Term
| Name the layers of the skin |
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Definition
epidermis - outer avascular layer of stratified squamous epithelieal cells
dermis - thickest layer composed of tough connective tissue
subcutaneous: underlies the skin composed primarily of fat and connective tissues |
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Term
| What are skin appendages? |
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Definition
| hair, nails, eccrine sweat glands, apocrine sweat glands, and sebaceous glands |
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Term
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Definition
- protection
- thermoregulation
- sensation
- metabolism (skin synthesizes vit D. Vit D is necessary for efficient absorption of calcium and phosphorus)
- communication: (through facial expression and physical appearance)
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Term
| Characteristics of normal skin |
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Definition
Color: from tan to darkbrown or black/ from ivory to pink
Temperature: normally warm. peripheral areas may be cool if basoconstriction has occured in skin
Moisture: normally dry. anxiety increases in axillae or palms
Texture & Thickness: smooth; good elasticity
Odor: free from odor |
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Term
| Factors affecting integumentary function |
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Definition
- Circulation
- Nutrition
- condition of the epidermis
- allergy
- infections
- abnormal growth rate
- systemic diseases
- trauma
- burns
- mechanical forces
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Term
| Adequate circulation is necessary for health, viable tissues. Adequate skin perfusion requires four factors: |
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Definition
- Heart must be able to pump adequately
- the volume of circulating blood must be sufficient
- arteries and veins must be patent and functioning well
- local capillary pressure must be highter than external pressure
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Term
How does a deficiency of protein or calories effect skin and hair?
What vitamins are important to prevent anormal skin changes?
What minerals are important to prevent abnormal pigmentation and changes in nails and hair? |
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Definition
hair becomes dull and dry and may fall out
skin becomes dry and flaky.
A, B6, C, K, niacin, and riboflavin
Adequate intake of iron, copper, and zinc |
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Term
Skin that is continually exposed to moisture softens and becomes _____, increasing it's susceptibility to trauma and infection.
This kind of tissue appears ______ and is _____ in appearance than healthy tissue |
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Definition
Macerated
wrinkled and lighter |
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Term
The normal epidermal turnover rate is __-___ days.
Psoriasis increases it to ___-___days. |
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Definition
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Term
| Which chronic diseases can produce skin abnormalities and ulceration? |
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Definition
| Inflammatory bowel disease, pemphigus, peripheral vascular disease |
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Term
| Injury, such as a knife, gunshot, burn or surgical incision; heals within 6 mo |
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Definition
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Term
| Wound that persists beyond usual healing time (greater than 6 mo) or recurs without new injury to the area |
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Definition
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Term
1. present in the skin; tissue damage present
2. No break seen in the skin, but soft tissue damage evident |
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Definition
1. open wound
2. closed wound |
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Term
| Wound involving friction of skin; superficial; dermatoligic procedure for scar tissue removal |
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Definition
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Term
| intentional or unintentional penetrating trauma by sharp or pointed instrument that penetrates skin and underlying tissue |
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Definition
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Term
| cut in the skin; wound edges may be smooth or jagged; depth may be shallow or deep; object possibily contaminated; infection risk |
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Definition
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Term
| closed wound; bleeding in underlying tissues from blunt blow; bruising |
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Definition
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Term
| Closed surgical wound that did not enter gastrointestinal, respiratory, or genitourinary systems, low infection risk |
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Definition
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Term
| wound entering gastrointestinal, respiratory, or genitourinary systems; infection risk |
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Definition
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Term
| Open, traumatic wound; surgical wound with break in asepsis; high infection risk |
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Definition
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Term
| wound site with pathogens present; signs of infection |
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Definition
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Term
| surgical openings in the abdominal wall that allow part of an organ to open onto the skin |
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Definition
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Term
| The degree of burn damage depends on: |
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Definition
- the type of burn
- its extent and depth
- the patient's state of health before the burn
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Term
| Burns that can be superficial or moderate to deep. |
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Definition
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Term
| a first degree; epidermal burn that is pinkish or red with no blistering. ex: mild sunburn |
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Definition
| superficial partial-thickness burns |
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Term
| a second degree, dermal or dep dermal burn that may be pink, red, pale ivory, or light yellow-brown. Usually moist with blisters. Exposure to steam can cause this type of burn |
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Definition
| moderate to deep partial-thickness burn |
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Term
| a third degree burn varying form brown to black to cherry red or pearly white. Thrombosed vessesls and blisters or bullae may be present. appears dry and leathery. Sometimes when fascia, muscle, or bone is extensively damaged, the injury is called a fourth degree burn. |
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Definition
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Term
| The most common type of burn caused by contact with various heat sources, including flames, hot liquids, hot surfaces, and steam. |
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Definition
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Term
| occurs when two surfaces rub together. When skin rubs against a firm surface, such as wrinkled bedding, small abrasions occur, increasing the possibility of ulcer formation |
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Definition
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Term
| occurs when tissue layers move on each other, causing blood bessesls to stretch as they pass through the subq tissue. Most commonly occurs when patients slide down in bed or are pulled up in bed. Capillaries in the underlying tissue are stretched and often torn. |
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Definition
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Term
| localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure or pressure in combination with shear and/or friction. |
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Definition
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Term
- intact skin
- nonblanchable redness of a localized area
- usually over boney prominence
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Definition
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Term
- Partial-thickness loss of dermis
- presents as a shallow open ulcer with a red-pink wound bed, without slough.
