Term
| Function of the Skin: ______ input |
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Definition
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Term
| Function of the Skin: ______ regulation |
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Definition
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Term
| Function of the Skin: ______ regulation/excretion _______ |
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Definition
| sweating/fluid regulation/excretion of waste |
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Term
| Function of the Skin: production of |
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Definition
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Term
| vitamin d is critical for the absorption of what mineral |
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Definition
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Term
| Function of the Skin: barrier to |
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Definition
| infection, harmful chemicals, and UV radiation |
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Term
| Function of the Skin: protection |
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Definition
| physical protection to underlying structures |
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Term
| 4 layers of the skin from surface to deep |
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Definition
| epidermis, dermis, subcutaneous fat, deep tissues |
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Term
| how thick is the epidermis |
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Definition
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Term
| where are the thickest portions of the epidermis |
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Definition
| plantar surface of foot/palms |
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Term
| is the epidermis vascular or avascular |
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Definition
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Term
| what is the epidermis primarily made up of |
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Definition
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Term
| how many layers does the epidermis ahve |
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Definition
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Term
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Definition
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Term
| a thin layer of epidermis lines what (3) |
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Definition
| hair follicles, sweat, and sebacous glands |
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Term
| 5 layers of the epidermis from deep to surface |
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Definition
| basal layer, stratum spinosum, stratum granulosum, stratum lucidum, stratum corneum |
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Term
| the basal layer of the eipdermis is held to the dermis by the thin basement membrane by cells called what (2) |
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Definition
| desmosomes, hemidesmosomes |
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Term
| layer responsible for the mitotic activity of keratinocites |
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Definition
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Term
| layer of epidermis with spiney apperance and houses a more mature layer of keratinocytes |
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Definition
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Term
| how many cells thick is the stratum granulosum |
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Definition
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Term
| first layer where dead keratinocytes appear |
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Definition
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Term
| how many cells thick is the stratum corneum |
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Definition
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Term
| layer which makes up 75% of teh epidermis |
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Definition
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Term
| which -mosome attaches cells to each other |
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Definition
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Term
| which -momsome attaches the cells ot the basement membrane |
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Definition
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Term
| how long does it take for a cell to migrate from the basal layer to the stratum cornium |
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Definition
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Term
| types of cells in teh epidermis |
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Definition
| langerhan's cells, merkel cells, melanocytes |
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Term
| langerhan's cells are derived from what? |
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Definition
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Term
| langerhans cells are located where in the epidermis |
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Definition
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Term
| eipdermal cell that may help to fight infections |
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Definition
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Term
| which epidermal cell may play a part in graft rejections |
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Definition
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Term
| epidermal cell that functions as a mechnaoreceptors |
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Definition
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Term
| merkel cells attach to what in the epidermis |
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Definition
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Term
| merkel cells attach to keratinocytes in the epidermis by what |
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Definition
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Term
| merkel cells provide what feed back |
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Definition
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Term
| cell in the epidermis that gives individual skin tone |
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Definition
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Term
| what is the thickest layer of the skin |
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Definition
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Term
| what is the dermis primarily made up of |
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Definition
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Term
| what are the senses that the nerve end sensory organs contained within the dermis (5) |
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Definition
| touch, pain, vibration, temperature, pressure |
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Term
| is the dermis vascular or avascular |
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Definition
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Term
| what are the 2 layers of the demris |
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Definition
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Term
| layer of dermis directly below basement membrane |
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Definition
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Term
| which layer of the dermis is made up of morem dense collagen |
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Definition
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Term
| why is the reticular dermis made up of more dense collagen |
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Definition
| provide structural support to the skin |
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Term
| which layer of skin are hair follicles located in |
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Definition
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Term
| hair is made up of what type of keratin |
