Skin Integrity

The Stratum corneum acts as a semipermeable barrier.

True.

Which epidermal layer is responsible for the capability to stretch?

Stratum lucidum

Which cells are important for the modulation of the adaptive immune response?

Langerhans cells

What is the function of Merkel cells?

Neuroendocrine function

Which layer serves as the interface between the epidermis and the dermis?

Basement membrane (lamina)

What cell type is responsible for producing collagen and elastic fibers?

Fibroblasts

Which skin component releases histamine and heparin?

Mast cells

Which glands are responsible for body odor?

Apocrine glands

What is the primary role of Eccrine glands?

Temperature regulation

Which specialized nerve receptor is responsible for light touch?

Meissner's corpuscles

Name the receptor for pressure and vibration

Pacinian corpuscles

 Subcutaneous fat is essential for the metabolism of sex hormones.

True

_______ is the connective tissue layer located beneath the subcutaneous fat that overlies the muscle.

Fascia

________ are critical structures that permit the adhesion of keratinocytes to each other to maintain skin integrity.

Desmosomes

What is the role of Hemidesmosomes?

Adhesion of basal keratinocytes to the basement membrane

Which collagen type is the basement membrane primarily composed of?

Type IV

What anchors the dermal–epidermal junction to the papillary dermis?

Type VII collagen and anchoring filaments

What percentage of the dry weight of the dermis is comprised of collagen?

75%

________  is associated with collagen synthesis defects, leading to hyperextensible joints and skin.

Ehlers–Danlos syndrome

Which syndrome is linked to defects in elastic fibrils?

Marfan syndrome

 What are three primary consequences of compromised skin integrity?

• Infection

• Impaired mobility

• Decreased function

_________ include nutritional status, vascular disease, and diabetes.

Intrinsic factors

___________ include pressure, falls, immobility, and surgical procedures.

Extrinsic factors

What is another name for Decubitus ulcers?

Pressure ulcers (or bed sores)

What is the chief cause of pressure ulcers?

Extrinsic pressure

Where is the risk for pressure ulcers greatest in a hospital setting?

• ICU

• Orthopedic patients

Pressure ulcers usually develop after the first month of hospitalization.

False

List four modifiable risk factors for pressure ulcers.

• Immobility

• Dry skin

• Nutrition

• Weight/BMI

What characterizes a Stage I pressure ulcer?

Nonblanchable erythema on intact skin

Define a Stage II pressure ulcer

Partial-thickness skin loss

Which stage involves full-thickness tissue loss where subcutaneous fat may be visible?

Stage III

What defines a Stage IV pressure ulcer?

Full-thickness loss with exposed bone, muscle, or tendon

What is an "Unstageable" pressure ulcer?

Ulcer covered by eschar or slough

 Describe a "Suspect Deep Tissue Injury."

Purple or maroon localized area of discolored intact skin

What is the first epidermal response to pressure?

Hyperemia

_______ erythema occurs when capillary refilling happens after gentle pressure.

Blanchable

_________ erythema exists when finger pressure does not produce blanching.

Nonblanchable

Where do arterial ulcers typically occur?

• Distal leg

• Lateral malleoli

• Toes

What is the clinical appearance of an arterial ulcer?

Gangrene (wet or dry)

Which diagnostic test is inexpensive and accurate for peripheral arterial disease?

Ankle-brachial pressure index (ABI)

What is the most important factor in the development of a diabetic ulcer?

Neuropathy

 What is the typical appearance of a diabetic ulcer?

Deep crater-like appearance with callus

Name three pathophysiological causes of venous leg ulcers.

• Reflux

• Obstruction

• Calf muscle pump failure

What are common physical exam findings for chronic venous stasis disease?

• Pigmentation changes

• Weeping

• Edema

Where is the "gaiter" area located?

Malleolar area upward to the knee

Describe the typical shape and bed of a venous ulcer.

Irregularly shaped, shallow, and exudative

 Maintaining a dry wound environment increases the rate of healing.

False

List three therapies that are detrimental to chronic wound healing.

• Dry gauze

• Heat lamps

• Air exposure

Which dressing type showed a high number of persons healed (455 more per 1000)?

Tripeptide copper gel

What are some adjunctive therapies for treating pressure ulcers?

Growth factors and debridement

Where do most pressure ulcers develop on the body?

Bony prominences like the sacrum and heels

Pressure ulcers always progress linearly from Stage 1 to Stage 4.

False

What is the most common mechanism for traumatic wounds?

Blunt force

How do sharp objects produce wounds?

Shear forces

Traumatic wounds account for what percentage of all ER visits?

6%

What are the most frequent locations for traumatic wounds?

• Face

• Scalp

• Fingers

• Hands

Why do bite wounds require different management than other lacerations?

Higher risk for infection

_______ are those that are multilayered or present as flap, stellate, or corner flap wounds.

Complex lacerations

A _________ is typically superficial and linear in nature.

Simple laceration

List some systemic factors that negatively impact wound healing.

• Diabetes

• Renal disease

• Malnutrition

• Immunosuppression

What is the purpose of reviewing the mechanism of injury for a wound?

To identify risks for contaminants and foreign bodies.

Which protein family in desmosomes includes Desmogleins?

Cadherins

Name the proteins in the Armadillo family found in desmosomes.

• Plakoglobin

• Plakophilin

What does "lipodermatosclerosis" refer to?

Skin hardening in venous disease