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WorksheetsDerm Exam 1 - Minor Burns, Sunburns, and Wounds
Total questions: 95
Worksheet time: 8hrs 38mins
What are the two healing methods
regeneration
scarring
bandaging
What type of wound healing does regeneration deal with
superficial wounds
involving only the epithelial layer
deep wounds
involving deeper layers
What type of wound healing does scarring deal with
superficial wounds
involving only the epithelial layer
deep wounds
involving deeper layers
What are the phases of scarring
inflammatory phase
proliferative phase
maturation phase
regeneration phase
What are parts of the inflammatory phase
hemostasis
inflammation
epithelialization
fibroplasia
When does the inflammatory phase occur and how long does it last
immediately in response to injury
~ 3-4 days
~ day 3 - 3 wks
~ 3 wks - 2 yrs
What does the inflammatory phase prepare the wound for
tissue development
epithelialization
collagen breakdown
repigmentation
What happens during the inflammation phase
nutrients and immune cells migrate to area
bacteria and debris are removed (phagocytosis)
epithelial cells migrate into wound (moist environ)
new connective tissue is formed
What is the best environment for epithelial cells to migrate
Moist Environment
Dry Environment
Necrotic Surfaces
Blood Vessels
When does hemostasis happen & what does it do
immediately upon skin injury
stop blood loss
restore perfusion
collagen crosslinking & remodeling
What happens when hemostasis stops blood loss & restores perfusion
vasoconstriction
platelet aggregation
clotting cascade
fibroplasia
Injury to large vessels may require
pressure application
ligation
hemostatic agents (topical vs systemic)
electrocautery
hemostatic energy devices
When does the proliferative phase occur and how long does it last
immediately in response to injury
~ 3-4 days
~ day 3 - 3 wks
~ 3 wks - 2 yrs
What is epithelialization
migration of basal and epithelial cells
new connective tissue
new capillaries
inflammatory cells
What does the formation of granulation tissue consist of
migration of basal and epithelial cells
new connective tissue
new capillaries
inflammatory cells
What does new connective tissue include
Fibroplasia
Mediated by cytokines from stimulated macrophages
New capillaries
Inflammatory cells
What is fibroplasia
proliferation of fibroblasts
collagen synthesis
inflammatory cells
neoangiogenesis
What process forms new capillaries
neoangiogenesis
fibroplasia
epithelialization
wound closing
At what phase does the wound begin to close
inflammatory phase
hemostasis
proliferative phase
maturation phase
What phase is the longest phase of wound healing
inflammatory phase
hemostasis
proliferative phase
maturation phase
When does the maturation phase begin and end
~ 3 wks
~ 4 wks
up to 2 years
up to 3 years
What causes the maturation phase to be the longest phase
continual process of collagen synthesis and breakdown
the breakdown and reformation of the scab from scratching
the new skin being more sensitive and needing time to "toughen up"
Why does collagen continue to crosslink and remodel during the maturation phase
increase strength
increase area
decrease time
decrease risk of infection
What happens during the continual process of collagen synthesis and breakdown
early collagen breakdown
collagen crosslinking & remodeling
repigmentation with melanocyte migration
results is a scar with 70-80% strength of original skin
it is a more sensitive area
What are some examples of factors that affect wound healing
Tissue perfusion/oxygenation
Nutrition
Age and Weight
Exercise
What are some examples of factors that affect wound healing
Infection
Coexisting Diabetes Mellitus
Medications
Travel
What are some examples of factors that affect wound healing
Wound Characteristics
Smoking
Hiking
Swimming
Why does tissue perfusion/oxygenation affect wound healing?