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Definition
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Term
| each hair follice has what at its base |
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Definition
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Term
| the sebaceous gland secretes an oily substance called what |
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Definition
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Term
| what is the purpose of sebum |
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Definition
| lubricate the hair and skin |
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Term
| where skin layer do nails arise from |
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Definition
| stratum basal (stratum germinativum) |
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Term
| what cells do nails arise from |
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Definition
| epidermal and dermal cells |
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Term
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Definition
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Term
| where are sweat glands housed |
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Definition
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Term
| what does the stratum basal extend down through the basement membrane into the papillary dermis to serve as an additional anchor |
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Definition
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Term
| what area do blisters form |
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Definition
| layer between epidermis and dermal layer, basement membrane |
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Term
| 2 types of subcutaneous tissue |
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Definition
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Term
| is adipose tissue vascular |
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Definition
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Term
| how does epidermis recieve its nutrients |
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Definition
| diffusion from capillary beds/dermal appendages of dermis |
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Term
| role of adipose tissue (4) |
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Definition
| insulation, protection, energy storage, fat soluble storage |
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Term
| what are the fat soluble vitamins |
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Definition
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Term
| fibrous connective tissue, separates and surrounds almost all structures and is intimately involved in movement |
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Definition
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Term
| what are the deep tissues (5) |
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Definition
| muscle, ligament, joint capsule, cartilage bone |
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Term
| this healing model occurs in wounds such as 1st degree burns, scrapes, contusions, shear/friction injuries and should normally heal themselves with proper interventions |
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Definition
| superficial wound healing |
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Term
| wound healing models: healing of a surgical incision who's edges are clean and approximated with sutures. These wounds should close within 7 days with minimal to no scarring |
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Definition
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Term
| wound healing models: how can delayed primary intention occur (4) |
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Definition
| wound is contaminated, has large amount of tissue loss, abnormal amount of tissue tension, at a high risk of infection |
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Term
| wound healing models: treatment protocol for delayed primary intention wounds |
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Definition
| wound is left open then sutured closed in 407 days after risk of infection has diminished |
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Term
| wound healing models: delayed primary intention wound care is most often used with what type of wounds? |
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Definition
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Term
| wound healing models: what do partial thickness wound refer to? |
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Definition
| wounds who have lost the dermal layer |
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Term
| wound healing models: examples of partial thickness wounds (4) |
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Definition
| abrasion, skin tears, 2nd degree burns, stage 2 pressure ulcers |
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Term
| wound healing models: for partial thickness wounds, what does the body immediately begin to do |
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Definition
| inflammation process leading to epithelizalization |
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Term
| wound healing models: wound healing by contraction is which healing model |
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Definition
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Term
| wound healing models: what are the most frequent wounds PT's see |
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Definition
| secondary intention wounds |
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Term
| wound healing models: what is a contraction |
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Definition
| myofibroblasts (containing myosin and actin) act on the wound to cause the edges to contract. They influence both the rate and the amount of closure |
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Term
| What are the 3 phases of secondary wound closure |
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Definition
| inflammation, remodeling, proliferation |
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Term
| What is important to note about the 3 phases of secondary wound closure |
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Definition
| all phases occur together with 1 phase predominant |
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Term
| All wounds heal in a predictable pattern of events: 1/5 |
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Definition
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Term
| All wounds heal in a predictable pattern of events: 2/5 |
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Definition
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Term
| All wounds heal in a predictable pattern of events: 3/5 |
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Definition
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Term
| All wounds heal in a predictable pattern of events: 4/5 |
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Definition
| maturation/epithelilization |
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Term
| All wounds heal in a predictable pattern of events: 5/5 |
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Definition
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Term
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Definition
| vasoconstriction, platelet aggregation, fibrin deposition |
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Term
| what is the end result of hemostasis |
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Definition
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Term
| what is the purpose of clot formation (3) |
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Definition
| prevent further fluid loss, lessen contamination, provide a fibrin mesh for other cells to migrate and attach to |
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Term
| 4 key cells in inflammatory phase |
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Definition
| platelets, PMN, macromhages, mast cells |
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Term
| what is the role of platelets (2) |
