or disruption in the normal integrity of skin and tissues.
A liquid made of plasma and blood components that leak out into the area that is injured.
What causes swelling and pain at an injury site?
the accumulation of exudate
What causes heat and redness at an injury/wound side?
What is granulation tissue?
- the new tissue that forms the foundation for scar tissue development
- highly vascular, red, and bleeds easily
In wounds that heal by first intention, epidermal cells seal the wound within 24-48 hrs, so that what is not visible?
What is desiccation?
- cells dry up and die
- causes a crust to form over wound site and delays healing
What is maceration?
What is necrosis?
death of tissue
What are the most serious postoperative wound complications?
dehiscence & evisceration
What is dehiscence?
partial or total separation of wound layers as a result of excessive stress on wounds that are not healed.
What is evisceration?
- It is the most serious complication of dehiscence;
- wound completely separates, with protrusion of viscera throu the incisional area.
Who is at greater risk for dehiscence and evisceration?
- obese or malnourished,
- tobacco smokers;
- those who use anticoagulants;
- those with infected wounds;
- those who experience excessive coughing, vomiting, or straining
When is dehiscence a medical emergency?
when it occurs in an abdominal wound
What is a fistula?
an abnormal passage from an internal organ to the outside of the body or fro one internal organ to another (p.927)
Fistula formation is often the result of what?
- infection that has developed into an abscess;
- accumulated fluid applies pressure to surrounding tissues, leading to the formation of the unnatural passage.
What is an abscess?
a collection of infected fluid that has not drained (p.927)
A wound with a localized area of tissue necrosis.
What is ischemia?
deficiency of BLOOD in a particular area
What are the two mechanisms that contribute to pressure ulcer development?
- 1. external pressure that compresses the BV
- 2. friction & shearing forces that tear & injure BV & abrade to the epidermis
A patient who lis on wrinkled sheets is likely to sustain tissue damage as a result of ______.
Which part of the body is often injured due to friction when pts lift and help move themselves up in bed using their arms and feet?
skin over elbows & heels
What causes a shear?
- when one layer of tissue slides over another layer.
- it separates the skin from underlying tissues
What happens under the skin when a shear happens?
- small BV & capillaries in the area are stretched and possibly tear,
- resulting in decreased circulation to tissue cells
What type of wound can result on the back of pts when they are pulled or slid over sheets while being moved up in bed or transferred onto a stretcher?
A thick, leathery scab or dry crust that is necrotic and must be removed before the pressure ulcer stage can be determined accurately.
What is serous drainage?
- composed primarily of the clear, serous portion of the blood and from serous membranes.
- very clear and watery
What is sanguineous drainage indicative of?
- bright red - fresh bleeding
- dark red - older bleeding
What is serosanguineous drainage?
- mixture of serum and RBCs
- light pink to blood tinged
What is purulent drainage?
- made up of WBCs, liquefied dead tissue debris, and both dead & alive bacteria;
- is thick,varies in color (dark yellow or dark grn),
- often has a musty or foul odor
What is the goal of wound care?
to promote tissue repair and regeneration so that skin integrity is restored
What is debridement?
removal of devitalized tissue and foreign material
What is NPWT (negative-pressure wound therapy) used to treat?
wounds with heavy drainage, wounds failing to heal, or healing slowly
When is NPWT not used?
- presence of active bleeding;
- wounds with exposed BV, organs, or nerves;
- malignancy in wound tissue;
- presence of dry/necrotic tissue;
- with fistulas of unkown region
How does NPWT (negative-pressure wound therapy) work?
- stimulates cell proliferation & growth of new BV
- increases BF
- decreases swelling
- removes excess fluid
- decreases bacteria
What is pharmacology?
Study that deals with chemicals that affect the body's functioning.
What is the generic name of a drug?
- It identifies the drug's active ingredient &
- is the name assigned by the manufacturer that first develops the drug
- often derived from the chemical name
What is the official name of a drug?
- name by which the drug is identified in the official publications &
- is often the generic name
What is the trade name of a drug?
- AKA the brand name or proprietary name
- selected by the drug company that sells it and
- is protected by a trademark
A drug can have several _____ names when produced by different manufacturers.
The effect of the body on the drug;
The movement of drug molecules in the body in relation to the drug's absorption, distribution, metabolism, and excretion
The process by which a drug is transferred from its site of entry into the body to the bloodstream.
What does the rate of absorption depend on?
The route of administration
Which route of med administration usually takes to longest to be absorbed?
A drug that is more _____ soluble can be absorbed more readily and pass more easily through the cell membrane.
What type of drugs are absorbed well in the stomach?
Absorption is increased with increased ______.
When is a loading dose (larger than normal) given?
when a pt is in acute distress and the max therapeutic effect is desired ASAP
What does the distribution of a drug (after absorption in bloodstream) depend on?