impaired migration of immune cells and delivery of nutritents/oxygen
impaired migration of blood cells and delivery of nutrients/oxygen
impaired migration of collagen and delivery of nutrients/oxygen
What conditions is it common to have tissue perfusion/oxygenation affecting wound healing
diabetics
severe anemia
hypotension
PVD
heart failure
What type of nutrition affects wound healing
not having adequate macro- and micronutrients needed for collagen synthesis & cell energy
lack of Vitamin C
lack of Vitamin E
lack of Vitamin A
How could Vitamin C and E potentially help with wound healing
reduce inflammation/scarring
improve nutrient distribution in the body
help white blood cells react faster
Which would slow down wound healing
increased age and increased weight
decreased age and decreased weight
increased age and decreased weight
decreased age and increased weight
Why would infection slow down wound healing
traumatic wounds may be contaminated with skin flora
localized infection prolongs inflammatory phase, delaying new tissue growth
impaired blood flow
impaired cellular division
What are some local signs/symptoms of infection
erythema
edema
pain
purulent exudate
fever
What are some systemic symptoms of infection from a wound
fever
leukocytosis
flu-like symptoms
edema
pain
Why does Diabetes Mellitus slow down wound healing
impaired blood flow - reduced immune response/nutrient delivery
predisposes the patient to infection
elevated blood sugar causes insulin block healing
low blood sugar causes patient to ignore wounds and focus on raising blood sugars
Why would medications affect wound healing
impair immune/inflammatory response and may predispose infection
anticoagulants impair hemostasis
impair cell division
creates necrotic tissue
What types of medications impair immune/inflammatory response and may predispose someone to infection
corticosteroids
immunosuppressants
antianxiety
diuretic
What medication/treatment impairs cell division, affecting wound healing
antineoplastics
radiation therapy
anticoagulants
immunosuppressants
What wound characteristics would impair wound healing
necrotic tissue
eschar formation
foreign bodies/infection
lack of moisture
dead space
What are considered acute wounds
abrasions
punctures
lacerations
burns
ulcers
What are considered chronic wounds
pressure ulcers
arterial ulcers
venous ulcers
capillary ulcers
What are the classifications of wounds
Stage I
Stage II
Stage III
Stage IV
Unstagable
What are the ways you can classify wounds
classification by depth
classification by acuity
classification by severity
classification by duration
What are Stages I-IV based on
# of skin layers involved
# of inches deep the wound is
amount of tissue lost
# of cuts made
What is an unstageable wound
full thickness tissue loss, unable to stage due to slough or eschar covering wound
partial thickness tissue loss, unable to stage due to slough or eschar covering wound
What are the classifications of acuity
acute
chronic
deep
shallow
What is a Stage I wound?
No loss of any skin layer
Intact or ruptured serum-filled blister
Full-thickness skin loss - fat visible
Full-thickness skin loss - muscle, tendon, or bone visible
What is a Stage II wound?
No loss of any skin layer
Intact or ruptured serum-filled blister
Full-thickness skin loss - fat visible
Full-thickness skin loss - muscle, tendon, or bone visible
What is a Stage III wound?
No loss of any skin layer
Intact or ruptured serum-filled blister
Full-thickness skin loss - fat visible
Full-thickness skin loss - muscle, tendon, or bone visible
What is a Stage IV wound?
No loss of any skin layer
Intact or ruptured serum-filled blister
Full-thickness skin loss - fat visible
Full-thickness skin loss - muscle, tendon, or bone visible
Which stage has unbroken skin
Stage I
Stage II
Stage III
Stage IV
Which stage has a blister and a red-pink wound bed
Stage I
Stage II
Stage III
Stage IV
Which stage has visible subcutaneous fat
Stage I
Stage II
Stage III
Stage IV
Which stage has visible muscle, tendon, and/or bone
Stage I
Stage II
Stage III
Stage IV
What are the burn classifications
Superficial
Superficial partial thickness
Deep partial thickness
Full thickness
Degrees
Which burn classification describes a painful area of erythema that only involves the epidermis
Superficial
Superficial partial thickness
Deep partial thickness
Full thickness
Which burn classification describes painful blistering with damage to the epidermis
Superficial
Superficial partial thickness
Deep partial thickness
Full thickness
Which burn classification describes a patchy white to red area with some blistering involving the epidermis and part of the dermis
Superficial
Superficial partial thickness
Deep partial thickness
Full thickness
Which burn classification describes dry, leathery, painless area with no feeling
Superficial
Superficial partial thickness
Deep partial thickness
Full thickness
What are the different types of burns
Thermal
Electrical
Chemical
Sun
Water
How do you get a thermal burn
skin contact with hot objects
inhalation of smoke or hot vapors
flash burns
overexposure to UV radiation
What are the different types of electrical burns
flash burn
contact burn
acidic burn
radiation burn
What is a flash burn
result from high-temp arc of current close to the skin
contact with a high voltage source
inhalation of hot vapors
skin contact with acidic or alkaline substance
What is a contact burn
result from high-temp arc of current close to the skin
contact with a high voltage source
inhalation of hot vapors
skin contact with acidic or alkaline substance
What is a chemical burn
result from high-temp arc of current close to the skin