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Definition
| initiate clot formation, release growth factors which are chemotactic |
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Term
| what is the role of PMN (2) |
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Definition
| 1st responders to wound, clean wound, kill bactteria, secrete's MMPs (matrix metalloproteinases) |
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Term
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Definition
| secrete NO and enzymes to kill bacteria, growth factors and MMPs |
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Term
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Definition
| release histamine, enzymes |
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Term
| inflammation functions to rally (2) to the wound site to phagocytes bacteria |
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Definition
| macrophages and neutrophils |
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Term
| inflammation recruits ___ to assist in the breakdown of debris |
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Definition
| MMP's (matrixmetaloproteases) |
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Term
| Inflammation recruits these MMP's to assist in the breakdown of debris |
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Definition
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Term
| inflammation is characterized by what S/S (4) |
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Definition
| erythema, edema, heat, and pain |
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Term
| why is inflammatio ncharacterized by erythema, edema, heat, and pain? |
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Definition
| the wound transitions rom vasoconstiction to vasodilation |
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Term
| what is the purpose of mast cells releasing histamine during the inflammation stage |
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Definition
| histamine increases capillary permeability and allows a flood of proteins, WBCs to enter the area |
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Term
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Definition
| repair, epithelialization |
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Term
| the process of repalcing lost dermal tissue with granulation |
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Definition
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Term
| in the proliferation stage, what is not reproduced |
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Definition
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Term
| what produces scar tissue to fill in the gap during the proliferation stage? |
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Definition
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Term
| tensile strength of scar tissue compared to the original dermis |
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Definition
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Term
| when the wound first closes how strong is the scar tissue compared to the original dermis |
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Definition
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|
Term
| at 2 years post healing how strong is the scar tissue compared to the original dermis |
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Definition
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Term
| 3 key cells in proliferation |
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Definition
| fibroblasts, endothelial cells, myofibroblasts |
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Term
| proliferation: what are fibroblasts responsible for |
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Definition
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Term
| proliferation: fibroblasts are responsible for protein synthesis and the formation of what? |
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Definition
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Term
| proliferation: what is the purpose of the collagen matrix produced by the fibroblasts |
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Definition
| repllaces the original fibrin mesh (clot) |
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Term
| proliferation: what is the process of protein synthesis, formation of collagen matrix, and replacement of the original fibrin mesh stimualted by? |
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Definition
| release of growth factor (TGF-B, PDGF, EGF) |
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Term
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Definition
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Term
| describe epithelialization |
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Definition
| epithelial cells begin to migrate in a single layer across a GRANULATED wound surface towards the middle and begin to proliferate |
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Term
| what stops the process of epithelialization |
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Definition
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Term
| eipthelialization: how do rolled or curled edges occur |
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Definition
| frequently occurs in wounds that have no granular tissue to cross |
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Term
| eipthelialization: when is a wound considered closed |
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Definition
| when the epithelial integrity is restored |
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Term
| eipthelialization: when is a wound considered healed |
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Definition
| until tissue strength approaches normal |
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Term
| eipthelialization: what does the epithilialization look like? |
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Definition
| delicate, pearly pink islands |
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Term
| #1 causes of hypergranulation |
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Definition
| repeated trauma to wound bed |
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Term
| second most common cause for hypergranulation |
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Definition
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Term
| third cause of hypergranulation, inconclusive studies |
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Definition
| too much moisture, hydrocolloid dressings |
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Term
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Definition
| the process of re-establishing the tensile strength of tissue |
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Term
| what key cells from proliferation disappear in remodeling |
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Definition
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Term
| remodeling: what happens to collagen |
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Definition
| reorganizes and scar matures |
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Term
| remodeling: what is the role of collagenase |
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Definition
| regulates the balance between syntehsis and lysis of collagen (fibroplasia) |
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Term
| remodeling: how do keloids form? |
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Definition
| when the abnormal inhibitio of lysis causes an imbalance in fibroplasia, usually genetic in origin |
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Term
| what can cause hypertrophy of granular tissue (hypergranulation) |
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Definition
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Term
|
Definition
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Term
| what are rolled wound edges called? |
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Definition
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Term
| tricks of the trade to stop hypergranulation (4) |
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Definition