- BF to the tissues,
- the drug's ability to leave the bloodstream, &
- the drug's ability to enter the cells
What is metabolism of a drug?
- the hange of a drug from its original form to a new form
- *liver is primary site
What happens after a drug is broken down to an inactive form?
- it is excreted -
- mostly by the kidneys, many through bile in the GI tract,
- also by the lungs and thru sweat, salivary, & mammary glands
The process by which drugs alter cell physiology and affect the body.
An immune syste response to a drug that occurs when the body interprets it as a foreign substance and forms antibodies against it.
Most common serious allergic effect.
How is an anyphylactic rxn treated?
- O2 therapy
- IV fluids
When does a cumulative effect of a medication occur?
- when the body cannot metabolize one dose of a drug before another dose is administered
- -can cause toxicity
Any unusual or peculiar response to a drug that may manifest itself by over response, under response, or even the opposite of the expected response.
- idiosyncratic effect
- (sometimes called paradoxical effect)
In a drug-drug interaction, the combined effect of two or more drugs acting simultaneously produces an effect less than that of each drug alone.
In a drug-drug interaction, the combined effect of two or more drugs acting simultaneously produces an effect greater than that of each drug alone.
Drugs with potential to cause developmental defects in the embryo or fetus and are contraindicated.
What is a drug's therapeutic range?
the concentration of a drug in the blood serum that produces the desired effect without causing toxicity
What is the trough level of a drug?
- the point when the drug is at its lowest concentration;
- specimen usually drawn in the 30-min interval B4 next dose
What two things can modify the trough level of a drug?
- the dosage schedule
- the half-life
What is a drug's half-life?
the amount of tie it takes for 50% of the blood concentration of a drug to be eliminated from the body
PRN orders are often written for treatment of ______.
What does the word parenteral mean?
outside the intestines or alimentary canal
A glass flask that contains a single dose of medication for parenteral administration.
A glass bottle with a self-sealing stopper through which the medication is removed; some contain several doses of a medication.
Which med administration route has the longest absorption time of all parenteral routes?
Injections that are administered into the dermis, just below the epidermis.
Where are subcutaneous injections administered?
into the adipose tissue layer just below the epidermis and dermis
Angle of administration for intradermal injection.
Dosage for intradermal injection.
small, usually .5 mL
What size needle is used for an intradermal injection?
26-27 guage needle
Sites commonly used for intradermal injections.
- inner surface of forearm and
- upper back, under scapula
What are intradermal injections used for?
- sensitivity tests (TB & allergy)
- local anesthesia
Sites for subcutaneous injections, in order of absorption rate (fastest to slowest).
- outer aspect of upper arm
- anterior aspects of thigh
- upper ventral or dorsogluteal area
- (can also be given in upper back, but book did not specify absorption time for back)
Why is the Z-track technique recommended for all intramuscular injections?
- to ensure medication does not leak back along the needle track and into the subcutaneous tissue;
- reduces pain & discomfort
What specific agent is best given via the Z-track method?
iron b/c of discoloration & irritation associated with it
What is the most dangerous route of drug administration? Why?
- IV route
- the drug is placed directly into the bloodstream, cannot be recalled, and its axns cannot be slowed
The IV piggyback delivery system requires the intermittent or additive soon to be placed _____ than the primary soln container.
What is the mini-infusion pump (syringe pump) used for?
This type of infusion allows med mixed in a syringe to be connected to the primary line and delivered by mechanical pressure applied to the syringe plunger.
mini-infusion pump (syringe pump)
What are topical application meds usually intended for?
direct axn at a particular site, although some can have systemic effects and are given for systemic effect
Medication mixed with alcohol, oil, or soap which is rubbed on the skin.
Med in a clear liquid containing water, alcohol, sweeteners & flavor.
Semisolid preparation containing a drug to be applied externally; AKA unction.
How are drugs classified?
- 1. by their effect on body systems
- 2. by chemical composition
- 3. by clinical indication or therapeutic effect (analgesic, antibiotic, etc)
Why do subcutaneous injections have a slow, sustained rate of absorption into the capillaries?
B/c the drug is administered into the adipose tissue layer below dermis & epidermis which has very FEW BV.
IM injections are used to administer what type of drugs?
antibiotics, hormones, and vaccines
What route of med admin bypasses the stomach and intestines and is absorbed directly into the bloodstream and is NOT an injection?
What is a disadvantage to subcutaneous injections?
only a very small amount can be given, absorption is relatively slow
When using abdominal site for subQ injection, how far should you stay from the umbilicus, and how far for repeated injections?
- at least 2 in from umbilicus
- repeated injections at least 1 in apart
The IM site that is away from major BV and nerves and is least painful.
IM site which can only be injected with 1 mL of fluid.
Which nerve and artery is the deltoid IM site near?
radial nerve, brachial artery
A patient has an abnormal, unexpected response to a drug. This is called a ______ effect.