contact with a high voltage source
inhalation of hot vapors
skin contact with acidic or alkaline substance
What is sun exposure
result from high-temp arc of current close to the skin
contact with a high voltage source
inhalation of hot vapors
overexposure to UV radiation
What are abrasions and how do you treat them
rubbing/friction injury
a sizable cut
involves epidermis and possible the uppermost portion of dermis
self-treatment unless wounds are deep
need to see a physician for treatment
What describes punctures and how do you treat them
result of a sharp object piercing epidermis
difficult to cleanse - need to check for foreign bodies
self-treatment not advised
self-treatment - disinfect and bandage
What are lacerations and how do you treat them
sharp object cutting/slicing through skin
self-treatment depending on depth
professional help if stiches are needed
rubbing/friction injury
What describes chronic wounds
wounds that do not proceed through the 3 phases in a timely fashion
underlying disease/external factors contribute to poor healing
wounds that heal quickly
wounds that become infected
When should a chronic wound be referred for further medical evaluation
after 1 month
after 3 months
after 1 year
all wounds should be evaluated
How do you get pressure ulcers
unrelieved pressure
shearing forces
friction
moisture
stress
What are the risk factors for increased chances of pressure ulcers
advanced age
obesity
malnutrition
incontinence
immobility
What are characteristics of arterial ulcers
secondary to PVD
often occur in lower extremities
can be very painful
result from dysfunction of venous valves
What are venous ulcers
result from dysfunction of venous valves
incompetent/damaged valves allow pooling of blood and high venous pressure in legs
result of dysfunction from arterial valves
incompetent/damaged valves allowing pooling of blood and high arterial pressure in legs
What are the treatment goals for wounds
promote healing
protect from further trauma
prevent infection
minimize pain, scarring, deformity, loss of function
What are some exclusions for self-treatment of sunburn
fever, extreme pain, severe swelling
large areas of blistering, signs of infection
headache/confusion, visual changes/dizziness
redness, peeling, minimal pain
What are some exclusions for self-treatment for minor burns and wounds
chemical, electrical, inhalation burns; deep partial thickness/full thickness burns
wounds due to human/animal bite; signs of infection; wounds with foreign bodies after irrigation
non-accidental injuries, chronic wounds, larger than 3 inches
wounds on face, hands, genitals, feet, or perineum
worsening/unhealed after 7 days
What is wound debridement
cleans the wound removing dirt, debris, bacteria, eschar
cleans area around wound but does not touch wound
What are different types of debridement
surgical
enzymatic
biologic
saline
When would surgical debridement be used and how
devitalized tissue removed with sharp instrument
devitalized tissue removed by pulling it out
preferred for large necrotic areas and infection
preferred for small delicate necrotic areas and infection
When would enzymatic debridement be used and how
exogenous enzymes remove necrotic tissue
using Collagenase (FDA approved), Papain, Bromolain
good option if unable to use surgical
preferred for large necrotic areas
When would biologic debridement be used and how
medical maggots applies to wound area
secrete proteolytic enzymes that digest necrotic tissue
active chemicals work to digest necrotic tissue
What are the types of irrigation used and why
normal saline (preferred)
sterile water
removes dirt and debris
begins the healing process
use of antiseptics/iodine are generally unecessary
What could potentially happen if you use hydrogen peroxide as an antiseptic
tissue toxicity
good bactericidal activity
toxic to bacteria
thyroid dysfunction
Is isopropyl alcohol/ethyl alcohol recommended for wound cleaning
yes
no
Is povidone/iodine recommended for wound cleaning
yes
no
What pharmacological treatments are involved in wound care
protectants
analgesics
complementary therapies
antibiotics
alcohol
When should you use topical anesthetics
temporary relief on minor wounds
application to large wounds for pain relief
What are nonpharmacological treatment options
wound dressings
negative pressure therapy (wound-vac)
skin grafts
hyperbaric oxygen therapy
What would the ideal wound dressing include
remove excess exudate and maintain moist (not wet) wound environment
permeable to O2, thermally insulate wound, protect from infection
be free of particulate or toxic contaminants
be easily removable without disrupting new tissue
conforms to wound shape eliminating dead space
Where and what would you use "open" or absorptive dressing
most useful on heavily exuding wounds
adhesive bandages, gauze, composite/island dressings, carbon impregnated, alginates, foam dressings
Xeroform, transparent adhesive films, liquid bandages
when healing process moves to proliferative phase
Where and what would you use for "semi-open" or moisture maintaining dressing
most useful on heavily exuding wounds
adhesive bandages, gauze, composite/island dressings, carbon impregnated, alginates, foam dressings
Xeroform, transparent adhesive films, liquid bandages
when healing process moves to proliferative phase
Where and what would you use for "semi-occlusive" or moisture providing dressings
most useful on heavily exuding wounds
adhesive bandages, gauze, composite/island dressings, carbon impregnated, alginates, foam dressings
dry wounds covered with dead tissue
hydrocolloids, hydrogels