| e stim, silver nitrate sticks, compression wraps, massage |
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Term
| tricks of the trade to stop hypergranulation: e stime |
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Definition
| (+) pole to repel mast cells and decrease hypergranulation |
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Term
| tricks of the trade to stop hypergranulation: silver nitrate sticks |
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Definition
| knock down hypergranulation |
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Term
| tricks of the trade to stop hypergranulation: compression wraps |
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Definition
| decrease perfusion and therefore O2, suppress collagen synthesis and increase lysis |
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Term
| tricks of the trade to stop hypergranulation: massage |
|
Definition
| remodeling phse is appropriate time to being soft tissue work to prevent adhesion formation |
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|
Term
| time frame of healing phases: inflammatory phase |
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Definition
|
|
Term
| time frame of healing phases: proliferation phase |
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Definition
|
|
Term
| time frame of healing phases: remodeling phase |
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Definition
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|
Term
| a wound that fails to prgoress in a timely manner through the normal phases of hlealing |
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Definition
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Term
| 9 things that can make a wound chronic |
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Definition
| repeated trauma, poor nutrition, co morbidity, poor perfusion, bioburden, chronic inflammatory response, improper treatment/diagnosis, compliance, old age |
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|
Term
| age related healing: decrease in (3) |
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Definition
| dermal vascularity, collagen density, number of mast cells |
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Term
| age related heailng: fragmentation of what |
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Definition
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|
Term
| age related healing: flattening of |
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Definition
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|
Term
| an absence of inflammation will be seen in pt's (5) |
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Definition
| taking steroids, with malnutrition, immmune disorders (HIV/AIDS), leukemia, anti-inflammatory drugs |
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Term
| what are potential reasons for chronic inflammation? (5) |
|
Definition
| foreign body in wound bed, gauze fibers, stitch, repeated trauma (as in wet to dry), use of cytotoxic agents (dakins, peroxide, betadine) |
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|
Term
| how long can chronic inflammation continue for? |
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Definition
|
|
Term
| chronic wound fluid compared to acuite wound has: decreased (2) |
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Definition
| metabolic activity level, growth factors (which stimulate chemotaxis, angiogenesiss, proliferation) |
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|
Term
| chronic wound fluid compared to acuite wound has: excessive |
|
Definition
| MMP's compared to TIMPS (need a good balance of MMPs and GF's for normal wound healing) |
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|
Term
| chronic wound fluid compared to acuite wound has: a large number of |
|
Definition
|
|
Term
| what are the inhibitors of mmps? |
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Definition
| TIMPS (tissue inhibitor of metalloproteins) |
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|
Term
| chronic wound fluid is metabollicaly active but |
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Definition
| unable to proliferate well |
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|
Term
| protein is essential to healing as it is a critical component of what? (3) |
|
Definition
| fibroblast formation, collagen synthesis, wound contraction, and scar formation |
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|
Term
| protein is also important for the formation of (2) needed to prevent infection |
|
Definition
| antibodies and leukocytes |
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|
Term
| a depletion of muscle, visceral protein stores and body fat |
|
Definition
| protein calorie malnutrition |
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|
Term
| signifcant wt loss: 6 months |
|
Definition
|
|
Term
| signifcant wt loss: 3 months |
|
Definition
|
|
Term
| signifcant wt loss: 1 month |
|
Definition
|
|
Term
| signifcant wt loss: 1 week |
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Definition
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|
Term
|
Definition
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|
Term
|
Definition
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Term
|
Definition
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Term
|
Definition
|
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Term
|
Definition
|
|
Term
| visceral proteins measured (3) |
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Definition
| albumin, transferrin, TLP |
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|
Term
| carbohydrate and lipd recommendations for adults |
|
Definition
| 25-30 kilocalories/kg/day |
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|
Term
| protein recommendations for adults |
|
Definition
|
|
Term
| protein recommendation for adults with burns, or extensive ulcerations |
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Definition
|
|
Term
| why should overfeeding be avoided |
|
Definition
| causes hypoglycemia, fatty liver change, hyperlipidemia, immune suppression, diarrhea |
|
|
Term
| 6 vitamins and minerals for wound healing |
|
Definition
| vitamin C, vitamin A, Zinc, Vitamin E, Iron, L-arginine |
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|
Term
| what is vitamin C necessary for? |
|
Definition
| fibroblasts to synthesize collagen |
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|
Term
|
Definition
|
|
Term
| if vitamin c deficient, won't see what tissue? |
|
Definition
|
|
Term
| vitamin a is essential for what? |
|
Definition
|
|
Term
| Vitamin A intake should be boosted d/t what? How high? |
|
Definition
| autoimmune disease or chronic steroid use. 25K IU/day orally, 200K IU to wound |
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|
Term
| zinc is extremely important for what (3) |
|
Definition
| collagen synthesis, RNA formation, protein synthesis |
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|
Term
| zinc can be easily depleted by what (4) |
|
Definition
| diarrhea, stress, open wound, chronic illness |
|
|
Term
| if this mineral is depleted, it can be a major reason for wound not heailng |
|
Definition
|
|
Term
| vitamin essential for cell wall stability and enhancing immune response |
|
Definition
|
|
Term
| too uch witamin e will do what? |
|
Definition
| decrease collagen production and decrease inflammatory response |
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|
Term
| vitamin e is necessary for ____ maturatino and ___ transport |
|
Definition
| collagen maturation, O2 transport |
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|
Term
| only amino acid that generates significant amount of nitric oxide |
|
Definition
|
|
Term
| L-arigine also stimulates (3) |
|
Definition
| protein synthesis, angiogenesis, collagen remodeling |
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|
Term
| L-arginine has also been studied for prevention of wasting in which pt population |
|
Definition
| people with critical illness |
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|
Term
| L-arginine has been studied for these 3 other purposes |
|
Definition
| wound healing, body building, spermatogensis |
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