- may also present as an intact or open/ruptured serum-filled blister
- presents as a shiney or dry shallow ulcer without slough
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Definition
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Term
- full thickness tissue loss
- subq fat may be visible, but bone, tendon, or muscle is not exposed.
- Slough may be present but does not obscure the depth of tissue loss
- May include undermining and tunneling
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Definition
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Term
- Full-thickness tissue loss with exposed bone, tendon, or muscle
- Sloth or eschar may be present on some parts of the wound bed
- Often includes undermining and tunneling
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Definition
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Term
| Full-thickness tissue loss in which the base of the ulcer is covered by slough (yellow, tan, gray, green, or brown) and/or eschar (tan,brown, or black) in the wound bed. |
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Definition
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Term
| Purple or maroon localized area of discolored intact skin or blood-filled blister due to damage of underlying soft tissue from pressure and/or shear. The area may be preceded by tissue that is painful, firm, mushy, boggy, warmer, or cooler as compared to adjacent tissue |
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Definition
| suspected deep tissue injury |
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Term
| What are the 4 phases involved in wound healing? |
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Definition
Hemostasis
Inflammatory phase
proliferative phase
maturation |
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Term
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Definition
| It begins immediately upon wounding with the onset of vasoconstriction, platlet aggregatoin, and clot formation |
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Term
| Describe the inflammatory phase |
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Definition
| Lasts up to about 3 days. Marked by basodilation and phagocytosis as the body works to clean the wound to begin the repair process. |
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Term
| During the proliferative phase, partial-thickness wounds use a process called ______ whereas in a full-thickness wound, the proliferation phase begins with the development of ______ ______. |
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Definition
epithelialization
granulation tissue |
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Term
| The final stage of full-thickness wound healing. It begins about 3 weeks after the injury and may last as long as 2 years. # of fibroblasts decreases, collagen synthesis stabilizes, and collagen fibrils become increasingly organized resulting in greater tensile strengty of the would. |
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Definition
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Term
Primary Secondary or Tertiary Intention
clean surgical incisions
shallow sutured wounds
"hairline" scar" |
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Definition
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Term
Primary Secondary or Tertiary Intention
Full-thickness tissue loss
deep lacerations, burns, and pressure ulcers
gaping irregular wound, granulation, epithelium grows over a scar |
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Definition
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Term
Primary Secondary or Tertiary Intention
occurs when a delay ensues between injury and wound closure |
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Definition
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Term
| Factors Affecting Wound Healing |
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Definition
Systemic Factors
- nutrition
- circulation and oxygenation
- immune cellular function
Individual Factors
Age, Obesity, Smoking, Medications, Stress
Local Factors
Nature of injury, Infection, Local Wound Environment |
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Term
| Complications of Wound Healing |
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Definition
- Hemorrhage and Interstitial Fluid Loss
- Hematomas
- Infection
- Dehiscence
- Eviscerataion
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Term
| A localized collection of blood. It appears as a swelling or mass underneath the skin surface, often with a bluish color. |
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Definition
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Term
| A total or partial disruption in wound edges. Wound separation, most commonly used to describe surgical incisions in which the skin has separated but underlying subq has not parted. |
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Definition
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Term
| The protrusion of viscera through an abdmonal wound opening. The opening extends deeply enough to allow the abdominal fascia to separate and internal organs to protrude |
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Definition
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Term
| an abnormal tubelike passageway that forms between two organs or from one organ to outside the body |
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Definition
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Term
| What are the parts of the Physical Examination of skin abnormalities/wounds |
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Definition
- inspection of the skin: color, vascularity, turgor, mobility, texture, presence or absence of lesions
- wound assessment
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Term
| What are the parts of the wound assessment |
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Definition
- wound type
- wound location
- wound size
- wound classification
- wound base
- wound drainage
- undermining/tunneling
- tubes/drains
- signs and symptoms of infection
- condition of surrounding skin
- pain
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